Medicare Compliance & Reimbursement

Ophthalmologists take note: No complaint may mean no coverage. Often, ophthalmologists don't take full advantage of the Medicare market since many patients need only routine, non-covered services, such as refractions and routine check-ups. But wait: You can serve the Medicare patients in your area and get paid if you follow these three simple rules from our experts: Rule 1: Don't Overlook Covered Chief Complaints Of course your ophthalmologist can't -- and doesn't -- manufacture patient complaints. But it is appropriate to ask patients follow-up questions to extract an accurate and complete history which may glean relevant information -- and potentially discover that an office visit is benefit-eligible. Payment rules: Medicare will not cover examinations performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury. For instance, a refraction test (92015, Determination of refractive state) is a type of non-covered service that is typically unrelated to diagnosing some specific [...]