Running your own optometry practice requires learning, establishing, maintaining and streamlining many time-consuming and complex processes and procedures. With all of the time and energy you must dedicate to the administrative, legal and financial aspects of your business, you run the risk of losing what should always be your primary focus: delivering the highest quality services and care to your patients. Optometric billing and coding is a complicated and daunting area, especially for small practices, and when done incorrectly or inefficiently, can result in major headaches for you and your team.
This article will introduce some tips and solutions to help ease the optometric billing burden and maximize the financial health of your optometry practice. With accurate, streamlined processes, your practice’s billing will evolve and be a tool for growth and success rather than stress!
Why You Need The Right Optometric Billing System
The time and cost the medical industry as a whole dedicates to billing and insurance claims is astounding, and complicated optometric billing and coding is no exception. For example, a Health Affairs survey found that doctors spend about three hours per week dealing with billing-related matters, and for each doctor, an additional 19 hours per week are spent by medical support staff. On average, 36 hours per week of administrators’ time is eaten up by cumbersome billing and coding related tasks. There are many things you can do or solutions you can employ to reduce these high costs, increase the effectiveness of your optometric billing, and improve the overall fiscal health of your optometry practice.
Tips to Improve Your Billing and Avoid Claim Denials
One of the major concerns for your practice is likely dealing with insurance claims and denials. The vast majority of denials can be avoided with a little extra training, time and careful attention. The following tips can help your practice in its quest for more efficient and accurate billing:
- Review patient eligibility before you provide services: Your administrative staff should verify each patient’s insurance benefits and ensure their coverage has not lapsed or been terminated as soon as possible, before any services are scheduled or delivered. Staff should then clearly explain to clients what their financial responsibilities will be to encourage timely payment. It’s a good idea to double check and review the patient’s eligibility before each appointment, as circumstances can frequently change. You may want to consider using an automated eligibility system, which will improve your organization and accuracy. If you wait to confirm eligibility until the time comes to file a claim, you run the expensive risk of having the claim denied.
- Request pre-authorization from insurance providers: Pre-authorization by insurance providers is required for many non-emergency, planned treatments, especially for expensive diagnostic or surgical procedures. It’s important to obtain pre-authorization whenever possible and required, this too will help avoid denied claims.
- Check (and double check!) that you are using the correct code: This one may seem obvious, but is highly important. Make sure you are using an up-to-date codebook as the codes can change. You can use different resources such as: CPT (Current Procedural Terminology), ICD-10 (International Classification of Diseases) or HCPCS (Healthcare Common Procedure Coding Systems). Regardless of what you use, make sure you’re consistently referring to the correct and current code set. You should always conduct a careful review your coding entries to double check that they are correct.
- Prioritize your claims and don’t wait to file! Keep in mind that billing and filing deadlines can range in length, typically falling anywhere between 90 days to one year from the date of treatment. It’s a good idea to prioritize your claims and focus on submitting those with the shortest claim filing timelines first. As a general rule, it’s a good idea to file claims as soon as possible so that you do not fall behind. Falling behind on billing is both financially risky and causes an unsustainable amount of stress for your practice and team.
If you do receive a claim denial, keep in mind that a majority are recoverable, so make sure you have the systems and capacity in place to respond to them in a timely manner.
Streamlining Your Optometric Billing Process
Many optometry practices choose to do optometric billing in-house. If this is what you decide to do, here are a few tips to help streamline the complicated billing process and improve your practice’s operations:
- Master the use of modifiers: Misuse of medical billing modifiers can lead to returned payments to insurance companies and third parties. More importantly, they can result in a financial audit and fines that can run up to $10,000 per offense. This risk should be known by all team members and the importance of correctly using modifiers cannot be overstated.
- Educate your team about common coding denials: Make sure your administrative staff is well-trained and supported in this area. It’s a good idea to offer regular educational refreshers for administrative staff to ensure they are kept up-to-date on any changes. One study found that 90% of denied claims are preventable and 63% are recoverable, with these high rates, you certainly want your team to master both avoiding and respond to denied claims.
- Review and optimize your processes: Assemble your core administrative team to analyze your current optometric billing processes and practices and identify any inefficiencies or areas for potential improvement. Next, develop an action plan to address the inefficiencies and put together a timeline for the implementation of your plan. Finally, identify whether there are any overly cumbersome or technical areas where you require further training, advice or external support from specialized advisors or an optometric billing team. When in doubt, consider hiring an optometric billing consultant or investing in optometric billing solutions to save you time and money in the long-run.
Mastering Your Optometric Billing Operations
Turning to professionals for help in optometric billing and coding will help your practice:
- Reduce your administrative staff time and expenses
- Minimize back and forth with insurance providers
- Break the never ending accounts receivable cycle
- Improve efficiency and prevent denied claims with accurate eligibility and benefits verification
- Avoid financial audits and expensive fines
Options for optometric billing solutions:
- Hire an optometric billing consultant: For a more short-term solution, you can contract an expert optometric billing consultant to review your operations and help you address any shortcomings or areas of concern.
- Outsource your optometric billing: If you are looking to outsource some or all of the billing and coding for your optometric practice, you should be sure to hire an expert in the specific field of optometry, rather than a more general medical billing company. Medical billing companies often do not have the specialized knowledge or experience required to handle optometric billing, which includes specific medical and routine vision billing and coding requirements. The downside of this option is higher expenses and the risk of becoming less self-sufficient.
- Invest in tools, support and training for your team: Rather than outsource your entire optometric billing system, which can quickly add up and make your practice less self-reliant, you can join a membership program like the PECAA Billing & Coding Program which provides access to advisors, education, support, tools and resources to help you improve the overall productivity and compliance of your administrative operations.
With many options for billing solutions, it’s best to analyze the amount of money you’re willing to spend and the amount of control and self sufficiency you’re willing to give up. Our opinion is that it’s best to source assistance from trained professionals and train your own team to be self sufficient and knowledgeable on their own! This will be more cost effective, sustainable and empowering.
PECAA’s Optometric Billing Solutions
Included in our monthly membership, PECAA’s optometry billing solutions and coding support can help your optometry practice navigate through the complex billing and coding processes by:
- Understanding individual payer policies for successful claim submission
- Advising on efficient and effective billing processes
- Understanding the explanation of payment from insurance payers
- Advising on effective claims resolution and denial management
- Remaining up to date on Centers for Medicare and Medicaid Services (CMS) rules and regulations to keep your billing practices compliant
Additionally, the program provides assistance and recommendations to achieve complete and predictable claim cycle management in the following areas:
- 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
The program also assists with coding education, compliance, documentation and other support. Experienced advisors will be on hand to assist in all your billing and coding questions and concerns. If you’re ready to reduce billing risks for you optometry practice, join our network group and learn how to ease the administrative burden for you and your team! Optometric billing does not need to be a feared or loathed process, with extra training and support your practice’s billing will be streamlined, predictable and profitable!