Contact Lens Spectrum Supplements

Special Edition 2017

Contact Lens Spectrum

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CODING SUMMARY Prescribing MNCLs is intellectually and financially rewarding to the practitioners who are able to do so effi- ciently, ethically, and skillfully. Their patients enjoy the best vision possible, comfort, and wearability, and they become patients for life. No business disruptor will be able to take that away. Making a living at prescribing MNCLs takes just as much study as the science of pre- scribing, because as I tell my staff, "In today's world of managed care, it's not what you bill and code. It's what you can keep after an audit that matters." CLS when you are managing their MNCLs. Patients insured by Medicare are required to sign this form. This docu- ment explains that the patient is financially responsible for any procedure determined by their insurance to be a noncovered service. From experience, I can tell you that it is well worth a conversation with the patient about this document prior to initiating services. For example, some carriers (including Medicare) reimburse for 92132, ante- rior segment OCT, for evaluating the cornea in the pres- ence of a contact lens; however, some insurers summar- ily exclude this test as "experimental," and the patient is financially responsible for it. If you know a patient's insurance excludes this test, it is best to find out ahead of time whether or not the patient wants the test performed. Maximum reimbursement for office visits, testing, and lenses also varies widely among carriers. It is best to evaluate each insurer's contract and fee schedule pri- or to signing your annual contract. Some insurers' fee schedules for MNCLs are not acceptable to our practice, therefore, we choose not to be included in those panels. With a carefully crafted letter and a receipt for services from your practice, those patients whose insurance we do not accept but who elect to proceed with MNCLs are often successful at recovering out-of-network benefits from their carriers. Dr. Sonsino is a partner in a high-end specialty contact lens and anterior segment practice in Nashville, TN. For more than 12 years, he was on the faculty at Vanderbilt University Medical Center's Eye Institute. He is a Diplomate in the Cornea, Contact Lenses and Re- fractive Technologies Section of the American Academy of Optom- etry (AAO), chairman of the Cornea and Contact Lens Section of the American Optometric Association (AOA), a fellow of the Scleral Lens Education Society (SLS), board certified by the American Board of Optometry (ABO), and is the 2017 Gas Permeable Lens Institute (GPLI) practitioner of the year. He is a consultant to Alcon, Con- tamac, Johnson & Johnson Vision, LVR Technology LLC, Optovue, Shire, SynergEyes, Visionary Optics, and Visioneering Technologies and has received research funding from Precision Ocular Metrology.

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