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Improved RCM process for better insights and efficiencies in Optometry Billing

May 24, 2016

Improved RCM process for better insights and efficiencies in Optometry Billing

With a number of changes occurring in the healthcare industry, revenue cycle management (RCM) is getting more and more unorganized and confusing. The Affordable Care Act and upcoming ICD-10 codes will add yet another series of steps to an already confusing RCM process, thus affecting the reimbursements of medical practices.

Optometry Billing is no different to other medical billings and any loose end may result in greater denials, lost claims or underpayments. Following practices will give an insight in your existing RCM processes and guide you in making your billing system efficient:

  1. Patient Information and Appointment Scheduling: This is the very first step of a revenue cycle. A checklist of required information would ensure that no important patient details are missed. Additional information related to registration process, co-pays, documents required like medical history etc should be informed to the patient prior to the first scheduling.
  2. Patient Registration Process: Once a record is set in the database, on every following visit, the patient’s and insurance details should be confirmed and changes made, if any. The billing staff should review the forms for completeness and ensure there are no mistakes.
  3. Pre-Authorization and Claim Submission: There are distinctive claim submission and reimbursement cycles for Medicare, Medicaid and other insurers. Ensure that your optometry billing service is aware of its payer mix and can plan for pre-authorization and documentation accordingly.
  4. Policies and Guidelines for Records Documentation: Using Optometry templates, responsibility matrix, policies related to date entry, timelines for completing a patient’s record, signing, diagnosis, performed procedures, approvals are all good practices which should be included in maintaining records (electronic or handwritten) in a systematic way.
  5. Staff training: Training your medical staff on regular procedures and operating routine machines can improve overall efficiency of your Optometry practice
  6. Customer Satisfaction: This is the key to any service. With increase in optometry consultants and online eyewear market, optometrists should focus on their customer service and satisfaction to ensure consistent profitability.
  7. Audits: Regular audits of your billing services will help in focusing on your strengths and weaknesses, thus giving an opportunity to tighten weak links, improve efficiency and increase profitability.
  8. Adopt EMR (Electronic Medical Record): Adopt an EMR system that can be customized as per your optometry service. This will not only reduce manual efforts but will also help in updating any coding changes in your Optometry medical billing directly.
  9. Monitoring and Follow-up of claim: Follow up your claims regularly and monitor the reasons behind claim denials. A constant focus and improvement on billing and claim process will directly improve profitability of your OD practice.

For attaining short term as well as long term profitability, it’s important for Optometrists to adopt and follow effective data collection, billing and coding practices.


Category : Revenue Cycle Management