Billing Medicare to get a denial to sent on to BCBS for routine eyewear .

[bwarren]

The office manager and myself are having a issue with billing.( BIG SURPRISE ) So the Patient has medicare primary and lets say BCBS secondary and the BCBS has a benefit for routine eye wear. We can't get Medicare to take it because they don't understand the v codes and Dmerc won't pull it from the system. We have sent it point of service office 11 . Should we be changing the point of service to home 12? If any one can help it would be wonderful Thanks

[sweet2lookat]

The office manager and myself are having a issue with billing.( BIG SURPRISE ) So the Patient has medicare primary and lets say BCBS secondary and the BCBS has a benefit for routine eye wear. We can't get Medicare to take it because they don't understand the v codes and Dmerc won't pull it from the system. We have sent it point of service office 11 . Should we be changing the point of service to home 12? If any one can help it would be wonderful Thanks

Did the patient have cataract surgery?

[jpways]

Have you tried directly submitting to the BS plan?

As an aside the question this raises in my head is that the only time I've seen a BS plan with routine eyewear benefits is either a Medicare Advantage plan or an employer sponsored plan. In either case the BS plan would be primary to Medicare, based on Medicare rules (as I understand them) even if the employer sponsored benefit is a spouse's benefit. (And now the actual question) So is this a Medicare Supplement with routine eyewear or one of the other plans I've already mentioned? In any case I'd just submit the BS plan because I'd figure I'd just be banging my head against the wall trying to get Medicare part B to process the claim in the way I wanted.

[bwarren]

BCBS will not pay they want primary Insurance to show a denial first .BCBS just kicks it back . These Patient have Medicare primary and BCBS secondary and it is not advantage plan .The benefit is for routine eye wear not after cataract surgery. I do feel like banging my head over and over. When I called BCBS they told me they can't tell me how to bill to them and medicare was no help . Thanks

[Uncle Fester]

What codes are you using? Frame V2020 Bifocal V2200 etc?

Our crackerjack bookkeeper says you must bill medicare first and wait for the denial so something must be wrong with the codes.

[jpways]

And what diagnosis code are you using, one of the 367s or one of the more esoteric ones like 368.8 (problems with vision)

[bwarren]

We are using V2025 for frame and V2200 etc . V72.0 is diagnosis code. My issues is Medicare will not pull from the system does not understand v codes so I can't get an denial so should it go to Dmerc instead?. If so Point of service home or office . SOOOO many Questions I LOVE INSURANCE

[newguyaroundhere]

The code may be wrong. I know when I bill for glasses with Dmerc the only code I can use is V43.1 for post cataract glasses

[GOS_Queen]

Howdy - I suggest using dx 367.9 (verses the V72.0). Location should be 12 - modifier gy (non medicare covered service) bill to DMERC (not medicare)

I bill glasses all day long - i'm in jurisdiction D

[walleye]

As far as I know Medicare NEVER pays for glasses on a routine basis. They only pay DMERC providers for post cataract glasses under diagnosis code V 43.0
You have to bill their BC/BS provider or maybe they really have a BC/BS HMO and Davis Vision or another third party is the eyeglass provider.
We bill Medicare directly and sometimes our billing provider sends it back and says xxx HMO is the primary. The patient may not even know.

[Jubilee]

We have to do this too with our medicaid. As GOS_Queen stated, you got to bill DMERC not Medicare for the glasses. There is a difference. They will recognize the codes, then you can get your denial to send in.

One of the many hoops insurers make you go through to get paid...

[drstewart74]

We have come across this a few times. What you have to do (what we did to
get paid) is send an actual copy of the MC denial along with the paper claim to BC/BS together. It's a royal pita but that's what we've done. Hope that helps...

[ioptical72]

I use 367.4 as my diagnosis code. and then v2020 and v2203 etc etc. I haven't as of yet had any issues receiving a denial from medicare to send on to the secondary insurance. And my service office code is 12.