Optimization in Optometry Billing Practices



Although taking care of eyes is the main aim of every optometrist, staying in the business is equally important where billing and coding becomes its vital element. Optometry experience and expertise, hence the path being taken in billing and the reimbursements which can maximize the revenues needs to be constantly looked after.

Certain parameters have been defined which aid in optimizing optometry billing.

  • Implementation of Electronic Medical Records, Electronic prescribing and usage of certain software assist in optometry billing. Coordination of information and usage of tools if communicated to PQRS could qualify the optometrists for a bonus. Specific usage of specific level and/or add-on codes can enhance reimbursements (usage of these codes implies usage of resources to manage time proficiently).
  • Another strategy is to take the ‘Accounts Receivables’ into consideration. Apposite documentation followed by accurate codes, and checking on the monthly status from the billing department which states if any insurance provider must be dropped due to regular slow reimbursements also removes hurdles in optimized billing. In case of outsourcing, revenues too could be speedy and apt as the outsourcing agency would always try to be on time and work without denials or unpaid claims to be followed upon.
  • Optometrists should also consider billing separately to vision carrier or the medical carrier for reimbursements. In case of a comprehensive eye examination, the doctor can bill the vision carrier. Simultaneously, in a follow-up schedule for dry eye testing (disease, diagnosis and treatment), the billing can be sent to a medical carrier.

Billing in Optometry practice can also be improvised using various techniques such as: educating and marketing the optometry business to older patients, understanding of medical decision making and billing a refraction service while linking it to a medical diagnosis, creating a carrier-specific manual, selling supplements, and reporting punctual plugs. Being aware of sub-terms, suffixes and prefixes, ICD-10, HCPCS Material V-codes & CPT codes, evaluation and management (E/M) codes for new and existing patients, apt modifiers, anterior and posterior segment, and external ocular adnexa, aids the billing process. Along with these, a good understanding of the difference between vision plans vs. health insurance is equally vital.

Certain rules for optometry billing are: Every patient must be coded and the coverage is determined by the reason of the patients’ visit rather than the diagnosis. Always record the patients’ details in complete words and appointments should be mentioned by the type of service. Verify the health and vision insurance at every office visit and keep a scanned copy of the ID and insurance card. Keep the patient informed of the deductibles and co-pays before examining the patient. Send the claim in the set time period from the date of service.

Correct testing equipment, protocols, accurate coding, maintaining records and billing systems, multiple examination lanes and appropriately skilled staff leads to optometry billing optimization.

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