Lesson Summary

In this video, the importance of building and coding appropriately in eye care offices is highlighted, in light of a growing demand for medical eye care.

• The U.S. population is aging, creating a greater need for eye disease management. The number of ophthalmologists is expected to remain stagnant, leading to a gap in medical eye care that needs to be filled by optometrists.
• Medical insurance reimbursement tends to be superior to vision discount plans.
• Patients requiring medical care still need eyewear, leading to additional revenue opportunities.
• Medical patients may require special testing and follow-up appointments, offering more billing opportunities.

While offering medical eye exams can lead to more comprehensive care and utilization of optometric training, there are challenges:

• Medical encounters can be time-consuming and challenging.
• Medical charting demands more time and documentation.
• Complaints and arguments over medical copays can arise.
• Concerns about clinical and documentation errors may be heightened.

Comparisons between medical eye exam reimbursement from medical payers and vision discount plans are also discussed:

• Billing medical eye exams to medical payers can lead to triple-digit reimbursements, much higher than vision discount plans.
• There are considerations regarding patient payments, deductibles, copays, and special testing costs.
• Conversations with patients about billing to medical payers versus vision plans must be navigated with care.

The video suggests two options for billing and navigating these conversations:

• Option 1: Bill the patient's medical insurance for medical complaints, but this may lead to higher copayments than expected by patients.
• Option 2: Bill the patient's vision plan for an exam and have them return for a medical visit, which may affect patient follow-up.

Deciding whether to prioritize chief complaints or the physician's interpretation can vary among eye care professionals, leading to different approaches in practice.