Should you bill routine vision or medical insurance?


One of the more challenging decisions eye care professionals face is when a patient has both medical and vision plan insurance. It can be confusing and difficult to decide which one to bill, especially when patients want to be part of the decision and are concerned with what they will have to pay. However, there are many circumstances where you can bill vision and/or medical.

The best practice is to select the insurance plan based on the patient’s chief complaint and medical diagnosis, but sometimes it’s not that simple. Our Fast Pay medical billing and coding experts can help you determine how to bill the visit and make sure claims are clean and free from errors, before we submit them. At Fast Pay, we know that being FAST and preventing rejections in the first place means you get paid FASTER.

Case Study Example

An established patient who has both vision and medical plans is seen for a routine annual vision exam. During the dilated eye exam, the doctor detects a choroidal nevus, sometimes called a freckle in the eye. Because melanoma can resemble a nevus, the doctor performs extended ophthalmology services on the same day. The exam can now be billed to the medical insurance since the doctor used medical diagnosis codes. In addition, always list the medical diagnosis codes as primary diagnosis codes to avoid rebilling. 

Best Practice Tips

  • Verify both medical and vision plans prior to the office visit; scan or copy both sides of the cards.

  • Inform the patient what deductibles and co-pays you will collect before you see the patient.

  • Many medical plans are no longer paying for eye exams with a diagnosis of blurred vision or a headache. These are considered a routine vision exam.

  • Clearly document the patient’s history, exam, assessment and plan.

  • When you document the chief complaint, provide a concise description of the problem or laboratory test—this will help you in case you are ever audited.

  • A missing chief complaint can result in a claim denial based on incorrect levels of care.

  • Never bill both vision and medical for the same service.

We love getting paid faster. Our staff no longer spends hours on the phone with insurance companies, which allows them to focus on what’s important—the patient.
— Cindy Hess, Columbia Family Eye Care Center, Clarksville, MD

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At Fast Pay, our billers take care of the billing hassle to maintain consistent cash flow and improve the turn-around time on your claims. We work with each of our offices to provide a solid billing solution. No two practices are alike and we pride ourselves on maintaining open communication between every office and their Fast Pay biller to stay in sync. Contact us for a free practice analysis to see how we can help you.