Article Date: 6/1/2004

coding q & a
More New Issues with DMERCs
Part two of the series continues its review of the changes for 2004.
By Suzanne Corcoran, C.O.E.

Last month, we discussed a number of important changes affecting Medicare post-cataract eyeglasses dispensing. This month, we'll cover recent Medicare clarifications on record keeping as well as the increase in site inspections.

Coming to a site near you . . .

You may have heard last year about a huge Medicare scam involving power wheelchairs in Texas. What does that have to do with you? Unfortunately, Medicare funds your post-cataract eyeglasses under the same law that pays for wheelchairs, hospital beds and home oxygen. The power wheelchair fraud has prompted a crackdown on all types of Medicare suppliers -- including optical dispensaries.

One major result of this is an increase in unannounced site inspections. A representative of the Durable Medical Equipment Regional Carrier (DMERC) will visit your office and ask to verify that you are in compliance with Medicare rules and regulations. What will they look for?

Signage. You must have your name and business hours clearly displayed for customers and potential customers.

Supplier Standards. You must be able to show that you provide each and every patient receiving Medicare-covered eyeglasses with a copy of the Supplier Standards.

Receipts. Are you getting a signed and dated proof of delivery for all Medicare eyeglasses? Be prepared to show this.

Assignment of Benefits. You must have a signed statement from your patients that you have permission to file claims and receive payment for their Medicare benefit. Medicare requires specific language. You should have this signed for each pair of Medicare eyeglasses that you dispense.

Advanced Beneficiary Notice. When you dispense extra features (tints, deluxe frames, etc.) you need to notify the patient in advance, using an Advance Beneficiary Notice (ABN) form. The patient must complete this form before dispensing.

Get clarity

In January, the Centers for Medicare and Medicaid Services (formerly HCFA) issued a clarification on delivery instructions and records retention specifying that you keep records for seven years. It also clarified required documentation on delivery receipts.

You must have a delivery receipt (proof of delivery) signed and dated by the patient or the patient's designee. A notation by the dispensing personnel is not sufficient.

The delivery receipt must include an itemization of the components of the glasses. Many practices use a copy of the lab order because it usually includes all of the features of the glasses and describes the frame.

Rx rules

Medicare specifies that you include the following elements on a prescription that you're filling that another provider wrote:

► Patient's name and address

► Diagnosis (either words or ICD-9 code)

► Description of the item(s) (either narrative or brand name and model number)

► All options and additional items that are separately ordered (e.g., polycarbonate lens when required)

► Physician's original ink signature and date. Note that the doctor must personally enter both the signature and the date; a stamped or surrogate signature is not acceptable.

You'll be in the clear

Documentation requirements continue to be an important area of concern to optometrists dispensing Medicare post-cataract eyeglasses. Follow these guidelines to stay out of trouble.

If you have a coding question you'd like Suzanne to answer, send it to René Luthe, c/o Optometric Management, 1300 Virginia Drive, Suite 400, Ft. Washington, PA 19034 or to

Suzanne Corcoran is vice president of Corcoran Consulting Group.  Reach her at (800) 399-6565 or at SCORCORAN@CORCORANCCG.COM.


Optometric Management, Issue: June 2004