Billing Vision Plan for Refraction same day as annual medical eye exam

[nicolaismom]

We are questioning the legality of billing to their vision plan, the patient's Refraction charge, the day they come in for a medical annual exam. I was under the impression that if you are sending out a medical claim on this date to the medical plan, that it was not allowable to separate the routine refraction charge and bill it to the patient's routine vision plan. Any insights and supporting documentation would be immensely helpful and appreciated!!!

 

[Cheezum51]

Most vision plans will not pay anything if you just bill them for the refraction. Some, VSP has some plans that do this, allow coordination of billing. In order to do this, you have to bill the refraction to the medical plan, in addition to the charges for the level of exam provided to the patient. DO NOT link any of the refraction codes to the medical codes. When the medical plan denies payment for the 92015, VSP has a special form on its website which allows you to bill it for the refraction if you also attach a copy of the medical carrier's EOB. In some instances, apparently becoming fewer all the time, you can send VSP the EOB and it will pay its normal fee for the refraction and may even pay something towards what the patient paid in deductibles/copays.

Eyemed, Spectara and Davis do not allow any coordination of benefits.

Realistically, your best bet is to have the patient pay you out of pocket for the non covered refraction and forget about trying to do any COB because even VSP is now doing that for very few of its plans any more.

Tom Cheezum, OD, CPC, COPC

 

[nicolaismom]

Thank you so much for the information. That was what I thought, but I wanted to verify.

 

[nicolaismom]

Have you come across Humana patients being told by their member services that they are not responsible for the 92015 because it's a routine service charge?