As an Optometrist, you are not just providing eye care services to your patients, but your facility is your business as well. Optometry specialists should know that there are fundamental of medical billing and coding concepts that must be understood. And if not done correctly you may stand to lose patient trust.
While some optometrist knowingly and willingly committed fraud, then there are others who find themselves in trouble because of misunderstandings or lack of knowledge optometry medical billing.
Here are some vital points as to why do optometrist need optometry billing companies to win patient trust.
Not knowing if you’re in-house billers codes according to HIPAA
HIPPA has a set of codes that every insurance company must use. However, some insurance companies in the process of becoming compliant can make the optometric billing service very confusing. Until everyone is HIPAA compliant, if there is a question about the code set being used, the doctor’s staff should call the insurance company’s customer service department.
Optometrists and their employees stay on top of the insurance company guidelines. Doing these things has added a little bit more to my workload, but in the long run, payments are coming in a little more quickly. This keeps both, the Optometrist and patient happy.
Charging two insurance companies for the same procedure
Some in-house optometry billers wrongly bill, both the patients’ medical and vision insurance for the same procedure. It is possible, however, to bill [the patients] medical service to their medical insurance and their vision service to their vision insurance, if he or she is being seen for both a medical and a vision service on the same day. And, in fact, patients, in that case, can actually have two copays. Thus, keeping your patient satisfied.
Billing office visit and foreign-body removal done on the same day to the patients’ medical insurance
The only way you could bill an office visit to the patients’ medical coverage on the same day as a foreign-body removal, is if the two were unrelated. For example, a patient came in for a glaucoma evaluation, but during that evaluation, the doctor found lashes scratching on the cornea and decided to remove them. S this procedure would be separate from the office visit. The doctor should inform the payer of this by putting the appropriate modifier (separate procedure) on the surgical procedure and by using the glaucoma diagnosis code with the office visit.
Using the time at the wrong time
Another possible coding mistake is when optometrists use the time to increase a visit to higher coding levels, when in reality; no time has been spent counseling or coordinating the patients care.
The three important factors in the selection of an Evaluation and Management (E&M) code are history, exam and medical decision making. Time is only to be considered when counseling and coordination of care dominate the visit. You can’t simply look at the number of minutes spent with the patient and use that to determine what code level you have performed. This will make the patient pay higher and you may lose his trust.
Using maximum reimbursement to choose a code.
You cannot choose a code based on reimbursement. The bottom line is you have to work from the correct side of the coding equation, which is based on history, exam and the medical decision making. Also, lots of issues have propped up regarding coding incorrectly for extended ophthalmoscopy.
For this, there must be a medical reason for this procedure, and you must perform all the components of the procedure to be considered a truly extended ophthalmoscopy.