Preparing your Optometry Billing for Medicare Audits

optometry medical billing servicesThe field of Optometry has seen exponential growth in patient traffic and scope of care over the past decade. With healthcare reforms aiming to bring more and more people under coverage for primary care, government is inducting many alternative healthcare specializations into primary care. As Optometry practices are finding expansion of their scope, their liability is also increasing. 60% of the patients walking into OD clinics today are relying on Medicare coverage to avail medical services. Therefore, in addition to adhering to required ICD-9 coding requirements of Optometry, there are a series of activities that ODs have to adopt in order to prepare for and avoid Medicare audits.

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Incorrect billing is also considered as fraudulent billing at the time of Medicare/Medicaid audits and Optometric practices are required to reimburse the insurance carriers with the additional paid amount. Sometimes an amount is penalized as well given the extrapolation of extra reimbursements. This in turn puts heavy financial pressure on any Optometry practice that has to suffer through Medicare audit. To avoid such financial burden, therefore, it is important to prepare your Optometry practice for avoiding and surviving audits.

  • Patient satisfaction – Medicare audits are usually triggered by customer complains or due to questionable utilization. Therefore, it is important to ensure customer satisfactions with diagnostic, evacuation and minor surgical procedures offered as eye care by your Optometry practice. Customer satisfaction can in turn be ensured with the help of transparency in billing procedures and data recording.
  • Coding practices – Optometry Billing Services relies predominantly on Current Procedure Terminology (CPT) codes for diagnosis which are legally billable. The codes generally come under the 92012 or 99202 series and are most prevalent in Optometry billing. Incorrect application of any other ICD-9 or ICD-10 codes for diagnosis can attract claim denials and resultantly medical audits. Thus, best way to prepare your Optometry practice for a Medicare audit is to adopt correct coding and billing practices. Training of staff and updating of EMR or other billing software at a regular interval plays an important role here.
  • Billing transparency – Another important procedure performed by OD practitioners is glandular evacuation. If the Optometrist utilizes LipiFlow Thermal Pulsation System and administer meibomian gland evacuation, then billing can be done for evacuation procedure rather than diagnosis. While this is a procedure reimbursed at a higher rate, incorrect usage can attract unwanted audits.
  • Having audit reviews – To avoid unwanted surprises, it is better to have regular reviews of your systems and processes. This simple operational addition can save your Optometry practice thousands of dollars of audit costs. is a coding and billing partner that offers the expertise of a team of Optometry medical billers to your Optometry practice. With specialized focus on Optometry billing, you can avoid coding and billing errors thereby improving customer satisfaction as well as avoid any future audits.