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Thread: Medicare post op glasses

  1. #1
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    Medicare post op glasses

    There is some confusion in our office regarding the date you file post op glasses. Do you file them when you order them or when they are dispensed? We have been filing them e-claim the day they are ordered with no problem. Although with pressure being put on us to have every "i" dotted and "t" crossed I don't want to be doing something wrong.

  2. #2
    OptiBoardaholic OptiBoard Gold Supporter Mick's Avatar
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    I file when ordered. They are committing to the sale, and you are committed to the cost of the materials. I have been doing this for years, and haven't had an issue (yet). As I'm sure you know, the glasses will be long gone before you receive payment anyway.

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    Master OptiBoarder CCGREEN's Avatar
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    Our office does not file them until the patient has come and picked them up and signed that they have them and have paid their share if there is any.
    And agreed, you dont want to be caught doing something wrong..........so my suggestion, just dont give them a chance to come down on you. When in doubt its better to error on the side of caution.
    Our office has never had a issue.

  4. #4
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    per dpos rules

    The glasses must be dispensed with all records and final sigitures. That being said I haven't heard of an oddice that doea it that way.

  5. #5
    Rising Star
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    I have always been under the understanding that your date of service needs to be the same date your proof of delivery is signed. We submit with the dispense date as the date of service.

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    Quote Originally Posted by acoakley View Post
    I have always been under the understanding that your date of service needs to be the same date your proof of delivery is signed. We submit with the dispense date as the date of service.
    Okay this helps but brings up another question, the date of service is in the computer when the order is placed. So the date they are dispensed would be different. How does that play into the filing process?

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    Master OptiBoarder CCGREEN's Avatar
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    Quote Originally Posted by JENNIFER H View Post
    Okay this helps but brings up another question, the date of service is in the computer when the order is placed. So the date they are dispensed would be different. How does that play into the filing process?
    Lets use this scenario. Pt comes to me at 4:45 pm we close at 5:00. I get necessary measurements and have pt sign and date papers on all our hard copy's for that day. Now I don't key the order into the computer till the next day. Then its a week before they get their glasses delivered to them. At the time they pick up glasses they again sign and date a form stating that they have them.
    We do not file Medicare till after they pick up their glasses using the date they pick up their glasses as the date of service. And as I said before we have never had any issue.

  8. #8
    Master OptiBoarder
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    "......Then its a week before they get their glasses delivered to them."

    A week!?!?!?! ours runs 4 months!

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    Okay next question...do you all charge a dispensing fee on Medicare glasses? We never have and someone has questioned this?

  10. #10
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    dispensing fee is new to me. we file after they've been picked up (as we have been instructed), the patient has to pay ALL overages before the glasses are even ordered and we also have them sign an agreement stating that medicare may decide not to pay for squat and they will be responsible for the balance (but more medically appropriate ) I have a few cheat sheets if you'd like to see them! e-mail me rebecca.griffin@visioncareofmaine.com
    "what i need is a strong drink and a peer group." ... Douglas Adams - Hitchikers Guide to the Galaxy

  11. #11
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    Quote Originally Posted by becc971 View Post
    dispensing fee is new to me. we file after they've been picked up (as we have been instructed), the patient has to pay ALL overages before the glasses are even ordered and we also have them sign an agreement stating that medicare may decide not to pay for squat and they will be responsible for the balance (but more medically appropriate ) I have a few cheat sheets if you'd like to see them! e-mail me rebecca.griffin@visioncareofmaine.com
    Thank you and I will email you. I have "cheat" sheets but would LOVE to have a peek at yours.

  12. #12
    Master OptiBoarder
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    its at least quasi useful :) they havent denied any claims yet, but hey, we're still waiting for the payment too!!
    "what i need is a strong drink and a peer group." ... Douglas Adams - Hitchikers Guide to the Galaxy

  13. #13
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    I hope you are all doing ABN's. My understanding is that once the ABN is signed and they have paid their portion then you can submit the claim to DMERC. I am also having each pt sign a DMERC Standard Agreement. My payment from DMERC takes about 3 weeks and glasses are picked up with in 2 weeks. As far as picking the DOS for the claim, it should be the same across the board in your practice. What will hurt you is treating Medicare or DMERC differently then the others. With that being said, your claim is submitted to VSP the day the glasses are ordered, so that forces you to submit all your claims the day the glasses are ordered.

  14. #14
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    So on the medicare note, i'm looking into realigning some of our pricing with base medicare reimbursement, good idea, bad idea? anyone who has done this before?
    "what i need is a strong drink and a peer group." ... Douglas Adams - Hitchikers Guide to the Galaxy

  15. #15
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    On the Dispensing fee note, we noticed that if we bill to a MCR replacement plan (UHC is the one I checked), they EXPECT that you will be billing a dispensing code, and A LOT of the re-imbursement is taken out of the lens, and added to the disp fee code - break out everything!

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