Routine vs Medical

Whether you have been practicing optometry for quite some time now or are about to enter the field soon, you would know how important it is to satisfy patients in terms of eye care and the overall service you provide.

And a major difficulty faced by ODs and optometrists worldwide is when their patients can’t understand why their visit is being billed when they have insurance or when their examination is called ‘routine’ and when it is ‘medical.’

Apart from customer satisfaction, what lies between your optometry practice being profitable and incurring revenue losses is to know when an examination is routine or medical and therefore, bill it accordingly.

While customers are normally confused between the two types of exams, a part of the confusion stems from doctors themselves.

When the ODs and the staff are clear and confident about the services they provide only then can they can satisfy their patients better.

What is a routine exam?

A patient’s exam will be considered routine if there is no emergency or chief compliant behind their reason to visit. If they don’t have a history of any major eye illness or disease, the diagnosis involves low to no decision making or the primary diagnosis is refractive in nature, then the examination will be considered routine.

What is a medical exam?

Unlike a routine exam, a medical exam requires some important decision-making. There is usually a chief complaint or some other ailment that compels the patient to visit an optometrist.

If the medical diagnosis correlates with their complaint or even if there is no apparent reason but the patient has a history of some ocular disease then their examination will be marked as a medical exam.

It goes without saying that everyone wants to save money. Therefore, most patients want to use their routine benefits in order to save what they can. But being an experienced practitioner, if you deem the exam to be medical then it is necessary to explain to the patient why you will be billing their medical insurance.

You need to handle such situations well because it shows to customers that you provide a higher level of eye care than they might have imagined.

It is best you sort things out as early as when a patient calls or visits to book an appointment.

Ask them if they have any medical condition such as diabetes, hypertension.

Diabetes is amongst the leading causes of blindness, so in case a patient is diabetic, let them know that their exam will be considered medical.

Also, ask the patients about their insurance details so that you can decide whether they are eligible for bill reductions or not.

Suggest if they require an OCT scan or a retinal photo and confirm their eligibility for different eye-health benefits.

Give your patients an intake form that explains when an examination is routine and medical.

Ask them to carefully read it and then sign and submit it to you before the exam.

This shows that they acknowledge their understanding of routine and health insurance benefits and how these benefits can be utilized.

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