Improving collections is an essential strategy for revenue growth. A healthy bottom line translates to a healthier financial trajectory for your eye care business. Follow these Optometry Practice Collection tips to help your business thrive. An optometry practice shares the same end goal as other small businesses i.e., you want to thrive. A thriving business is one that focuses on growing revenue while providing great experiences for its customers. In your case, your customers are patients.
Optometry Practice Collection Tips
Prior Benefits Verification
Many patients have both vision and medical insurance plans. While the best billing practice is to select which plan to bill based on the patient’s chief complaint and medical diagnosis, sometimes it’s more complicated. It is critical to verify both vision and medical plans before the office visit. One of the fastest ways to increase your practice cash flow is to develop an upfront collection process. During check-in or check-out, if the patient’s insurance plan includes a co-pay, coinsurance, or deductible, always collect before they leave the office. Sending invoices before the due date reduces Accounts Receivable (AR) delays, helps avoid late payments, and increases your chances of getting paid on time. Open balances also create a false image of your AR.
Obtain an Advance Beneficiary Notice
If you suspect that the procedure or service you will provide to the patient may not be covered by Original Medicare (fee-for-service) or commercial non-Medicare plans, and the patient may be responsible for out-of-pocket costs, obtain an Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The patient must sign the ABN before you provide the procedure or service to the patient. And the ABN is invalid for any contractually obligated write-off.
One of the first steps in optometric medical billing is making sure the provider has been credentialed by the insurance payer. Remember to submit and track provider credentialing applications based on insurance plan requirements. Take it one step further and follow up with insurance payers regularly to make sure the providers are enrolled in-network when enrollment is open.
Use Accurate CPT Codes
Many offices bill an OCT/GDX (CPT® codes 92133/92134) and fundus photography (CPT® code 92250) on the same visit. If you do not code this correctly, Medicare may deny both codes or only allow payment on the code with the lowest reimbursement. If you are looking at a single problem, such as glaucoma, both tests cannot be paid according to Medicare’s National Correct Coding Initiative (NCCI) edits; codes 92133/92134 and 92250 are considered mutually exclusive.
NCCI edits prevent bundling/unbundling due to incorrectly using CPT® procedure codes and HCPCS billing codes, including combining inappropriate code combinations. While the NCCI edits do allow the use of a modifier for OCT/GDX and fundus photography, be careful and use a modifier correctly, or it may result in a rejection or denial. Depending on local policies, if both tests are necessary due to two separately identifiable conditions, you may be able to link the appropriate diagnosis code to each CPT® and add modifier 59 to the second procedure.
Stay Current with LCD Updates
To ensure you are coding your eye care claims correctly, you must remain diligent with Local Coverage Determinations (LCD) and Medicare Administrative Contractors (MAC) in your area and sign up to receive payer listserv updates.
Review on Denied Claims
A majority of claim denials are due to administrative errors. For example, the procedure code is inconsistent with the modifier you used or the required modifier is missing for the decision process (adjudication). Once you correct the errors, you can resubmit the claim to the insurance payer.
Follow-up on Claim Denials
On average, two-thirds of denials are recoverable, and nearly 90% are avoidable. While tracking down why the insurance payer denied the claim in the first place is time-consuming and frustrating, the longer you wait for determining what went wrong, the more likely you won’t recover the maximum amount (or any) from the insurance payer.
CMS announced several E/M documentation changes to help doctors streamline patient record documentation. Doctors no longer have to re-enter or re-document the patient’s chief complaint and any history that ancillary staff or the beneficiary already entered in the medical record for E/M office/outpatient visits (both new and established patients). The doctor only has to add a note in the patient’s health record that the doctor reviewed and verified the information. So always keep accurate records that document the specific Evaluation and Management (E/M) service the patient received for the treatment i.e., clear reference, review, and verify.
Perform Interpretation and Report (I&R)
Every diagnostic test that you perform requires an Interpretation and Report (I&R) which is not optional. The I&R ‘interprets’ the diagnostic test results and ‘reports’ how the test affects the patient care plan: clinical findings, comparative data (change in condition), and clinical management. Don’t forget to establish medical necessity for each diagnostic test you order and perform, or the insurance payer may deny the claim as an invalid claim. If an insurance payer requests an I&R and you didn’t create one, the payer may audit your practice, which may result in penalties and interest.
You’ll have a team of professionals working for you, submitting requests quickly and accurately. In addition, outsourcing saves up more time for your staff to concentrate on patients.
Managing an optometry practice is a complicated, demanding job. Give your optometry faculty more patient focus time by outsourcing your billing process. Outsource Optometry’s medical billing process or find a billing solution that suits your practice best. We can help you increase your Optometry practice collection. To know more about our Optometry billing and coding services, please get in touch with us!