Charging for eye infection visit.

[Iforaneye]

I had a patient that was seen for a regular eye exam. During the exam he mentioned that he had a previous hx of eye infection the month before that went away after taking an antibiotic for his knee infection. During the exam his ocular heath was normal with no signs of infection. He came back to the office 5 days later complaining of a red eye with mucus discharge. I did a exam and concluded that it was indeed a bacterial infection. I wrote a prescription for the antibiotic and charged him for a medical exam. He refused to pay and walked out without the prescription saying this should be included in the previous exam. Am I wrong in charging him for a medical visit? Also am I am responsible for the health of his eye if the infection gets worse?

---

Members don't see this ad.

 

[KHE]

I had a patient that was seen for a regular eye exam. During the exam he mentioned that he had a previous hx of eye infection the month before that went away after taking an antibiotic for his knee infection. During the exam his ocular heath was normal with no signs of infection. He came back to the office 5 days later complaining of a red eye with mucus discharge. I did a exam and concluded that it was indeed a bacterial ifection. I wrote a prescription for the anitbiotic and charged him for a medical exam. He refused to pay and walked out without the prescription saying this should be included in the previous exam. Am I wrong in charging him for a medical visit? Also am I am responsible for the health of his eye if the infection gets worse?

Why would treatment for a subsequent problem be covered by a previous exam? If you get a brake job and a week later get a flat, do they give you a free tire?

Cmon man. You knew the answer to this question.

 

[Iforaneye]

If he had come in for a routine eye exam and he had a bacterial infection at the same time. You treated the infection and completed the routine exam. Would you charge him twice, once for the vision exam and once for the medical portion? That fact that this happended so close together had me second guessing myself.

 

[NCiDOC]

If he had a bacterial infection during his eye exam, I would let him know that we needed to treat his eye infection first, under his medical insurance, and once it was cleared up, we could do his exam. Otherwise, his refraction could be off because of corneal or conjunctival issues and he may not like the new glasses/contacts he gets.
It is very rare that you will run across someone (patient) that does not get this so don't lose sleep over it.

 

[mclem222]

you know the answer to this...however you bring up a good teaching point. I don't think all eyes with discharge and red eye are bacterial. They are most often viral and resolve on their own...otherwise a ton of people without access to optometrists would be going blind from bacterial conjunctivitis. Anyway...your patient was never charged a medical exam initially so that was different...

 

[KHE]

If he had come in for a routine eye exam and he had a bacterial infection at the same time. You treated the infection and completed the routine exam. Would you charge him twice, once for the vision exam and once for the medical portion? That fact that this happended so close together had me second guessing myself.

If his infection was significant enough to require intervention I would treat it and then check his Rx at follow up.

An "eye exam" is not a year long retainer where you treat all subsequent eye problems at no charge.

 

[syma]

And re: the OP, he should have been charged a second time. And annotate your records as what occurred.

 

[Meibomian SxN]

If he had come in for a routine eye exam and he had a bacterial infection at the same time. You treated the infection and completed the routine exam. Would you charge him twice, once for the vision exam and once for the medical portion? That fact that this happended so close together had me second guessing myself.

Yeah, the initial exam was covered under the vision but the second exam was a medical exam. The patient most likely knew this also, that's why they stormed out without paying. But I'm curious, how did he get past the front desk without paying his medical co-pay? I'm guessing he slipped through with a lame excuse?

 

[Commando303]

I like KHE's example about brake-work and a flat-tire. As I understand it (and, I'm not a practitioner; my understanding, here, is quite limited), only "follow-up care" should be free. If I pay for a surgery, I shouldn't be charged more when I go in to see the doctor, a month after the procedure, for an evaluation of my recovery. If I visit the dentist to have my braces adjusted, though, and some weeks later need routine x-rays taken, I'd expect to get a new bill for the service.

 

[KHE]

I like KHE's example about brake-work and a flat-tire. As I understand it (and, I'm not a practitioner; my understanding, here, is quite limited), only "follow-up care" should be free. If I pay for a surgery, I shouldn't be charged more when I go in to see the doctor, a month after the procedure, for an evaluation of my recovery. If I visit the dentist to have my braces adjusted, though, and some weeks later need routine x-rays taken, I'd expect to get a new bill for the service.

That's only applied to follow up care related to surgery.

For surgical procedures, there is a global billing period in which the fee covers the post operative care, usually for 90 days.

For office visits, every visit is supposed to incur a charge but you generally bill a lesser amount for the follow up visit.

The confusion on patients end comes from the fact that they have the same copayment regardless of the charge. So for example, you might charge $75 for the initial consultation and then $50 for the followup. The patients copayment in both cases is $25.

So in their mind, they are paying twice but you are actually getting paid less for the second visit. Trying to explain that to people can be a challenge.

 

[Commando303]

That's only applied to follow up care related to surgery.

For surgical procedures, there is a global billing period in which the fee covers the post operative care, usually for 90 days.

For office visits, every visit is supposed to incur a charge but you generally bill a lesser amount for the follow up visit.

The confusion on patients end comes from the fact that they have the same copayment regardless of the charge. So for example, you might charge $75 for the initial consultation and then $50 for the followup. The patients copayment in both cases is $25.

So in their mind, they are paying twice but you are actually getting paid less for the second visit. Trying to explain that to people can be a challenge.

So, if a patient comes in for a C.L. fit, for which she or he fully pays upon that visit, and is given a trial to use for one week, and told to return after that week to learn whether this prescription will work (and, if it will, to place an order for, say, a year's supply of the lenses), the patient will be to pay to be seen after the seven days?

 

[KHE]

So, if a patient comes in for a C.L. fit, for which she or he fully pays upon that visit, and is given a trial to use for one week, and told to return after that week to learn whether this prescription will work (and, if it will, to place an order for, say, a year's supply of the lenses), the patient will be to pay to be seen after the seven days?

I meant office visits to handle separate issues like a routine exam and a subsequent infection.

In the case of CL fits most doctors charge a global fee.