How to Increase Your Optometry Practice Collection?

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How to Increase Your Optometry Practice
Collection?
Improving collections is an essential strategy
for revenue growth. A healthy bottom line
translates to a healthier financial trajectory
for your eye care business. Follow these
Optometry Practice Collection tips to help your
business thrive. An optometry practice shares the
same end goal as other small businesses i.e., you
want to thrive. A thriving business is one that
focuses on growing revenue while providing great
experiences for its customers. In your case, your
customers are patients.   Optometry Practice
Collection Tips   Prior Benefits
Verification Many patients have both vision and
medical insurance plans. While the best billing
practice is to select which plan to bill based on
the patients chief complaint and medical
diagnosis, sometimes its more complicated. It is
critical to verify both vision and medical plans
before the office visit. One of the fastest ways
to increase your practice cash flow is to develop
an upfront collection process. During check-in or
check-out, if the patients insurance plan
includes a co-pay, coinsurance, or deductible,
always collect before they leave the office.
Sending invoices before the due date
reduces Accounts Receivable (AR) delays, helps
avoid late payments, and increases your chances
of getting paid on time. Open balances also
create a false image of your AR.
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How to Increase Your Optometry Practice
Collection?
Obtain an Advance Beneficiary Notice If you
suspect that the procedure or service you will
provide to the patient may not be covered by
Original Medicare (fee-for-service) or commercial
non-Medicare plans, and the patient may be
responsible for out-of-pocket costs, obtain an
Advance Beneficiary Notice of Noncoverage (ABN),
Form CMS-R-131. The patient must sign the ABN
before you provide the procedure or service to
the patient. And the ABN is invalid for any
contractually obligated write-off.   Get
Credentialed One of the first steps in optometric
medical billing is making sure the provider has
been credentialed by the insurance payer.
Remember to submit and track provider
credentialing applications based on insurance
plan requirements. Take it one step further and
follow up with insurance payers regularly to make
sure the providers are enrolled in-network when
enrollment is open.   Use Accurate CPT Codes Many
offices bill an OCT/GDX (CPT codes 92133/92134)
and fundus photography (CPT code 92250) on the
same visit. If you do not code this correctly,
Medicare may deny both codes or only allow
payment on the code with the lowest
reimbursement.
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How to Increase Your Optometry Practice
Collection?
If you are looking at a single problem, such as
glaucoma, both tests cannot be paid according to
Medicares National Correct Coding Initiative
(NCCI) edits codes 92133/92134 and 92250 are
considered mutually exclusive.    NCCI edits
prevent bundling/unbundling due to incorrectly
using CPT procedure codes and HCPCS
billing codes, including combining inappropriate
code combinations. While the NCCI edits do allow
the use of a modifier for OCT/GDX and fundus
photography, be careful and use a modifier
correctly, or it may result in a rejection or
denial. Depending on local policies, if both
tests are necessary due to two separately
identifiable conditions, you may be able to link
the appropriate diagnosis code to each CPT and
add modifier 59 to the second procedure.   Stay
Current with LCD Updates. To ensure you are
coding your eye care claims correctly, you must
remain diligent with Local Coverage
Determinations (LCD) and Medicare Administrative
Contractors (MAC) in your area and sign up to
receive payer listserv updates. Review on Denied
Claims
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How to Increase Your Optometry Practice
Collection?
A majority of claim denials are due to
administrative errors. For example, the procedure
code is inconsistent with the modifier you used
or the required modifier is missing for the
decision process (adjudication). Once you correct
the errors, you can resubmit the claim to the
insurance payer.   Follow-up on Claim Denials On
average, two-thirds of denials are recoverable,
and nearly 90 are avoidable. While tracking down
why the insurance payer denied the claim in the
first place is time-consuming and frustrating,
the longer you wait for determining what went
wrong, the more likely you wont recover the
maximum amount (or any) from the insurance
payer.   Proper Documentation CMS announced
several E/M documentation changes to help doctors
streamline patient record documentation. Doctors
no longer have to re-enter or re-document the
patients chief complaint and any history that
ancillary staff or the beneficiary already
entered in the medical record for E/M
office/outpatient visits (both new and
established patients). The doctor only has to add
a note in the patients health record that the
doctor reviewed and verified the information. So
always keep accurate records that document the
specific Evaluation and Management (E/M) service
the patient received for the treatment i.e.,
clear reference, review, and verify.  
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How to Increase Your Optometry Practice
Collection?
Perform Interpretation and Report (IR) Every
diagnostic test that you perform requires an
Interpretation and Report (IR) which is not
optional. The IR interprets the diagnostic
test results and reports how the test affects
the patient care plan clinical findings,
comparative data (change in condition), and
clinical management. Dont forget to establish
medical necessity for each diagnostic test you
order and perform, or the insurance payer may
deny the claim as an invalid claim. If an
insurance payer requests an IR and you didnt
create one, the payer may audit your practice,
which may result in penalties and
interest.   Youll have a team of professionals
working for you, submitting requests quickly and
accurately. In addition, outsourcing saves up
more time for your staff to concentrate on
patients.   Managing an optometry practice is a
complicated, demanding job. Give your optometry
faculty more patient focus time by outsourcing
your billing process. Outsource Optometrys
medical billing process or find a billing
solution that suits your practice best. We can
help you increase your Optometry practice
collection. To know more about our Optometry
billing and coding services, Get in touch with
us!