Wiki Help... Vision and or Medical?

[NStone]

I work at a multi-specialty medical billing company and have a client that is billing patient's vision insurance for routine/glasses/contacts but if they also present with a medical issue (dry eyes, glaucoma, etc) he is also having a bill sent to their medical insurance for that portion. Is this correct?

I've looked for documentation and all I have found is use of modifier -25... this doesn't apply in this case since there are 2 insurances involved.

Please help...

Thanks!

Noelle



*** Also, anyone specialize in Ophthalmology billing and would be interested in completing an audit for our client as a contractor?

 

[aleciaaa10]

I work in ophthalmology and despite not wanting to be a "one-stop shop", sometimes our doc sees patients for medical (like glauc) and also does refraction/CL at the same visit.

We make sure the medical insurance is primary and vision insurance secondary. I don't know the ins and outs of the billing process of that, but from what I understand the medical will take care of a portion of the office visit and any medical testing. The vision insurance usually pays a little towards the office visit and the refraction.

We have found that patients usually just owe whatever the copay is for the vision portion, so we collect that upfront, but tell the patient we have to file it and see.

We don't use modifier 25 for the office visit.

If there is no medical testing done, we send just to the vision insurance with rt diagnoses. Hope that helps!

 

[NStone]

Just to clarify, if the patient comes in for a routine vision exam and there ends up being a medical issue, you file to the health as primary and vision as secondary?

Would you ever send just the medical to the health and the routine to vision? Or does the medical take precedence over the routine?

 

[mrsjehu]

I've worked in Ophthalmology for several years. Our clinic is Medical only, no glasses, contacts etc. We do however do refraction. When a refraction is done with a medical visit we bill both to the medical insurance. The refraction will be non-covered, patient responsibility. If you are contracted with the vision insurances you can then submit to them. We are not contracted with vision insurances so the patient has to do that on their own. We have been told that the vision typically covers the refraction.

I don't see why you would ever separate the claim, nor would you bill a vision exam and a medical exam. If a medical exam is done this takes precedence over the routine exam.

If you have any other questions or need help feel free to PM me.

 

[drakena74]

Hi, I have worked in ophthalmology/optometry as biller for several years. If the patient is seen for routine eye exam, you bill vision plan. If the patient has a medical condition (glaucoma, retinopathy, etc..) you coordinated the benefits with medical & vision ins. You only do this if the the patient is getting a complete eye exam (exam & refraction). You bill medical first once they pay then you bill the vision plan. The patient is responsible for both the medical copay & vision plan copay, so collect both upfront. Also after the 2nd ins pays, technically the patient is responsible for the balance up what the contract amount is for primary insurance, but that is your choice whether you want to bill them or not.