I work in an ophthalmology practice. They do a lot of cataract surgeries that are billed to Medicare. The question is: If you do Medicare surgeries do you have to do Medicare glasses. We submit and resubmit and just don't get paid. I would like to just give a discount and cut out the Medicare submitting altogether but my practice administrator doesn't want to authorize it.
Howdy himeroo,
The two provision channels are completely distinct: you can provide either, both, or neither under Medicare.
Whether or not you're enrolled with Medicare for surgical reimbursements, your ability to file with Medicare for post-op specs depends on whether your facility enrolled for the Medicare DMEPOS (Durable Medical Equipment/Prosthetics/Orthotics/Supplies) program.
It's gotten pricey in order to weed out fraud, so unless you're ready for a monumental effort to get paperwork transmitted back and forth and the joys of Medicare filing once you're successful...your idea of a simple "in-house discount" to offer your post-op patients is the better one. (imo)
Hayde's right on.
What's more, the benefit stinks, anyway.
Just offer the discount.
Our office just opted out March 1st. We looked at reports over the last 3 years and decided to end it. It was very simple to do and now offer those patients our "value" pricing. We are explaining it as getting the paperwork and government out of the way and they seem to like that.
We also simply discount.
We do quite a bit of post cataract spectacles. We quit filing Medicare for them 10 years ago. We simply give Medicare patients $125.00 credit towards a complete pair. Not a lot of profit but we make up some on the post op fee while providing for our Medicare patient's needs. Plus no headaches!
Hmm, our DME reimbursement for base frame and lens is 65% of our U&C fees, which is right in line with other vision plan reimbursements, and patients pay U&C for any overages. That seems pretty good to me. We do have a full-time insurance coordinator who is very familiar with Medicare and DME, so the headaches are invisible to me and routine to her, but the payments are decent IMO.
My experience is the same DanLiv. It has also allowed me to grow a relationship with many MDs in the area who now reccomend me to all of their patients, cataract or not.
I think you bring up a good perspective, Dan--even if your Insurance coordinator is spoiling you. ;) Keep in mind those reimbursements are offsetting a $500 fee for program enrollment every three years. If you're doing good volume with Medicare and already knew you needed dedicated staff for insurance, then the marginal headache might make sense. However I'm thinking himeroo's admin. won't get two weeks into researching it before changing his/her mind.Originally Posted by DanLiv
My practice manager insists that if our Doctor excepts assignment for surgeries we must except assignment for eyeglasses. Is there a link to verify one way or another ?
That is NOT true. I've been seeing Medicare patients for many years and the optical has not accepted assignment to sell glasses. It is a separate process to get the optical credentialed to sell glasses for Medicare and it is in most Doctor's opinions not worth the hassle. If you look up the process on how to get this done, you will find it very discouraging. Every insurance you sign up for has separate application for exams vs selling optical goods. So you can sign up for Medicare and have no obligation to sell glasses to Medicare patients under assignment.
I guess I need to clarify. After the MD does cataract surgery and gives a Rx, do I need to except assignment to make this person eyeglasses and submit to medicare? Can I just fill out form for Pt. and submit for reimbursement directly to them ? Or even offer a discount instead submitting ?
To find out if your office accepts assignment, you can look on the medicare website under find suppliers (https://www.medicare.gov/supplierdirectory/search.html) put in your ZIP code, then look under 'Prosthetic Lenses: Conventional Eyeglasses' it will show who in the area accepts assignment. My old office used to accept assignment, but just recently backed off. The trouble is the double claims for covered and non-covered options, ABNs, etc. Seems simple, but all it takes is one order to not be filled out correctly, and one phone call to put a target on your offices back.
Also, be careful for offering discounts just to cataract surgery patients. That will get ya in trouble with the AKB(Anti-Kick Back) offering patients a discount on glasses because they had cataract surgery with you. What I would strongly recommend is something like a 10% discount on orders on a self pay basid, or offer package pricing; but let the patients know the package pricing is not valid on managed care plans (VSP, Eyemed, etc) and the discount is not offered if the office has to bill insurance.
But the saving grace there is the 10% self pay discount. Since the discount is available to everyone, it doesn't put anyone in jeopardy, but insurance can't be billed if they opted in for the discount.
Reimbursement:
You can HELP them fill out the form, but I would put the responsibility to mail it out on them. Even if they purchase glasses from you and your office doesn't accept assignment, the patient still has to sign an ABN letting them know they cannot go elsewhere and bill out for After-Cataract DME glasses.
WBVCI is correct, you can accept assignment for medicare to just do office exams, visits, surgeries, and not have to opt-in to provide DME Glasses.
The reimbursement process on DME glasses was getting ridiculous, so my previous office opted out. The claims we taking longer to get approved, then it pushes out the time for the secondary to in too.
Also another thing to be aware of, the patient still has to meet their deductible before medicare pays the allowable on the glasses. I.E Patient had cataract surgery mid November, after all the follow-ups (still in 90 day window for follow-up in Jan, calendar exception) But now it's January 10th and they wanted to get their glasses, now their deductible started over. So they won't be happy when they get a bill from your office for the glasses. Unfortunately, that is not in writing anywhere from medicare.
Hopefully this wasn't too all over the place, and let me know if any if this info has changed in case I may have been wrong.
Last edited by tsdelphous; 07-21-2017 at 11:48 PM.
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