Ophthalmology and Optometry Coding Alert

Question: When I took over as bookkeeper, I found that all fluorescein angiography [FA, 92235] had been billed by my predecessor as a unilateral procedure. The doctor was doing an FA on each eye, but the bills were only for one. Im planning on re-billing these charges, but what I want to know is, how far back can I go?

Jennifer Hoover, Bookkeeper
Finger Lakes Eye Center, Horseheads, NY

Answer: Back billing is largely payer-dependent, explains Barbara Cobuzzi, CPC, president of Cash Flow Solutions, a Lakewood, NJbased medical billing and consulting firm. For Medicare, you can bill one years worth of back bills and expect 100 percent reimbursement, she says. If its within that year, and its covered, they will pay it, she states. If a bill is more than a year old, and its covered, Medicare will take a 10 percent reduction.

However, private payers are a different story. Some have very strict limitations on how far you can back bill, says Cobuzzi. She has seen policies which allow you to go back only 60 days, for example. It really is up to the payer, the consultant explains.

For the kind of situation Hoover describesthe billing person who is taking over in a practice which has had a protracted billing error that needs to be fixedCobuzzi recommends talking to provider representatives at the private plans with which the practice contracts. If I took over a practice and I saw a major problem, I would call each provider rep, Cobuzzi says. I would say, Heres my problem. What can you do for me? Then you can work out a deal; its unlikely that the insurance company would pay you 100 percent on these back bills, but it may well pay 50 percent, or more.