Optometry Coding & Billing Alert

Published on Thu Aug 24, 2006 PDF

Keep these 6 forms on file for each Medicare eyeglasses beneficiary

If your office is dispensing glasses to post-cataract patients, you may also be seeing more of your DMERC inspectors. And if you can't produce the forms they-re looking for, you could be facing a failed audit.

A Medicare patient is entitled to one standard pair of glasses after each cataract surgery with an IOL implant. -Medicare pays for these glasses under the same durable medical equipment regional carrier (DMERC) rules that pay for wheelchairs, hospital beds and home oxygen,- says Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va. Past fraud cases have caused Medicare to -take a closer look at all suppliers, including optical suppliers,- he says.

If you have an on-site audit, the DMERC inspector will ask you to produce the following forms for patients who receive post-cataract eyeglasses, Wimbish says:

- The new eyeglass prescription, written after the surgery. -The prescription must be new and medically necessary,- Wimbish says.

- An assignment of benefits (AOB), usually called a -signature on file,- if your office has accepted the assignment.

- An advance beneficiary notice (ABN), if the glasses have any special features such as deluxe frames or progressive addition lenses (PAL). -To show that you have an ABN on file, you-ll append modifier GA (Waiver of liability statement on file) to each special item on the CMS-1500 form,- Wimbish says.

- A deluxe frame or deluxe lens form, if the patient received either or both.

- Proof of delivery (POD)--a receipt for the glasses dispensed, signed and dated by the patient.

- The supplier standards form (see below).

-This looks like an awful lot to keep up with,- Wimbish says. -But most dispensaries are giving this much information to patients now--just not putting it in writing. But to be protected, all six of these forms must be used for every DMERC patient.- Exception: If the patient is getting only standard frames and lenses, you will not need items 3 or 4.

Don't miss: As Item 6 suggests, you must also inform the Medicare beneficiary of the CMS DMEPOS (durable medical equipment, prosthetics, orthotics and supplies) Supplier Standards. The NSC provides forms you can download to give to your patients. You should also keep a copy of the standards on display in your dispensary, Wimbish says.

Visit www.palmettogba.com and click the -National Supplier Clearinghouse- link under -Providers.- Click on -Supplier Enrollment- and then on -Standards and Compliance.- Look for the -21 Supplier Standards- link in the left-hand navigation bar on the -Standards and Compliance- page.

Note: For more advice on successful DMERC billing and coding, read -Dodge DMERC Denials With Crystal-Clear Refractive Lens Coding- in the March 2006 Optometry Coding & Billing Alert.