When you’re first getting started with your optometry practice, billing and coding can seem like a daunting topic, leading many to search for assistance and guidance. Unfortunately, this topic is not thoroughly covered in your schooling, or at least not regularly. This article will offer a brief explanation on the matter, but for more thorough guidance or mentorship on the subject, we highly suggest learning from other optometrists or joining an
optometrist network group like PECAA.

The First Steps to Billing and Coding

how to do billing and coding for optometryJust like other medical specialty fields, optometry has very specific guidelines, procedures and rules that all practices must follow. These rules are very strict in terms of accuracy, and in order to be reimbursed by insurances, claims must be highly detailed and free from errors. 

To start the process, you must first decide which insurance panels are right for your practice. Choosing the right insurance panels is an important decision that requires careful research. For starters, determine the largest employers in your target area and the most common insurance used, then factor in the reimbursements on the vision plans you are considering. It’s also important to note that insurance credentialing rules vary from state to state, so it’s best to speak with other optometrists working in the same area. 

Common Mistakes in Billing and Coding for Optometry

  1. The first common mistake made in coding and billing is submitting a medical exam to a routine insurance carrier. This mistake will result in a much lower reimbursement and overtime can become a financial burden for your practice.
  2. The second common mistake in coding is using modifiers incorrectly. Modifiers are used to describe services more accurately, but when used incorrectly can result in a denied claim.
  3. The third most common error in billing and coding is submitting claims to insurance panels before being properly credentialed. This error will also result in a denied claim.

Information about ICD-10 Codes

If you’re just starting out or are unfamiliar with ICD-10 Codes, they are alphanumeric codes used by doctors, health insurance companies, and public health agencies to represent diagnoses. ICD-10 stands for International Statistical Classification of Diseases and Related Health Problems 10th Revision. Getting to know the ICD-10 specific to the optometry industry is a very important step and one that will eventually save you a lot of time. As an optometrist, you’re likely to familiarize yourself with hundreds or potentially thousands of ICD-10 codes throughout your career. A helpful resource for memorizing or learning more about the codes is ICD10data.com. This website allows you to search all diagnosis codes and can help you choose the most specific code for each scenario. 

PECAA’s Exclusive Training: How to do Billing and Coding for Optometry

We hope this brief introduction to billing and coding for optometry has been helpful for you, but it’s important to note that the subject requires far more research than reading a blog post. Luckily, members of our network are provided access to PECAA’s billing and coding program which helps members learn to properly bill and code their practice’s medical and vision services with personalized consultations and exclusive, customized education opportunities. 

PECAA’s billing and coding program is broken into three categories:

1. Optometric Billing: The optometric billing section of our training focuses on having consistent optical billing processes. This makes a big difference in receiving timely and accurate payments. This section will cover the following topics:

  • Understanding individual payer policies for successful claim submission
  • Advising on efficient and effective billing processes
  • Understanding the explanation of payment from insurance payers
  • Effective claims resolution and denial management
  • Remaining up to date on CMS rules and regulations to keep your billing practices compliant

2. Optometric Coding: The optometric coding section will keep you current on information related to CPT, ICD-10 and Quality Payment Initiatives. This section includes:

  • Optical coding support
  • Proper modifier usage
  • Documentation for compliance
  • ICD-10-CM support
  • Understanding Quality Reporting requirements

3. Revenue Cycle Management: The third section of PECAA’s billing and coding program offers recommendations to achieve complete and predictable claim cycle management by improving the following:

  • Insurance verification process
  • Patient revenue capture at the time of service
  • Optimizing the claim cycle workflow
  • Monitoring and managing accounts receivables
  • Managing aging patient balances

If you’re new to billing and coding for optometry, our advice is to start slow, be thorough, and engage with other optometrists for cross-learning. If you’re interested in learning more about PECAA’s exclusive billing and coding program, feel free to contact us!

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