decisionhealth Newsletters, Coder Pink Sheets - 2004 Issue 10 (October)
Optoms: Don't bill under MD's name/number
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Article Overview
This article discusses payer credentialing and billing concerns in practices that include both optometrists and ophthalmologists. It focuses on private-payer rules, the risk of billing services under another provider’s name or number, and the need to understand how payer policies and state practice rules affect reporting and payment. It also notes related confusion in the Veterans Administration setting and the importance of coordinating scheduling and coding responsibilities.
Why This Topic Matters
It helps coding and billing staff recognize a common compliance risk in multi-provider eye care practices and understand why payer-specific credentialing rules matter.
What You Will Learn
- Why credentialing status matters when reporting services in a mixed eye care practice
- How private payer policies can affect billing and payment for optometrist services
- Why practices need to understand payer rules alongside state scope-of-practice requirements
- How VA-related rules can vary by state and affect scheduling and coding workflows
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Ophthalmology practices
- Optometry practices
- Compliance staff
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