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    ODs’ top 4 gripes about vision care plans: Part 3—Reimbursements


    3. Bill correctly, bill medical when appropriate

    We will look in depth at the topic of medical billing in Part 5 of this series. For now, my experience working with doctors is they do not bill medical when they should.

    Both Vision Service Plan (VSP) and EyeMed clearly state in their contracts that if the patient has a medical condition, the visit should be billed to the patient’s medical insurance. Many practices simply do not have good processes and protocols in place to make sure patients are informed and medical insurance is billed when appropriate.

    Related: 6 tips to navigating the insurance game

    It is also common to see practices under-bill and/or charge patients incorrectly. Given the large number of variation within the VCPs, this is not surprising. You must develop a systematic process to ensure you are billing appropriately.

    For example, not billing VSP for backside ultraviolet (UV) protection on lenses not only results in you not getting paid, but it also results in a loss because VSP will incur chargeback. Other areas that are easily missed with VCPs include:

    • Custom measurements

    • Wrong contact lens fitting fees

    • Other add-ons

    Up next: Reconcile explanation of benefits

    Carl H. Spear, OD, MBA, FAAO
    Dr. Spear owns a multi-location group practice with his wife Dr. Katie Gilbert Spear in Pensacola, FL. Dr. Spear is commander of the ...


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