Ophthalmologists Should Get Paid For “Routine exams”- Here’s How

March 2, 2009

Many plans do not pay for routine exams or refractions, and many don’t pay when the patient’s complaints like headache, blurred vision etc. are due to refractive error. On the other hand, some do.

I advise figuring this out by trial and error- try all kinds of diagnosis codes like “blurred vision”, “headache”, “subjective visual disturbance” etc., and watching the EOB and see which insurance plan paid for what, then re-submitting with a different diagnosis. Then keep track, and now you know which plans pay for what for future reference.  Sound annoying? You bet!

Anyway, make a note of this in your letter that every patient must read and sign before the exam, so patients can’t claim to be surprised when they get a bill. For example, in my letter, I write: “For complaints like blurred vision, where the exam is normal except for a refractive error, your plan will deny payment and you will be responsible for the $175.00 fee (except for the following plans- Aetna and Blue Cross…”)

Last piece of advice- ask the patient if they have floaters, itching, some crusting in the morning- these will allow you to check off diagnoses like vitreous floater, allergy, blepharitis etc. so the whole thing is moot.




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