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presentation

Optometry Coding Expert for Smooth RCM

April 11, 2016



Optometry Coding Expert for smooth RCM

Whether Optometry or any other medical discipline, billing and coding need to be handled well in order to improve revenues. Hence, optometric medical billing services are no exception when it comes to accuracy in billing and coding, which needs one to be an expert in coding guidelines, use of modifiers, conventions and well versed with several difficult terminologies related to optometry. Being well informed in all these areas makes one handle medical coverage, justifying the need for a particular service provided, or diagnosis and course of treatment prescribed.


New Technologies

With new technologies being introduced for various optometric tests, it is indeed challenging when it comes to interpreting and reporting the need or justification for such a test. In order to fulfill such a requirement, every minute detail that starts from the prescription to the plan of treatment the test indicates need to be meticulously documented in a patient's treatment records. Important points to note here include:

  • Avoid loss of revenues due to under-coding arising due to faulty choice of office visit codes.
  • Remember all the five office visit codes, the last digits of which indicating the level of complexity.
  • Complexity levels are determined by examination of patient, history, and diagnosis.
  • Hence, the need to have thorough knowledge of billing and coding, along with proper documentation to ensure smooth revenues.

Optimizing revenue management system

It is important to optimize revenue management system so that it is geared to handle the challenges present in today's coding and billing scenario. The process needs to be scrutinized and assessed to locate revenue leakages, if any.

  • Identify outdated software systems if still in use and replace them with new updated versions.
  • Fine tuning all lengthy processes and replacing them with new efficient ones.
  • Training personnel in all areas of medical billing and coding, and incorporating new techniques and methodologies.

Efficient Medical Billing Management Cycle

It is important to implement a system that is driven by medical protocol, which can be achieved through development of clinical paths that generate maximum revenues for every single diagnosis. Keeping abreast of the latest submission guidelines and requirements or various carriers is equally important. Initiatives taken for eliminating denials helps with enhanced and uninterrupted revenues.

  • Pay attention to accuracy with charge-capture and adopt electronic filing of claims.
  • Understand multi-tiered appeal processes and fulfill compliance standards.
  • Take care to avoid mistakes while transiting to ICD-10 and HIPAA 5010 compliance.
  • Focus on denial elimination which leads to enhanced collection rates.

Deciding on which insurance to bill

There may be instances where the primary insurance of a patient may not cover the entire cost of the service extended. The logical step then would be to bill the secondary or tertiary insurance of the patient, and it is important to understand the difference.

  • With primary claims it is the working parent of the family who has primary insurance.
  • If both parents work, then the primary insurance is the employer insurance of both parents.
  • For secondary or tertiary claims, the submission can be either on paper or electronically.
  • If submitted on paper, claim needs to be printed on a CMS form along with a copy of explanation of benefits (EOB)
  • Tertiary claims can be submitted only if there is a third insurance provider and the patient has any balance.
 

Category : Revenue Cycle Management