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Balancing Medical and Vision Plans – Review of Ophthalmology

Managing Medicare, vision and medical plans without compromising patient care can be complicated. Here’s help.

This article answers the following questions:

  • What is a “vision plan”?
  • Will Medicare provide the same benefit as a vision plan for a routine eye exam?
  • Is it possible for a Medicare patient to have a separate vision plan?
  • If a patient has both medical and vision insurance, which is primary?
  • Where is the reason for the visit documented?
  • If a medical diagnosis is found in addition to the refractive diagnosis, should we also code the medical diagnosis?
  • When a patient comes for a routine exam and pathology is found, may we bill the medical plan?
  • Which plan is responsible if a patient needs urgent, sane day medical and/or surgical care?
  • Is it ever possible to bill both medical and vision insurance?
  • Do vision plans provide a “routine” eye exam for diabetics?
  • Are there ways to reduce confusion with patients on this subject?
  • How should we handle the patient who asks our staff to modify a claim to avoid personal responsibility?

This article was published in Review of Ophthalmology’s Medicare Q & A column, which is written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA. To view the entire article in Review of Ophthalmology, click on the link below:

See page 22.

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