As per the US Centers for Disease Control (CDC), about 12 million individuals in the United States experience some degree of vision impairment, while an additional 93 million adults face a heightened risk of severe vision loss. These statistics underscore a pressing need for optometric services, indicating an anticipated surge in demand for optometrists.
Consequently, it’s projected that the employment opportunities in optometry will outpace those in many other professions in the US. As optometric care becomes increasingly sought, it’s crucial for practicing optometrists to streamline their billing and coding procedures to adhere to industry standards and regulations. For accurate medical billing and coding, outsourcing the billing side to third-party medical billing services in Arkansas can help get maximum reimbursements, billing and healthcare management, and better patient satisfaction.
We have compiled a comprehensive guide on optometry billing and coding to help you navigate this critical aspect of optometric practice management.
Billing and Coding Strategies for Optometry
Whether you are establishing a new practice or seeking to expand your range of vision plans, the following steps can streamline your billing and coding procedures:
Choosing Insurance Panels and Meeting Credentials
Before you pick which insurance plans to work with at your practice, it’s important to do some research on the big employers in your area. You need to check out how much they pay for services covered by the different vision plans you are considering joining.
Each insurance company has its own rules for getting approved to work with them. The goal is to pick an insurance company that has lots of customers. If your practice isn’t super busy, it might be smart to go with a big one like Medicare.
Medicare covers almost 60 million people now, and that number is expected to go up to 80 million by 2030. That means a lot of potential patients. Plus, Medicare accepts all eye doctors who apply to work with them, unlike some other companies that might be pickier.
There are other options too, like BCBS, CIGNA, and AETNA. They might offer better-paying plans, but it can be harder to get approved to work with them.
Establish Examination Fees
If you choose Medicare for your healthcare, it’s important to agree to accept the assignment. This means agreeing, as a healthcare provider, doctor, or supplier, to accept the amount approved by Medicare as the full payment for services covered by Medicare. It’s required by law. To do this, you need to sign an agreement.
Accepting assignments helps lower the amount your patients have to pay out of their own pockets. This might bring in more patients over time. To figure out the right check-up fees, it’s a good idea to check the latest Medicare allowances in your state.
Master Claim Submission Procedures
Once you know how much to charge, it’s important to learn the right way to send your claims. Doing things correctly means you will receive reimbursements from insurance companies. Using different tools is the best way to send claims properly.
You can send claims through an Electronic Health Record (EHR) system, a clearinghouse, or a trusted medical billing service. Also, make sure your staff knows about optometry coding rules to send accurate claims and keep money coming in steadily.
Be Proficient in Optometry Billing and Coding Procedures
In an ideal situation, experts in billing should handle billing tasks, and doctors should focus on coding. For healthcare providers using electronic health record systems, it’s important to learn the right way to code ethically for accurate claims. There are many diagnosis codes designed for different specialties, so it’s important to understand them well.
To make learning easier, there are various resources available to help with mastering billing and coding for optometry.
A comprehensive comprehension of Medicare operations
Utilization of CMS.gov resources such as The Fee Schedule, the MIPS Incentive Program, and Modifiers
Familiarization with Eye Exam CPT Codes
Once you are proficient at claim submission, you must familiarise yourself with optometry coding guidelines for medical and routine exams. This step is integral to optometry practice, necessitating meticulous record-keeping of exam specifics for each patient. The breakdown of CPT codes should be as follows:
Strategies for Improving Your Billing Collections
Enhancing your collections in optometry medical billing can be achieved by implementing the following tips:
Validate Approval
An essential step in optometric medical billing involves verifying that the provider has been credentialed by the insurance payer. Track provider approval applications and submit them in accordance with the insurance plan’s requirements. Regularly follow up with insurance payers to ensure that providers are enrolled in-network during open enrollment periods.
Maintain Accurate E/M Coding Records
Ensure accurate record-keeping for coding Evaluation and Management (E/M) services provided to patients during each visit. In 2019, CMS introduced several modifications to E/M documentation requirements aimed at streamlining patient record documentation for physicians. If you establish a practice, familiarize yourself with these changes to understand the new referencing, reviewing, and verifying procedures.
Prevent Rejections, Denials, and Penalties
Utilize modifiers correctly to prevent denials, rejections, and penalties. Many offices bill for fundus photography (CPT® code 92250) and an OCT/GDX (CPT® codes 92134/92133) during a single visit. Failure to code accurately can lead to the denial of both codes and potential penalties.
Stay Informed About LCD, MAC, and Listserv Updates
Stay abreast of all coding updates by monitoring any revisions that may occur. To ensure accurate coding of eye care claims, it’s important to remain current with updates related to Local Coverage Determinations (LCD), Medicare Administrative Contractors (MAC), and Listserv communications.
Outsource to the Third Party Medical Billing Company
When medical billing seems too much complicated, it is a wise decision to outsource to a third-party medical billing company. Outsourcing has always been a plus point. When healthcare practices have side hustles with medical billing and coding, they are more likely to miss the chance to pay full attention to the patients. When healthcare providers are not paying more attention to the patients, they are likely to choose another care provider for better treatment.
Conclusion
Overall, medical billing demands accuracy to get paid on time. When things are not accurate, For instance, faulty claims, late submission, or delays in medical claim submission. However, when healthcare providers pay attention to accuracy and outsource to third-party medical billing, they are more likely to get maximum reimbursement.