Working as an ophthalmic specialist has its own advantages and disadvantages. The plus point of being an Optometrist is that as a profession it’s a very decent industry for your growth as a practitioner, but the negative side of it is delayed and denied reimbursements, prolonged AR days, negative collections, billing rejection, and slow-paced income cycle, due to incorrect billing and coding.
Some of the common Ophthalmic Billing Rejections happen due to the following things:
Audit Medicare and Insurance Companies Policies
Remember to dependably check with your Medicare provider or other insurance agency’s strategies for the latest coding rules; they change as frequently as each year passes. Furthermore, Medicare’s National Correct Coding Initiative (NCCI) edit tables can be found on the CMS site.
Correct coding gets you paid
Numerous ophthalmic facilities charge an OCT/GDX (CPT codes 92133/92134) and fundus photography (CPT code 92250) on the same visit. If you don’t code this accurately, Medicare may deny both codes or only permit payment on the code with the most minimal repayment. If you are looking at a single issue such as glaucoma, both tests cannot be paid per Medicare’s NCCI edits; codes 92133/92134 and 92250 are considered mutually exclusive.
Utilize Modifier 59 Correctly to avoid fines and audits
Modifier 59 characterizes a Distinct Procedure Service and distinguishes methods or administrations that are not typically revealed together. In any case, modifier 59 is one of the most used modifiers and furthermore one that is frequently utilized erroneously.
Tip: Never attach modifier 59 to E&M benefits.
Contingent upon the local policy, if the tests are essential because of two independently identifiable conditions, you might have the capacity to connect the proper diagnosis code to each CPT and add modifier 59 to the second procedure. It is essential to stay aware of Local Coverage Determinations (LCD) for your region to ensure you are coding claims effectively.
Claim Scrubbing edits help maintain delays in Reimbursements
Some practice management system does exclude features that support claim scrubbing edits that alert you referring or requesting a doctor. What is the outcome? Claims are sent to insurance agencies with blunders/errors, causing rejections and delays in the reimbursement cycle. Certified Ophthalmic medical billers and coders are specialists at ensuring your claims are perfect and free from mistakes.
They realize that being effective and knowing how to keep those rejections at bay and to get reimbursed faster. That’s why they double-check and scrub every claim before submission. As a result, optometrist avoids delays in payments, a key benefit of using offshore medical billing company’s help.
Next in the list of common billing rejection are the issues to bill new and established patients.
So, when is the patient new or established? And how can his/her claim get rejected?
A patient is viewed as new in the event that they have not been seen by any doctor with a similar specialty or sub-specialty within their practice for the last three years. For solo insurance providers, this is simple, if the patient hasn’t been treated by them for the last three years, they’re subjected as new. However, for larger group practices, it can get dubious. Keeping legitimate records with the help of a proficient Ophthalmic billing company can keep those common group practice billing rejections at bay.
During some instances, an insurance payer may incorrectly reject a claim for a new patient. However, if you have an expert billing agency assisting you in the operations this can be resolved with a phone call to the payer, though some cases may require an appeal with medical documentation.