Clearing up the confusion around VSP COB Billing
Some of you may be aware that VSP Vision insurance offers a benefit for some of its members to allow providers to bill VSP as a secondary or tertiary insurance when the patient is seen for a medical condition. If you are not aware of this benefit, this article will explain when to use VSP as a secondary or tertiary insurance; how to bill it; and how to communicate this benefit effectively with patients.
When a patient is scheduled for a routine vision exam, and they have VSP as their vision insurance, an authorization should be obtained from VSP prior to the appointment. That authorization will indicate whether the patient has any exclusions on their plan that prevents you from COB billing. VSP has 12 different COB rules that may or may not apply. The one rule that staff should look out for is Rule 9: COB isn’t allowed. The other various rules were created for complicated billing scenarios, but they rarely apply.
If there are no exception rules that apply, the patient does have that benefit.
During the examination, if it is determined the patient needs to be evaluated for a medical condition, thus turning the vision exam into a medical exam, you can bill the secondary or tertiary “medical” insurance. Yearly diabetic exams are a great example of when an exam qualifies for both vision and medical COB billing.
Changing an exam from a vision exam to a medical exam can be confusing for patients. It is important to communicate the difference to your patient, and make them aware of the medical secondary or tertiary benefit they have with VSP. One way to effectively communicate this with the patient is to require the patient acknowledges this information with a signed document or consent (see resources below).
Once the exam is complete, and you have determined the exam was a medical exam, your billing team will bill the exam, refraction (if done) and any testing (if done) to the patient’s medical plan. Once the medical plan has processed the claim, your billing team will need to bill the exam and refraction (if done) only to VSP as the secondary or tertiary insurance. This can be done on VSP’s online portal through Eyefinity. VSP will process the claim as the secondary or tertiary payer and pay the provider according to the benefit provisions with the patient’s plan.
VSP offers many tools to assist the provider’s billing team to determine the benefits the patient has available, as well as the amount that VSP will cover as the secondary payer.
Below are several resources to help your office set up effective processes to maximize your reimbursement using VSP COB billing.
Additional Resources (Click to Download)