Critical Reasons you Need Revenue Cycle Management System for Optometry Practices


Certified medical billers and coders stand to be the backbone of your Revenue Cycle Management (RCM), as they are the experts that enhance your income cycle. Letting the professionals of finances take over your RCM cycle is a blessing in disguise, as it frees your time to check for patients with eye sight issues.

While looking for reasons as to why you need the partnership of a billing organization: Are you getting your money’s worth with your in-house billers or billing service for your eye care practice?

Remember that choosing the medical billing service is more than just finding someone to process claims. If you are considering outsourcing your ophthalmology medical billing service, and are still in dilemma about making the leap, here are eight reasons to help you decide.

In a basic explanation revenue cycle management (RCM) can be defined as the process of handling healthcare insurance claims, processing payment and generating revenue for a medical practice, ASC, outpatient facility and also hospital. It begins just at the time when a patient makes an appointment and continues till the balance on his account becomes nil. It includes various steps like checking patient insurance eligibility and coding claims.

Advantages of Having a Revenue Cycle Management Organization for assistance

  • A well-designed RCM system trails patient care, streamlines the billing and collection cycles, by registering, appointing, scheduling and processing the payment.
  • With the help of RCM, collaborating with the EHR and accounting systems becomes easier.
  • Revenue cycle management associates administrative documents like a patient’s name, insurance provider and other personal information along with the treatment received by a patient.
  • It bridges the gap between the business and healthcare sides of healthcare.
  • Healthcare providers also take help from revenue cycle management experts for preserving and managing patients’ billing records.
  • It diminishes the time between offering a service and receiving payment for it by interacting with other health IT systems like electronic health record systems and billing systems.
  • It empowers the RCM system to perform duties routinely. As this was previously handled manually employees, software support systems has been able to save healthcare practices time.
  • RCM is responsible for all administrative tasks including informing patients of an upcoming appointment, reminding payers and patients of an existing balance and questioning insurers, when a claim is denied.
  • It saves the money of Optometrists by reducing the amount of denied claims and enabling patients to pay their bills online.
  • It allows the in-house staff to enter all the information required for claims processing and management, and avoids the revision or resubmission of claims.
  • With the help of specialized RCM billers, an organization can buy analyze the income cycle operation in real time and use dashboards to determine or analyze revenue goals.
  • Aligning with the experts aides Optometry facilities to check where its revenue cycle has the scope of improvement by arranging billing data and producing corresponding reports.

The RCM Workflow

Communicating with health insurance providers is another critical aspect of revenue management. When a patient books an appointment, the healthcare center typically checks the patient’s described insurance coverage before the visit.

After an insured patient gets diagnosed, he supplies applicable copay. A healthcare provider or coder classifies the nature of the treatment as per the ICD-9 or ICD-10. The hospital submits the care summary with ICD and Current Procedural Technology codes to the patient’s insurance firm to see the procedure of treatment covered by insurance.

The revenue cycle management (RCM) system can make or break a hospital or physician practice. Hence, Revenue cycle management should be selected very wisely.

Posted in Medical Billing, Medical Coding, Optometry Billing, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment

Getting Involved in Optometry Medical Billing Process for a Clear Cut Business Vision


As a medical practitioner, who runs their own business endeavors, getting involved in Optometry medical billing and coding process provides you with fair view of the financial status of your facility.

Many times practitioners think and feel that they know exactly how an insurance claim is billed. But does this mean they are getting involved and making the best use of their time?

But then again you have the more established ones, who know the process to get paid, so staying involved can be great idea when you still are trying to establish yourself in the vicinity of the workplace or when the patient load is smaller. In other words staying involved is also effective in making sure that as a practice we set things up correctly.

Creating a Clear Business Vision

While optometry is not a new medical profession, the industry may not be enjoying the same benefits as larger medical facilities, when it comes to receiving their monetary gains in the form of financial reimbursement. This could be credited to the fact that optometrists are either not aware of the advantages of professional optometry medical billing and coding services, or because they are not utilizing it properly. In any case, there is a lot to be gained from an understanding of the processes and options involved in medical billing a coding and how physicians of any specialty can benefit from it to make their business run more smoothly and ensure that they are operating at maximum capacity.

Getting Involved in the Insurance Process

Every medical facility including Optometrists need to deal with a variety of insurance companies, but the foremost one, and the most complicated is Medicare. While it may take some time to comprehend the nitty-gritty of what different companies are willing to pay, it would leverage you to find out what they offer as reimbursement for your standard services, so that you are getting the most for your time.

For example, charging a standard fee is a thing of the past. If a certain private insurance player pays more than your regular fee, you may want to ask yourself if you’re charging enough for your services, as payouts are based on what the insurance provider deems to be fair. There are and will be many circumstances, wherein you will not be able to recover all costs through reimbursement, so perhaps you should consider an offshore medical billing and coding option when it comes to services or procedures that the coverage exceeds.

Getting Involved in the Coding Process

The financial outcome of your practice todays not only depends upon how well you look after the patients, but elements like accurate coding, also has higher importance. Keep in mind that there is no quicker way to lose money than through incorrect coding. If you’re fortunate enough, you will receive a reduced repayment, but it’s the chances of your claim being rejected stand higher. So take out some time from your daily work undertaking, and get involved in the details of medical coding in order to ensure that you get paid correctly. If you feel that the in-house billing department working with you is falling short of achieving the intended targets, you always have the option of hiring a professional optometry medical billing firm to streamline your facilities income cycle.

Posted in Medical Billing, Medical Billing Company, Medical Billing Services, Optometry Billing, Practice Management, Revenue Cycle Management (RCM) | Leave a comment

Radiology: Smarter RCM with Analytics


Many large payer organizations are beginning to embrace and promote analytics. However, soiled data and lack of incentives among the stakeholders are the major barriers that hold back the promotion of analytics for better RCM.

Interoperability is the main barrier of data liquidation that prevents a practice from harnessing the true potential of analytics. A lot of research is under process to solve this issue in particular.

Future and Growth

A number of fields in the healthcare value chain are well-suited for analytics and will likely offer an impressive return on investment. Some others are already experiencing quick uptake.

There is a great upsurge in imaging at the moment. The providers and vendors need to prepare for the opportunities that the imaging technology can bring to them in the near future. The advancement of imaging technology with several modalities will prove useful for various medical areas. There is an expected increase of 13.6% in medical imaging procedures. Counting in the number of Americans who will enroll into the healthcare system in the next couple of years, this percentage is expected to see a further explosion of data. Furthermore, sharing of images amidst different healthcare IT systems, with the help of electronic health record system will increase too. PACS is the system used traditionally to store images. They are shared through vendor neutral archive (VNA) systems.

Homecare is another area that lacks in the growth of images but holds a promise for future. Many fields like dermatology and diabetics have made use of images captured remotely at home since long to provide wound care for making intervention decisions. As of today, no established practice makes strict use of images captured at a patient’s home that are transferred to the electronic medical record system to support clinical follow-up or preventive intervention. However, changing trends of imaging explosion will add to the popularity of telemedicine.

Radiology and RCM

Today, Radiologists are not isolated service provider. Instead, they are an integral part of care collaboration that they make with multiple medical specialties. Images help the radiologists develop a better understanding of a patient’s medical history. Radiologists have a lot of scope for improvement in the care they provide the patient if the data on what treatment is rendered by the physician becomes available.

Accumulation and study of data gathered over a period of time can help Radiologists recognize patterns to review and improve the care delivery and service they provide.

Big Data -Automated Residents
Not all Radiologists have access to residents and fellows like the ones in medical centers. With the era of image explosion coming up, radiologists will require assistance in reviewing old images and in preparing synopsis before they are scheduled to see a patient. This will allow them to spare more time for the patients to explain to them the medical conditions and answer their questions. This can be done with the help of smart analytical tools caller “automated residents”.

Smarter Revenue Cycle Management

The affordable care act has put Radiologists in a place prone to risks due to the pay-for-performance payment model as compared to fee-for-service models. This makes it necessary for care providers to invest in analytics to grasp a better understanding of both the operational and financial aspects of the business. By applying different algorithmic tools and converting raw data to transformed data in such large datasets, there is a possibility of understanding and using radiology data for gaining new knowledge and insights. By using big data, the planning and implementation of radiological procedures in radiology departments can be given a great boost.

Posted in Medical Billing, Medical Billing Company, Medical Billing Services, Medical Coding, Practice Administration, Practice Management, Radiology Billing, Revenue Cycle Management (RCM) | Leave a comment