Optometry Coding & Billing Alert

Question: One of our optometrists is not yet credentialed with Medicare, and we have a Medicare patient who needs an exam and doesn't want to wait. If this optometrist performs the service, how should we go about billing for it?


Nebraska Subscriber


Answer: Medicare will allow you to place your optometrist's claims on hold and then file them once he receives his credentialing. You can do this for all your optometrist's Medicare services while he remains without credentials. Medicare will pay your claims retroactively to the date of the optometrist's new PIN application. Contact your carrier for details.

Try this: In the future, you may want to allow your office more time when trying to credential a new optometrist. Although credentialing the optometrist is simple, the process can take up to 90 days, according to Medicare. Experts recommend that you initiate this process far in advance of your new physician's starting date - two months ahead of time, if not more.
 
If you act early, you'll have the necessary credentials in place when the optometrist starts seeing patients and you won't have to hassle with delayed Medicare payments.