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Claims Processing: Optometry vs. Ophthalmology

Trusting a doctor with eye care is an important health care decision. The type of eye doctor a patient uses is largely a matter of personal preference if the eyes are healthy and don’t require specialized medical or surgical treatment. There are two types of eye doctors: optometrists and ophthalmologists. Both perform routine eye exams and are trained to detect, diagnose and manage eye diseases that require medical and non-medical treatment. Apex EDI handles both Optometry and Ophthalmology claims.

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An optometrist is an eye doctor who has earned the Doctor of Optometry (OD) degree. Optometrists examine eyes for both vision and health problems, and correct refractive errors by prescribing eyeglasses and contact lenses. Optometrists in the United States are also licensed to prescribe medications to treat certain eye problems and diseases. The scope of medical care that can be provided by optometrists is determined by state law.

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An ophthalmologist is a medical doctor (MD) or an osteopathic doctor (DO) who specializes in eye and vision care. Ophthalmologists are trained to perform eye exams, diagnose and treat disease, prescribe medications and perform eye surgery. They also write prescriptions for eyeglasses and contact lenses. It is important to seek care from an eye doctor highly trained if you already have a medical eye problem such as glaucoma, macular degeneration or cataracts. In many cases, this means that medical or surgical eye care by a specially trained ophthalmologist is in order.

Another factor in the patient’s selection of an eye doctor is determining if he or she is an authorized provider under the vision or medical insurance plan. Most optometrists and ophthalmologists accept Medicare for older patients. However, while Medicare covers your visits to an eye doctor for medically necessary eye care, it does not cover routine eye exams. Prior to the submission of a claim, it’s helpful to verify coverage and out-of-pocket expenses for the exam.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

 

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Ophthalmology Claims

As an ophthalmology professional, you must ensure all claims are submitted properly to ensure your business continues to run smoothly. Here are a few general tips to make sure claims are both accurate and timely.

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First, as with any claim, be sure to obtain and verify all of the necessary patient and provider information. Accurate information allows claims to be processed and paid without delay. It’s also important to submit claims promptly with all supporting documentation. Check the claim prior to the final submission to be sure that it is error free. This will help minimize stress that can be caused by claims that are coded or filed incorrectly. Common errors such as failing to submit a quantity of 2 to obtain payment for both eyes, or not indicating the correct modifier for the procedure performed can lead to weeks of delay.

Vision plans cover routine wellness exams for eye health. Medical eye care, on the other hand, is for the treatment of specific medical conditions related to the eye, such as pink eye, cataracts, or double vision. The diagnosis and treatment for these conditions should be billed through the medical eye care insurance. You’ll want to ensure that you are billing the correct insurance to receive payment promptly.

Following these simple steps when filing an ophthalmology claim, will increase the efficiency in your office and ensure you receive payment from payers in no time. Apex EDI can help ensure the best possible care for your patients by verifying vision and medical claims before they are sent to the payer for final submission. Apex EDI works to get you paid faster.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

Posted in: Ophthalmology Claims

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