“What do you MEAN it’s not covered?”
We’ve all heard patients ask this question, and it can be challenging to deal with a patient who is frustrated about non-coverage. Typically, you can eliminate the problem by communicating clearly with patients about which services are covered and which aren’t – and this is never truer than when dealing with refraction.
What this means: If you need a reminder (or a simple definition you can repeat to patients), “refraction” refers to the physician’s test of a patient’s refractive error so he or she can determine whether the patient requires glasses, and if so, what the prescription should be. It’s normally performed during a routine eye exam, and is described by CPT code 92015 (Determination of refractive state).
So what’s the problem? Medicare never covers refraction, and neither do most other payers. If patients want to go through the process of refraction, they’ll have to pay the practice out of pocket for the service. Patients are often not pleased to hear about the charge, creating issues for your front desk staff when it’s time to collect the fees.
Maintain a Written Policy
One simple step to eliminating complaints from patients about the fact that refraction isn’t payable is to incorporate your refraction policy into your practice’s financial agreement (hint: your patients are supposed to sign this when they join your practice). Some practices have separate refraction policies, but the reality is that you only need to add a sentence or two to your financial policy. Explain that refraction isn’t covered by most insurers and pointing out what the approximate cost will be to the patient.
When patients make an appointment with your practice for a visit that will include refraction, remind them that they’ll have to pay the refraction charge at the time of the visit. I also advise practices to mention it again during appointment-reminder calls. This helps ensure no one is blindsided at the appointment. You can also mention the expected out of pocket cost during these reminder calls to help patients prepare.
Keep in mind: Some patients do have separate vision plans in addition to their medical insurance. If that’s the case with your patient, you’ll want to validate whether refraction is covered under that vision plan before the patient presents to your office. If you aren’t already doing eligibility verifications before patients come in, then you should start now! It saves time and effort down the road and can smooth the path to payment by giving you a clear idea of exactly what charges the patient will face when they come to your office.
Consider This a Customer Service Issue
Although some practices think about the refraction non-payment as a billing issue this is at heart a customer service issue. The front desk staff is your first line when collecting patient payments, and if you don’t have a culture of customer service at your practice, that will show up in your front desk’s patient interactions. You must hire people who can compassionately collect, understand payment pitfalls, and mitigate a situation to explain the policy adequately when patients do have questions.
If you implement these policies and patients still seem puzzled about having to pay for refraction, that’s a sign that you may have to tweak the script you’re using so you can more accurately explain the refraction charges to the patient. Fortunately, if you have patients read and sign your fee policy up front and you’ve included information about your refraction payment guidelines, you can always show that to patients and remind them they signed it.
It’s also important to keep the dialogue open in your face-to-face patient interactions to make sure the human element is always front and center. Patients want to feel cared for, and patient satisfaction is playing an ever-growing role in reimbursement and the success of your practice.