Medicare Billing

[_Newbie]

So I am brand new to the optical world, though I’ve worn glasses since high school, I’m just now getting started in the field working. I am having issues with the billing of Medicare, using supplements, why some people won’t pay for their refraction and others do... the gals in my clinic are fired of my questions, I do tend to ask the same ones over and over... I just want to get this down so I can begin this career.. the lack of help from them make me want to give up. but I’m not a quitter so I’m here to learn!! Thanks in advance.

[jpways]

There does not seem to be a rhyme or reason as to who allows 92015. Some examples I know of: Medicare No, Highmark B/C B/S commercial plan Yes, Highmark B/C B/S Medicare advantage plan No, Anthem BC/BS generally no, but some prefixes yes, BC/BS of Michigan for GM No, BC/BS of Michigan for the Teacher's union Yes, Aetna Yes, Cigna No

If you want to make a list go for it, but be ready to correct it at a moments notice because of mergers and changing reimbursement decisions from insurance companies
Just to warn you a similar discussion would be who allows V2784 without an order of medical necessity for post Cataract eyeglasses (The answer is generally no, except for Aetna [and Coventry as it's an Aetna subsidiary] , and certain blue shield plans)

[_Newbie]

I don’t usually have to many questions about eye coverage like VSP, VCP, EyeMed etc... but Medicare is impossible for me to understand. I know if they have the secondary that it usually will pick it up... but when people don’t meet their deductible I was told to just go ahead and take the 92015 fee and the 20%. BCBS Medipak plan F pt’s who meet their deductible I believe shouldn’t get the 92015 covered bc it’s only supposed to cover what Medicare covers anyways, so it’ll pick up the 20% from the exam because Medicare at least covers that 80% already. But I’m not sure.

[mscoco]

have your new coworkers helped you out? I'm doing insurance verification right now, maybe one day i'll go back to optical. but from what i've recovered from my short time back is: supplemental plans c, j, f will cover medicare part b deductible and coinsurance, the others will only cover the coinsurance. plan n with aarp has a $20 copay, not sure if others have that copay too. there are exceptions, i've seen f plans with an extremely high deductible, and n plans that don't have a copay. i have all the insurance websites set up so i can verify coverage before the patient arrives, some i do have to still call though. as for refraction i always assume it will not be covered. unless i can specifically see that they have routine vision coverage, i always collect the refraction. if vision insurance is offered, they're usually carved out to a vision plan, there are times a supplemental plan provides it but it's rare. obviously you might see different plans where you are, but this is what i've seen here in social.