Inapt Billing by Optometrists could Result in an Audit and Remarkable Repayment

January 09, 2015

Billing errors can be the cause of various financial problems at medical offices. If the errors are not caught ahead of time, providers can face issues like delayed payments, loss of revenue, costly fines and even uncalled for audits. Similar to other medical specialties, optometrists also need to review medical claims in a periodic manner for identifying common billing mistakes. For instance, up-coding patient visit is one of the most common billing errors that can lead to an audit.

Medicare / Medicaid Audits more likely

Apart from preparing for the ICD-10 coding system, optometrists also need to adapt to a series of activities for avoiding Medicare audits. This is because around 60% of patients walking in in an optometry clinic for availing medical services rely on Medicare coverage.

Since incorrect billing is considered fraudulent billing in case of Medicare / Medicaid audits, providers need to spruce up their optometry medical billing services. In such cases they are required to reimburse the insurance companies with additional paid amount which can pose serious threats to their revenue cycle. At times the said amount (if penalized) puts extra financial pressure on optometrists. Therefore, in order to avoid audits and re-payments, it has become important for providers to streamline their optometry medical billing services.

How Can Optometrists Avoid Audits?

Due to the rise in billing scrutiny, optometry practitioners need to ensure that their billers are not billing high, even if it is accidental. It has become important for the billing departments to take a methodical approach towards coding and billing.

  • Accurate Application of ICD Codes:
    Optometry practices rely predominantly on CPT codes for diagnosis. In-correct application of ICD-9 or ICD-10 codes for diagnosis can lead to claims denials and audits. This makes it necessary to adopt error-free coding and billing practices to get paid on time and avoid audit-inducing errors. Providers need to get their staff trained and updated on EMR or other medical billing software to ensure error-free billing.
  • Transparency in Billing:
    Billing transparency is equally important for avoiding audits caused by inapt billing procedures. For instance, doctors of optometry (OD) perform an important procedure called glandular evacuation. If they utilize LipiFlow Thermal Pulsation System and administer the procedure of meibomian gland evacuation, the billing can be done for evacuation procedure rather than diagnosis. This procedure is reimbursed at a high rate; however, incorrect usage attracts unwanted audits.
  • Review the Stages of Billing
    Another effective way of avoiding audit caused by inaccurate billing procedures is to conduct audit reviews of processes and systems. This will prepare their practice for any unpleasant surprises and save thousands of dollars that go down the drain in case of audits.

Many optometry practices lack the time to train in-house billing staff or lack resources for hiring experienced coders and billers. Conducting periodical reviews also become a challenge as they have to keep attending patients and also comply with the other healthcare reforms. In such cases, they prefer outsourcing their optometry medical billing services to a third party such as MedicalBillersandCoders.com. Companies like MBC have a team of certified and experienced billers and coders who are well-trained in offering effective RCM solutions to different medical specialties.


Category : Outsource Medical Billing