Challenges for Optometry Practices in 2015

Many optometrists across the US are grappling with changes that are affecting the business side of their practice including staff management, strategic planning, marketing and finance. The move away from fee-for-service payment model, optometric oversupply and competition from optical service mass marketers has been posing various challenges for this specialty.

Vision care plans are also getting in the way of optometry practices that are providing services to patients via medical insurance. In the coming months, ICD-10 will also be causing cash flow disruptions if optometrists are not prepared.

ICD-10 is approaching

According to industry reports, many optometry practices are still not prepared for ICD-10. They are either relying on their staff or their electronic health record system to handle ICD-10 complexities which will have serious financial implications. To survive revenue disruptions post ICD-10, providers will have to keep the patient notes much more detailed. They will also have to keep themselves updated with extensively used procedural and diagnostic codes in ICD-9 that will be changing in ICD-10.

Patients with High Deductibles

With the implementation of Affordable Care Act, more Americans are buying insurance plans. However, they are opting for plans with high deductibles because they don’t wish to pay high premiums. When seeking medical care, such patients face challenges in making upfront payments to the provider because they have to first meet deductibles. This results in non-payment to the providers, including optometrists.

In case of primary care exams, optometry practices don’t have to worry about deductibles and non-payments because many services are covered under managed vision care plans. But secondary/tertiary and discovery of other ocular health conditions may fall into this category, pushing the need for optometrists to train their staff in determining primary and secondary insurance plans of a patient before an appointment is fixed. This has become necessary to ensure maximum payments for rendered services.

Necessary Preparation for Optometry Medical Billing and Coding

Optometry practices will have to ensure that their staff is well-trained in handling the above-mentioned challenges. They will have to hire or train expert coders and billers who can handle claims submission complexities post ICD-10. Front-desk staff will also require training in scheduling appointments, verifying all patient details and following-up with patients for payment.

Medical Debt for Optometrists- Is outsourcing the best solution?

It has been observed that 30% of an optometry clinic’s annual revenue is lost due to bad debts. This debt is the result of untrained staff handling billing and accounts receivable tasks. To solve this issue, many providers are seeking assistance from billing companies like to handle billing and accounts receivable tasks. Companies like MBC have an expert team of coders, billers and AR callers who work vigorously to get maximum payments from insurance companies and patients.

Such companies offer HIPAA-compliant medical billing, eliminating the risk of misuse or mishandling of confidential PHI (patient health information). By relying on medical billing companies, many optometry practices across the US have been able to increase earnings and reduce denials.

Published By - Medical Billers and Coders
Published Date - Apr-20-2015 Back

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