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refraction billing

Debbie Posted Thu 22nd of July, 2010 10:05:24 AM

As you know the patient is responsible for the refraction during their exam, we collect at the time of the visit. When the billing is transmitted to medicare claims, they have been deducting that money from the patient from our balance due. Can someone explain what we are doing wrong? Thanks for your input ahead of time.

SuperCoder Answered Thu 22nd of July, 2010 10:32:43 AM

Since refraction examinations are non-covered services and the patient is responsible for the payment, the appropriate way is to bill it (92015) with a modifier GY to indicate that you are aware of the patient's payment responsibility. If the payer still deducts the amount, the only way is to talk to them and clarify the situation.

K.c Answered Thu 30th of September, 2010 18:48:00 PM

WHEN WE ENTER A PAYMENT FOR REFRACTION ON A MEDICARE PATIENT, WE BLOCK THE PAYMENT FROM GOING TO MEDICARE. MEDICARE ASSUMES THAT THE PAYMENT IS ON CHARGES THEY COVER AND THEY WILL PAY THE PATIENT THE DIFFERENCE. YOU WILL HAVE A HARD TIME GETTING THE $ BACK FROM PATIENTS, SINCE IT IS MEDICARE THAT SENT IT TO THEM, NOT YOU.

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