Affordable Care Act Changes to Affect Optometry Billing in 2014


Affordable Care Act Changes to Affect Optometry Billing in 2014

As several key sections ofthe Affordable Care Act (ACA) are set to take effect this year optometry practices need to gear up to sail through the billing challenges. The primary focus of the ACA is to increase the number of American citizens with health insurance and for that, optometrists will need to provide services and eye care to the newly insured patients over time.

Many states in the US will expand and extend their Medicaid program to everyone under 133% of the federal poverty line in this year. The federal government will support this program for approximately three years by providing complete funding. Due to this, optometrists seeing Medicaid patients will witness a significant rise in number of people seeking treatment.

Even though states will receive monetary help for covering this population it will not translate into increased reimbursements for providers. The expansion is set to create a new patient dynamic, decrease in payment per transaction for optometrists. However, there will be a possibility of more transactions. Optometry practices may face some common challenges as other small practices in the healthcare industry. This will affect their staff as well as the treatment procedures.

Optometrists have increased inflow of patients because of health care reforms. Various services are being added to the care package and this has made optometry billing complicated. Some of the billing challenges faced by optometry practices are as follows:

  • Lack of trained staff for data recording is one of the major billing challenges for optometrists. Since electronic health records (EHR) and electronic medical records (EMR) have become popular, your staff needs to be capable of recording patient data at real time. They must know how to collect the required information and record it with appropriate codes.
  • Millions of Americans will get covered under Medicare by 2015 and a large number of patients are likely to come to your clinic. Billing and coding challenges will increase for  Medicare and Medicaid patients.

Practices need to check on their clearinghouse for rejections and improve their Accounts Receivable (AR) reports to ensure timely payments. Everything from patient access and opportunities to reimbursements are bound to change for optometrists due to the Act. However, it will depend on the individual optometrist to understand what value he adds to the system and how he can prepare his practice for the potential challenges. The need is to capitalize on opportunities and manage the risks related to billing.

Bad debts, not adhering to the reforms of HIPAA for protected health information (PHI) are some additional challenges that can affect billing for optometrists. Since ACA will bring a lot of changes to optometry practices, it would be a good idea for providers to outsource their billing and coding requirements to companies like MBC is the largest consortium of coders and billers who are well-trained in handling billing and coding changes for optometry specialty. The expert team at MBC makes use of the latest software and technology to ensure timely payments, maximize revenue and minimize claims denials

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