Optometry Coding & Billing Alert

Make sure staff explains the difference between -routine- and -medical- up front

A patient whose -routine- visit has turned into a medical eye exam may be confused and upset when he's charged a higher fee than he expected. Explaining the necessity of the higher fees up front can go a long way toward keeping your patients happy.
 
Example: A husband and wife both have vision insurance that covers routine exams. They come in on the same day. The wife has a routine visit, but the optometrist discovers cataracts in the husband. At the checkout window, the husband learns that his exam -- now a medical one -- is more expensive than his wife's routine exam.

 -At this point, your staff must be prepared to answer the question -Why is his exam more than mine?- - says Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va. To handle this seeming incongruity without upsetting the patients, your staff must be trained to explain the difference in the types of exams.
 
-This is especially true for receptionists,- Wimbish says. -They must be trained to explain that a medical exam requires more testing and takes more time.-
 
Do this: Wimbish advises receptionists to state, while making appointments, -Our fee for a routine eye exam is [for example] $79. But if we find a medical problem that requires more testing and more time, the exam fee is more -- usually [for example] $20 to $30 more.- Allow time at the end of the call for the patient to ask questions. 

 -It's better to answer ticklish questions while the patient is at home than when the patient's in the office,-  Wimbish says.