Ophthalmology and Optometry Coding Alert

Question: A patient was seen and left without signing the insurance authorization form due to our error. He had been to another ophthalmologist who scheduled him for cataract surgery, but the patient refused to sign consent forms for the surgery. At our office he was given a complete exam that took one hour of the doctors time. When asked for a copy of his insurance card as he was leaving, the patient told us that he was here for an evaluation of the doctor and would bring his card in a couple of weeks when he returns. We dont know if we will ever see the patient again. Can we bill Medicare, or should we ask the patient via mail to sign the insurance authorization so that we may bill Medicare or else make him responsible for the bill? How would you handle this situation? Obviously a few clerical mistakes were made in the office, but the doctor should get paid.

Anonymous Oklahoma Subscriber

Answer: Yes, the doctor should get paid, but the question is how? Your best bet is to call the patient, explain that a service was rendered in good faith by the doctor, which must either be billed to Medicare or to the patient if the patient does not have Part B coverage. Apologize for any misunderstanding the patient may have had, but be firm that the doctor does not provide free consultations.

Get the patients Medicare Part B number over the phone and offer to send the patient the signature-on-file form with a stamped return addressed envelope for his/her convenience. Once you receive the authorization form you can file the claim with Medicare. You could write to the patient instead of calling, asking him to sign either the insurance authorization or a waiver of liability form so you can balance-bill him if the insurance is not valid or if he refuses to sign.

But asking this kind of patient to pay, and actually getting payment, are two different stories. You may end up writing off the charges in spite of your efforts.

Tip: In the office, always ask patients for a copy of their insurance card before they see the doctor, collect any co-payment due (e.g., HMO or PPO), and explain that the patients will sign an authorization form when they check out that allows you to bill their insurance for the service.

If a patient ever refuses to provide the insurance card/information, that is your opportunity to say that without the insurance information, the patient cannot see the doctor. If the patient refuses to sign a signature-on-file form, explain that he/she will then have to sign the claim form before [...]