Mobile Optometry

[Bill the Biller]

I have a small business that is exploring several states for their new business. They are asking me questions about billing in order to figure out the most profitable way to do business. They are going to offer mobile optometry services for patients in nursing facilities.

These are their questions, I would really appreciate if anyone with experience or with the resource to check them up can answer some so I can get a hold of their business. Thanks in advance.

Question number 2 is most important. They need to be able to calculate what profit they can make. But here are the q's:

1. Is it correct to consider that most NF patients have state Medicare? Which means that they will generally get the same amount reimbursed for common procedures.

2. What is the Medicare max allowed (basically what will medicare pay) for each initial exam and for each follow up? The states they are exploring are Tennessee, Georgia, Ohio, Pennsylvania, NY and Maryland.

3. Which of these get reimbursed better, fitting glasses or providing eye exams, or do both get reimbursed nicely?

I would appreciate any help, or any referral where I can find this info. Thank you MBL community.

[Michele]

We bill for an OD that goes into several skilled nursing facilities.

1. Is it correct to consider that most NF patients have state Medicare? Which means that they will generally get the same amount reimbursed for common procedures.

Most are Medicare eligible however many enroll in Medicare Advantage Plans

2. What is the Medicare max allowed (basically what will medicare pay) for each initial exam and for each follow up? The states they are exploring are Tennessee, Georgia, Ohio, Pennsylvania, NY and Maryland.

You can go online and look up the fee schedule amounts for each CPT they will be doing for each state/area they want to be in.  For example, NY is:

www.ngsmedicare.com

PA:  https://www.novitas-solutions.com/webcenter/portal/FeeSchedules_JL

etc.  Just google Medicare part b fee schedule <insert state>

3. Which of these get reimbursed better, fitting glasses or providing eye exams, or do both get reimbursed nicely?

Our doc does mostly exams and testing.  He does a little fitting but most of his business is in the exams and testing. 

[Bill the Biller]

Thanks Michele, very helpful.

Do the Optometry CPT codes for exams and follow ups change if done at SNF, or do the same codes apply at office locations and at SNF locations?

[Michele]

Our OD uses the same codes as he did when he worked out of an office.  Our other OD does the same.   (We have two that do SNFs)