copay on office visit vs. testing at the office

copay on test in office vs. office visit


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kristieh

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Hello,

I work in a optometrist office. I'm trying to get clarification on patient paying copay for a test done at the office vs. a regular visit.
Should a patient pay co-pay on a test they are coming to do for a condition they have. It's technically not a office visit where they are sitting in chair doing routine coding a 99 or 92. Just testing.

Can anyone tell me if they should be charged a copay for test done at the office. (visual fields, pachymetry, OCT.) I don't think they should be charged but Dr. thinks otherwise.

Thank you in advance,
 
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CodingKing

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It really depends on the insurance benefit plan. One plan my apply an office visit copay for office based diagnostic procedures, another may only charge an office visit copay when there is an E&M code billed, One may have co-insurance on office procedures. There really is no one size fits all plan for the practice. Maybe if you have to refund enough copays, the physician may change their mind.
 

kristieh

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thank you so much CodingKing!! :) I will take a further look at some of the plans. I know we are not doing a lot of refunds because of deductible.

Thanks again
 

Cheezum51

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I'm an optometrist and agree with CodingKing. The copays are definitely plan specific. Since you're not refunding many copays, that tells me that your doctor is correct and most of the patients you see have copays for any service you provide.

Considering the relatively low fees insurances pay for services and that copays often make up well over 50% of the net fees you collect for a service, I feel it is always better to err on the side of caution and collect the copay at time of visit versus having to constantly bill, often several times per patient, to collect them after they've left the office.

Tom Cheezum, O.D., CPC
 
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