Denial Management in Optometry: How to Minimize and Manage Denials?

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Denial Management in Optometry How to Minimize
and Manage Denials?
Are claim denials cutting into your optometry
practice's revenue? If so, you are not alone.
According to industry statistics, claim denials
can account for up to 15 of a practice's lost
revenuea significant amount that could
otherwise be reinvested into patient care and
practice growth.  The stakes are highdenials
delay payments, inflate administrative costs, and
decrease overall efficiency. But heres the
silver lining most denials are avoidable. This
article provides a comprehensive guide to denial
management in optometry, offering detailed
strategies to reduce denials and improve
your revenue cycle management. Understanding
Optometry Billing and Coding Did you know that
incorrect coding and missing documentation are
among the top reasons for denials in optometry
practices? Optometry billing and coding involve a
complex set of procedures requiring meticulous
attention to detail. Understanding common denial
reasons is the first step toward effective denial
management.
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Denial Management in Optometry How to Minimize
and Manage Denials?
1. Duplicate Claims One of the most
common issues, duplicate claims, often arise when
a service is billed multiple times. Always check
with the insurance payer before resubmitting a
claim to ensure it is not still being
processed.  2. Expired Coverage Claims are
frequently denied when a patients insurance
coverage has lapsed. Verifying coverage before
each patient visit is crucial. This can be done
by checking the insurance card and ensuring that
the coverage details are up-to-date.
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Denial Management in Optometry How to Minimize
and Manage Denials?

• 3. Incorrect Patient Information
• Even minor errors in patient demographics, for
  instance misspelled names or incorrect dates of
  birth, can lead to denials. Implementing a
  double-check system for all patient information
  before claim submission can drastically reduce
  these errors.
• 5 Key Strategies to Minimize and Manage Denials
  in Optometry Billing
• 1. Proactive Verification
• Insurance Verification Before every patient
  visit, verify the patients insurance details,
  including coverage, eligibility, and any required
  pre-authorizations. Tools like Electronic
  Eligibility Verification (EEV) systems can
  streamline this process and reduce human error.
• Latest CPT Codes Keep your billing team updated
  on the latest changes to CPT codes. For example,
  the CPT code 92015 (Determination of Refractive
  State) is frequently used in optometry.
• 2. Coding Accuracy

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Denial Management in Optometry How to Minimize
and Manage Denials?

• Use of Modifiers Ensure that all applicable
  modifiers are correctly applied. For instance,
  Modifier 59, used to indicate a distinct
  procedural service, must be accurately applied to
  avoid denials. Another critical modifier in
  optometry is Modifier 25. It is used for billing
  a significant, separately identifiable evaluation
  and management service by the same physician on
  the same day of a procedure or other service.
• Up-to-Date Coding Knowledge The healthcare
  sector is constantly evolving, and so are the CPT
  codes. For example, the introduction of CPT code
  66987 (Complex Cataract Surgery) requires
  specific documentation to justify its use.
  Staying current with these updates is essential
  for avoiding denials.
• 3. Timely Submission
• Adhering to Submission Deadlines Missing
  submission deadlines is a common reason for claim
  denials. Each payer has specific timelines, often
  ranging from 90 days to one year from the date of
  service. Implementing a tracking system that
  alerts your team about impending deadlines can
  help avoid these denials.
• Regular Follow-Ups Set up a routine for
  following up on submitted claimsespecially
  those nearing the deadline. This ensures that any
  issues are identified and corrected
  promptlyreducing the chances of denial due to
  late submission.

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Denial Management in Optometry How to Minimize
and Manage Denials?

• 4. Regular Audits
• Internal Audits Conducting regular internal
  audits can help identify trends in denials and
  address them proactively. Audits should focus on
  common denial reasons, coding accuracy, and
  adherence to payer guidelines.
• External Audits Periodic external audits by a
  third party can provide an objective view of your
  billing practices. This helps identify the areas
  for improvement that might be overlooked
  internally.
• 5. Outsourcing Complex Billing Tasks
• Benefits of Outsourcing If in-house billing is
  becoming increasingly challenging, consider
  outsourcing to a specialized optometry billing
  service. Outsourcing can provide you with access
  to expert knowledge and advanced technology. It
  also ensures that your billing practices are both
  efficient and compliant. 
• Transform Your Practice with MBC's Expert
  Optometry Billing Services
• Medical Billers and Coders (MBC) offers
  specialized optometry billing services that
  streamline denial management, reduce claim
  rejections, and ensure compliance. By outsourcing
  to MBC, you will save time,

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Denial Management in Optometry How to Minimize
and Manage Denials?
reduce stress, and optimize your optometry denial
managementultimately improving your practice's
financial health. Ready to Eliminate the Stress
of Billing and Focus More on Patient
Care?  MBCs specialized team handles everything
from accurate coding to effective denial
management, ensuring compliance and maximizing
your revenue. Contact MBC today to uncover hidden
profits and enhance the financial stability of
your practice. FAQs Q What is medical denial
management in optometry? A Medical denial
management in optometry focuses on identifying,
analyzing, and resolving denied claims to
improve revenue cycle management. It involves
addressing common denial causes such as coding
errors and coverage issues. Q How can we
prevent denials in optometry practices?
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Denial Management in Optometry How to Minimize
and Manage Denials?
A Preventing denials involves verifying
insurance details before visits, ensuring
accurate coding, and submitting claims promptly.
Regular audits and the use of Electronic
Eligibility Verification (EEV) systems can
significantly reduce denial risks. Q Does MBC
follow government regulations and guidelines for
optometry billing? A Yes, Medical Billers and
Coders (MBC) strictly adhere to all government
regulations and guidelines, including HIPAA and Me
dicare rules. This helps ensure compliance and
minimize the risk of claim denials. MBC also
stays updated on the latest billing code changes
and payer-specific regulations.