How are your exams paid for?

[Oogilily]

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Questions for ODs out there. Just curious of how your exams are paid for.

Approximately what percent of daily exams are paid with Medicare?
How about vision only insurance such as VSP?
Medical insurance?
Cash only?

If anybody could give me an idea I would appreciate it.

Thanks!

 

[Ediddy]

Oogilily I hope you don't mind me piggy backing on your question...

Private Practice ODs: About what percentage of your patients do you bill medical rather then vision?

 

[KHE]

Questions for ODs out there. Just curious of how your exams are paid for.

Approximately what percent of daily exams are paid with Medicare?
How about vision only insurance such as VSP?
Medical insurance?
Cash only?

If anybody could give me an idea I would appreciate it.

Thanks!

In my office, I'd say about 20% of exams are medicare.
About 20% are vision insurance
About 60% are medical insurance.
Cash only is probably less than 1%.

In my office, we see a fair number of nursing home patients so our total medicare population is probably slightly higher than the average optometric practice.

Someone asked about vision vs medical and for us it's probably 80/20 but again, we're probably higher on the medical than the average practice.

 

[Ryan_eyeball]

In my office, I'd say about 20% of exams are medicare.
About 20% are vision insurance
About 60% are medical insurance.
Cash only is probably less than 1%.

With this much managed care your fees are capped out. If KHE bills at the maximum allowable charges, which I assume he does, revenue is stagnant. You have to either see more patients each year, perform more services (VF's, photos, gonio) or up sell glasses/contact lens brands.

Not a bad way to practice. Cash patients have advantages, but so do managed care.

 

[DILLIGAF]

For myself, I do not see very much Medicare as compared to KHE. Also, I am not a big fan of VSP as far as patients go. I run my main practice with a lot of cash payments, mainly because I have all patients given a quote prior to recalls, with room of course for additional testing that may come up. Last quarter, in my practice in NH, it ran about like this:

Medicare: 11%
Cash: 22%
Medical Ins: 57%
Vision Ins: 10%

Keep in mind that this is in a pretty young and affluent community. I worked at a Costco once that was almost 70% Medicaid/care, so it is amazing how much it can change from place to place.

 

[DawgOD]

Insurance payments in general average about 60-70% nationally...

As far as statistics ... it will all vary though based on the demographics of the area you practice.

 

[KHE]

With this much managed care your fees are capped out. If KHE bills at the maximum allowable charges, which I assume he does, revenue is stagnant. You have to either see more patients each year, perform more services (VF's, photos, gonio) or up sell glasses/contact lens brands.

Not a bad way to practice. Cash patients have advantages, but so do managed care.

A lot of that is true. You just have to raise your fees every year so that you stay ahead of any 3rd party payor profile and keep on top of non-covered things like contact lens fittings etc. etc.

The problem with going after "cash" patients is that most patients do in fact have insurance. As such, they aren't happy to pay a high U&C fee which means you have to start farting around with S-codes and all that kind of BS to try to classify some of these people as "routine" so that you can discount them.

Not worth the aggravation in my mind. Much too ridiculous a kabuki dance on too many patients.