Optometry as a practice is not that difficult to manage, but if proper medical billing and coding requirements are not followed, might lead to face many challenges. Optometry administrations have seen an expanding development in today's healthcare industry, and it is only a logical decision to oversee the billing service challenge with ease.
With new healthcare reforms in place, it allows optometry professionals to prescribe medications and perform minor treatments, as people like to visit an Optometry facility with minor eye care problems as opposed to booking an appointment with an Ophthalmologist. In any case, with expanding number of patient inflow and assortment of services getting added to the care package of Optometry facilities, medical billing has become vital to generate income, and streamline the Revenue Cycle Management.
Here are some of the Optometry Billing Service Challenges Optometrist can face with Ease:
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Settlement of Claims
Medicare, Medicaid and numerous private insurance suppliers require certain compliance guidelines and prior authorization for Optometry treatment. For any practice to remain monetarily feasible, a solid claim settlement ratio is imperative. Hence, vigilant data collection, pre-approval, HIPAA complaint information sharing, follow up of AR and timely claims submission must be must be observed to guarantee 100% claim settlement.
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Adhering to HIPPA guidelines
Adhering to rules and guidelines laid down by HIPAA for PHI (Patient Health Information) insurance is must for any covered entity. Offering medical data to insurance carriers such as Medicaid and Medicare for claim settlement makes an optometry practice a covered entity. Adjusting to HIPPA standards, accordingly, adds more weight to the EMR and coding arrangement of your optometry practice.
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Inefficient in-house billing department
To avoid data management errors and claims denials, numerous Optometrists outsource their billing and coding tasks to professional billing agencies that have the intricate details of the billing procedure. With highly specified coding and billing prerequisites of Optometry, it is a bit too much of a task for your in-house billers to provide quality outcome on each claim submission for reimbursement. Therefore, as you opt to outsource your Revenue Cycle Management and billing duties, it is important to conduct a quality check with the billing agency, and see to it that they are a reliable service provider.
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Understanding the Medicare and Medicaid billing requirements
With millions of Americans already covered under the Medicare and increasing by the day, the patient base of your Optometry center is probably going to incorporate a substantial number of patients covered under government healthcare providers. Though, most of the private Optometry practitioners don't offer their administrations to Medicare and Medicaid patients, including Medicare and Medicaid arrangements into your RCM can guarantee more noteworthy claim settlement ratio.
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Resolving the AR and bad debts issues
According to statistical data 30-40% of an Optometry facility's yearly income is lost due to irregular follow-up, increased Accounts Receivable days and customer disappointment. Optometrists must utilize standard follow-up and fulfill the data requirements along with settling the AR days to overcome this challenge.
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Untrained staff related to for information mining
With EMR and EHR turning into the standard procedure to follow, untrained in-house staff to record patient information can lead to severe revenue losses. Gathering all the required data and recording it with proper codes is the need of the hour for a faster reimbursement period, which if ignored can trounce the entire coding and billing process for your optometry practice. Due to insufficient attention paid to information collection, the expected revenue generation gets a setback. To resolve this issue a partnering firm in the form of an optometrist medical billing and coding agency stands to be very handy.
FAQs
1. What challenges do optometry practices face in billing?
Optometry practices often struggle with claim settlement, adherence to HIPAA, inefficient in-house billing, and handling Medicare/Medicaid requirements. These can lead to claim denials and financial losses.
2. How can I improve my claim settlement ratio in optometry billing?
Ensure accurate data collection, timely claims submission, and pre-authorization. Consistently following up on Accounts Receivable (AR) is also essential for better claim settlement.
3. Why is HIPAA compliance important in optometry billing?
HIPAA compliance ensures the secure sharing of patient health information (PHI) with insurance carriers. Non-compliance can result in legal issues and delays in claim processing.
4. How can outsourcing billing improve my practice's revenue cycle?
Outsourcing to professional billing agencies reduces errors, increases efficiency, and ensures accurate coding. This helps overcome challenges like claim denials and delayed reimbursements.
5. How can I resolve Accounts Receivable (AR) and bad debt issues in my practice?
Implement regular AR follow-up, improve data management, and streamline billing processes. A clear, consistent payment policy and dedicated staff for AR management can help reduce bad debts.
Published By - Medical Billers and Coders
Published Date - Dec-23-2016
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