Vision Payors vs. Medical Payors in Optometry Billing: What You Need to Know

by Applied Medical Systems

Optometry billing is different than billing for most medical practices. Eye care can either be covered by normal insurance plans or specialized vision plans. As all optometrists know, in the United States it is illegal to bill both the patient’s medical payor and vision payor for the same service. The provider usually selects the insurance plan based on the patient’s chief complaint. However, it is not always that easy.

Patient Concerns about Coverage

One of the main contributing factors in this optometry billing equation is the opinions that patients bring forward. The optometry practice is concerned about the revenue, but the patient is also concerned about how much they have to pay. A good practice will consider the point of view of the patient. Otherwise, you risk losing a patient’s long-term loyalty. You want to service the patient in the best way possible.

Optometry Billing Options: Patient’s Point of View

In combining the practice’s concerns and the patient’s concerns, there are several things to note. These range from the exact service being provided, the severity of diagnosis, the eye care provider’s own policies, and the patient’s understanding of how the decision is made. The following is a list of items to consider when educating the patient:
  • Look into the co-pay difference for the patient. Do not disregard this aspect, as it can heavily dictate how a patient responds.
  • Provide an explanation of the provider’s policy, which will most likely define the difference between a routine vision exam and medical exam. Do not confuse the patient. Put this information in simple terms. Patients are not medical experts.
  • Ask patients to bring information on both forms of insurance. This request is likely to bring up questions. The reason why this information is necessary is because, as many patients do not know, optometrists have the authority to provide eye-related medical care (treating conditions and comorbidities) and eye care.

Additional Suggestions for Billing Decisions

In addition to properly educating a patient, we also suggest keeping track of common insurances in your area. This way, you will be readily equipped with comparative information that will come up often. Billing for optometry services needs to be systematic and uniform. Because optometry billing is such a specific case as compared to other types of medical billing, there is a higher risk for billing mistakes and legal cases. Outsourcing billing may be the best solution for your practice. Applied Medical Systems is a professional medical billing and coding company. We provide specialized billing and coding services to practices to help maintain patient records and correctly perform insurance claims. To learn more about our services, contact our Durham, NC office today.