Every moment when you think that your optometry billing and coding prerequisites are under control, new reimbursement and claims submission guidelines, coding alerts, or dedicated staffing roadblocks occur.
When you as a practitioner are continuously managing claim denials and rejections, along with eligibility and benefits verifications, plus the claims submission and payment posting, looking into AR cleanup, and billing issues, it all compounds to the heavy workload that may impact your patient interaction.
According to the Medical Group Management Association report the average cost of reworking on a medical claim is somewhere around $25 to $30 and that 50-65% of rejections or denials are never re-worked.
Here the key financial metric to focus on is to make sure all the claims submitted are clean and free from errors. Do keep in mind that knowing how to prevent rejections or denials in the first place is the best Return on Investment (ROI) for your optometry facility.
Here is some vital evaluation that optometrist needs to consider in order to keep adequate cash flow and ROI for their practice.
The real cost of your Optometry billing and coding
Typically, healthcare providers will see an 8% to 12% increase in their net collections when they align their charging services with a Revenue Cycle Management (RCM) specialist.
To help you define the real cost of your billing and process, let’s look at some perilous financial and operational processes that are part of your ROI.
Analyze fixed costs
- Clearinghouse fees.
- Stationary, postage, and statement fees.
- Staff hourly wages and payroll costs.
- Workers’ compensation insurance and payroll taxes.
- Employee benefits.
Analyze the variable costs
- Evaluate and pinpoint key decision points for outsourcing billing.
- Are your accounts receivable (AR) for more than 50 days?
- Is the AR percentage over 120 days more than 15%?
- Patients are increasing, but there’s a decline in the revenue.
- Rise in rejections and denial rate.
- The decline in cash flow and net revenue.
- Increase in bad debt
- Unexpected staff sick leave or vacations
- Is the collection rate declining?
- Do you see a higher percentage of bad debt write-offs due to delinquent patient accounts?
- Is the in-house staff spending more time on claim follow-ups and calling insurance companies instead of on patient care and services?
Overcoming the ROI issue through able billing partners/organization
- Recover the patient collections process through regular and efficient communications.
- Educate patients on optometry benefits and patient financial responsibilities, which directly tackle the ROI issue.
- Act as a connection with your billing service provider to learn more about non-covered benefits, collecting deductibles, and more.
- Provide more efficient patient care and get more time for marketing your practice on social media, patient relationship management services, and promotional campaigns.
Why Choose MBC’s Optometry Billing and Coding Services?
Many optometrists lose profits due to poor first-pass ratio and claim re-work due to the never-ending healthcare changes. You can lose a big chunk of your revenue margins if you consistently re-work claims or you process outstanding AR as denials.
It’s essential to look at the number of days in AR and your net collections together. Connect with us and feel the difference of a positive ROI along with a higher growth rate for your practice and satisfied staff.
FAQs
1. What are the common challenges in optometry billing and coding?
Optometry practices often face claim denials, rejections, and staffing issues that complicate the billing process, impacting both revenue and patient care.
2. How can I reduce claim denials and improve cash flow?
Ensuring clean claims and aligning with a Revenue Cycle Management (RCM) specialist can significantly reduce denials and enhance your net collections.
3. What costs should I analyze for better ROI in my practice?
Focus on both fixed costs, like staff wages and clearinghouse fees, and variable costs, such as accounts receivable aging and collection rates.
4. Why is patient education important for billing?
Educating patients about their financial responsibilities and optometry benefits can lead to better collections and reduced bad debt.
5. How can partnering with a billing service help my practice?
A skilled billing partner can streamline the claims process, improve first-pass ratios, and free up time for your staff to focus on patient care and marketing.
