Knowledgeable insurance practices can result in higher net promoter scores

As we prepare our practices for 2020, a key area to focus on are updates to our vision plan and medical insurance manuals. Most insurance companies will have a “quick list” of updates. However, if we haven’t looked at the manual in a year or more, this is a great time for us to read it cover to cover.

Two areas I would review for each of our vision plans are:

1 DIABETIC EYE CARE SERVICES

New to some plans are procedures covered for patients who have diabetes. This may be client-specific or plan-specific, so we need to be certain to go to each plan we accept, search “diabetic eye care services,” and look for the steps our teams need to take to determine which of our patients have covered services. There are two types of services to investigate for coverage: screening services (such as retinal imaging and OCTs) for patients who have a diabetes diagnosis, and medical testing for a diabetic patient who has been found to have diabetic retinopathy.

Each of the plans will most likely have clinical guidelines to be followed when looking at frequency of utilization, as well as documentation required for these services, covered procedure codes and reimbursement amounts for procedures. On the plan website, there will be two links, one for more information outlining the details of the coverage for patients and the other for billing guidelines for these services. One reason it is important to investigate the coverage for diabetic eye care is that the co-pay will be reduced, if not zero, for qualifying patients on some plans.

THE NUMBERS

 

 

Number of managed vision care plans, reports The Vision Council.

 

 

of the U.S. adult population possesses some form of managed vision care, according to The Vision Council’s Q3 2019 Vision Watch Correction Report.

2 COORDINATION OF BENEFITS

This has been a benefit that has come and gone over the years with many vision plans. Let’s look at the updates to this coverage on our plans, as this has been updated for several to be included more often and for more clients. What coordination of benefits includes in many cases is the ability to bill the patient’s medical plan for an office visit and procedures, when medically necessary, as well as refraction.

After the explanation of benefits is received by our offices, indicating a denial of the refraction, we are then able to submit the refraction to the vision plan for payment. This benefit will depend on specific plan details of coverage. We need to look for the directions on the vision plan website to find the steps for filing the claim in these situations.

STAY CURRENT

By staying current with the specifics of each vision plan, we will be better able to communicate with our patients in an efficient manner and avoid problems after services are provided. Patients are always impressed when we can walk through the challenge of insurance benefits quickly and efficiently with them. We will find this will go a long way in improving our practices’ net promoter score as well, which can be found at www.netpromoter.com. OM

DR. JASPER practices in West Palm Beach, Fla.. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.