Eye care professionals should focus on patient care instead of managing repetitive medical billing and revenue cycle management (RCM) tasks. Your patients are the reason why you and your staff come into the office every day.

When you aren’t buried under repetitive tasks like insurance verification and filing claims, you can focus on improving patient care when your patients walk through the front door, during their visit, and after they leave.

That’s why having well-rounded RCM processes in place are essential to running a profitable optometry and ophthalmology practice, so your revenue doesn’t slip through the cracks.

Proactive RCM and Optometric Billing Services Reduce Denied Claims

A March 2021 Medical Group Management Association (MGMA) poll shows that 69% of healthcare leaders say “their organization’s denials have increased in 2021,” and “on average, denials have increased by 17% in 2021.”

The average cost of reworking a denied claim is $25.20. While that number may sound small, denied claims will multiply quickly. Nearly 65% of denied claims are never reworked or resubmitted to payers, says TriZetto Provider Solutions. The good news is that almost 90% of claim denials are avoidable with a proactive revenue cycle management and optometric billing solution.

Listed below are 12 RCM processes eye care professionals should have in place to get paid faster, so you have more time to care for your patients and generate revenue for a healthier bottom line.

1. Simplifying Provider Credentialing and Enrollment

The best eye care billing and RCM companies simplify the credentialing process by reviewing documentation to determine the provider’s participation status in the health plan, then submitting and tracking provider credentialing applications based on insurance plan requirements.

2. Verifying Patient Insurance Eligibility and Benefits

Verifying a patient’s insurance eligibility and benefits is critical before submitting an insurance claim to a clearinghouse or vision and medical insurance plan payers. It’s important to ensure demographic and insurance data is correct by verifying plan coverage and the amount a patient may owe (e.g., co-pays, co-insurance, and deductibles).

3. Increasing Profitability with Accurate Charge Entry

Charge entry is a process where you enter valid medical billing information and assign diagnosis and procedure codes before you file a vision plan or medical insurance claim. Accurate charge entry is crucial so your practice can collect maximum reimbursements, decrease payment denials and increase profitability.

An efficient RCM service eliminates the worry out of entering error-free patient demographics before vision plan and insurance claims are filed.

4. Keeping Up with Medical Billing and Coding Changes

Staying on top of never-ending optometry and ophthalmology medical billing rules, regulations, and code changes is frustrating and time-consuming. Certified medical billers and coders have a good understanding of anatomy and physiology, the disease process, and clinical procedures for all healthcare specialties, which allows them to apply the correct billing codes and modifiers to medical claims.

When you outsource your medical billing and RCM tasks, you don’t have to worry about keeping up with staff certifications, vacations, unplanned sick days, turnover, or costly re-training.

In addition, Fast Pay Health takes patient health information (PHI) security and privacy seriously. We train and monitor our optometric billing consultants continuously to comply with current PHI and HIPAA rules. To further minimize security risks, our team uses your practice management system to prepare and transmit claims, post insurance payments and run necessary reports.

5. Submitting Accurate Electronic and Paper Claims

Maintaining a high Clean Claim Rate (CCR) requires well-defined revenue cycle management processes. Fast Pay Health medical coders and billers maintain a 98% CCR by helping you determine how to bill the visit and make sure claims are clean and free from errors before submitting them to vision plans and insurance companies.

Accurate information is directly related to you receiving reimbursements, and clean and accurate claims get paid faster. While every eye care practice will experience claim rejections and denials, knowing how to prevent those rejections in the first place is the best cleaning solution to receive revenue quicker.

6. Managing Clearinghouse and Payer Rejections

Using a clearinghouse expedites reimbursements, reduces errors, and increases revenue by consolidating electronic claim submissions. A clearinghouse gives medical billers and billing managers access to thousands of insurance payers, across different states, from a single location.

While many clearinghouses offer RCM services, there are significant differences you may not be aware of before you sign on the dotted line. The most important difference is that a clearinghouse does not replace RCM, they work together.

Our optometric billing consultants track all claims we submit electronically through clearinghouses and ensure that insurance payers accept the claims. If we notice a rejection, we promptly and manually fix the errors to ensure timely insurance receivables.

If you want to speed up the process even more, choose a clearinghouse that integrates with your eye care practice management software so you can easily manage patient and insurance billing with built-in edit checks.

“Partnering with Fast Pay Health is one of the better decisions we’ve made in managing our practice. Their team is a welcome extension of our practice. They are well-trained, have positive attitudes, and have a fierce work ethic.” –Dr. Julie Honda (Kailua-Kona, HI)

7. Posting Insurance Payments Daily

By posting remits within 24 to 48 hours, you can move the balance to secondary insurance and bill that much quicker. At Fast Pay Health, we post payments that come in through Electronic Remittance Advice (ERA) and standard paper Explanation of Benefits (EOB) directly into your practice management system, so you have accurate and up-to-date accounts.

We analyze unpaid claims and EOBs to correct and reprocess denied claims to recover the amount due. Our clients see net collections increase by over 90% in the first 30–45 days.

8. Promptly Filing Secondary Claims

If a patient has secondary insurance, you can run into timely filing denials. For instance, many payers require you to bill a secondary carrier within a specific period after you receive the primary payment. Or, if there is a balance left for the patient to pay, it becomes increasingly difficult to collect payment the longer it’s been since the patient’s visit.

When your optometry billing cycle isn’t running smoothly, it works like a domino effect. If primary claims don’t get filed, then secondary claims and patient billing are delayed.

9. Researching and Managing Claim Denials

Researching unpaid or denied claims is a time-consuming process. Once a claim is denied or rejected, most insurers set a deadline to contest the denial. If you want to increase your cash flow, it’s important to review all rejected or denied claims and make necessary corrections as soon as possible.

Fast Pay Health optometric billers often process claims that are rejected for one or more of the following reasons: invalid insurance information, invalid member ID numbers, invalid insured information, and the patient isn’t eligible on the date of service.

10. Focusing on Accounts Receivable Cleanup and Insurance Follow-up

Are you focusing on accounts receivable (AR) and pesky aging claims daily to see why open balances are still outstanding? Accurate information is directly related to you receiving reimbursements—claims get paid faster! Our RCM specialists analyze unpaid claims then take the necessary steps to recover the amount due.

It’s critical that you look at the number of “Days in AR” and your “Net Collections” together. Days in AR may be at or above industry best practices, or Net Collections may be low because your medical biller merely writes off denied claims rather than following up with insurance companies.

The graph below highlights how the Fast Pay Health billing team reduced AR and aging buckets for a three-doctor, one location California-based optometry practice by more than 90% during one year—resulting in a higher return on investment (ROI) for the client.

AR and aging bucket ROI for a three-doctor, one location optometry practice.

In addition, a dedicated Fast Pay Health account manager provides weekly activity and financial reports, so you have insight into your AR status and benchmarking data. Better visibility means you can make more informed business decisions for your practice.

11. Avoiding Reimbursement Delays With Insurance Claim Audits

Before you submit insurance claims, it’s critical they are clean and free from all errors. Review AR aging claims daily to see why open balances are still outstanding. Preventing those rejections in the first place is the best way to increase your cash flow and improve your bottom line.

12. Reducing Expenses Using Patient Statement Services

Are you having a difficult time keeping up with printing and mailing patient statements? With a complete RCM service, you can reduce expenses, boost your revenue, and eliminate the time-consuming task of in-house printing and mailing.

Fast Pay Health will print and mail patient statements for your practice through our HIPAA-compliant print and mail service partner. Statements are typically mailed within 24 hours (during regular business hours) once you receive insurance payments. Or, we can print your patient statements to an assigned printer in your office, so that you can mail the statement to the patient.

Calculating Your ROI of Outsourcing Medical Billing and Revenue Cycle Management

Download our ROI to Outsourcing Eye Care Revenue Cycle Management Guide. Learn how to calculate the First Pass Acceptance (FPA) rate, days in accounts receivable, and net collection rate. In addition, see ROI examples and a sample ROI calculator.

Request a free practice analysis today and see how Fast Pay Health optometry and ophthalmology billing consultants take a proactive approach to help you get paid faster and improve the financial performance of your practice.

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12 Ways Eye Care Revenue Cycle Management Improves Cash Flow