Why is Charge Entry Critical to Optometric Billing?

Charge entry is one of the most critical steps in the optometric billing cycle—where the claims are created. Charge entry is when you enter accurate and complete medical billing information and assign diagnosis codes, procedure codes, and modifiers before you file a vision plan or medical insurance claim.

Even one mistake could lead to a rejected or denied claim, resulting in thousands of dollars in lost revenue. Medical claim errors can also cause conflicts or damage your patient–provider relationship.

Use these eight tips to help you manage the charge entry process better.

1. Enter accurate patient demographics on the claim.

A majority of claim denials are due to administrative errors. Verify the patient and guarantor’s name, ID, gender, date of birth, SSN, address, phone number, guarantor details, and insurance details.

Always include the following information on the superbill before you submit it to a clearinghouse or third-party payers, and cross-reference medical codes with patient information. Pay close attention as these elements are critical to the charge entry process:

• Date of service (DOS)

• Place of service (POS)

• Rendering provider details

• Date of admission

• Prior or pre-authorization details

• Diagnosis and procedure codes and number of units provided

• Modifiers (if needed)

2. Verify the vision plan or medical insurance payer has approved the provider.

Remember to submit and track provider credentialing and re-credentialing applications based on insurance plan requirements. Take it one step further and regularly follow up with insurance payers to ensure the providers are enrolled “in-network” when enrollment opens.

Related: Critical Steps for Efficient Provider Credentialing and Enrollment

3. Confirm patient pre-authorization details.

Verify if you need a prior authorization number before you see the patient. Make sure you include the prior authorization number on the insurance claim.

Related: Vision Plans vs. Medical Insurance: When Should You Bill?

4. Verify the patient’s eligibility and benefits.

Eligibility verification ensures the insurance data is correct and helps determine the amount a patient may owe (e.g., co-pays, co-insurance, and deductibles). Providing more accurate cost estimates to your patients can significantly boost patient satisfaction and save you from future claim denials.

Related: Reduce Denied Claims With Proactive Insurance Eligibility Verification

5. Enter charges and submit claims daily.

Don’t delay entering charges during the charge entry process; post charges the same day you provide the services to the patient. The longer you wait to post charges, the longer it takes to file a medical claim or bill the patient.

For instance, if your biller (who is posting the charges) overlooks a charge marked on an encounter form or the doctor forgets to indicate all the charges on the encounter, this will cause future problems with your medical billing.

At Fast Pay Health, our optometric billing consultants run a missing charges report from your ophthalmology or optometry practice management system to verify that charges were posted to the accounts.

By submitting claims either the day of the appointment or within one business day, you can maintain a constant flow of claims to get them paid promptly.

If you file claims only once a week, your accounts receivable (AR) will grow like a weed, which means a bigger backlog to work through that often results in more billing errors. Most major medical payers process claims in five to seven business days.

6. Allocate payments and post remits within one or two days.

Delaying posting payments keeps your AR artificially high, and you could miss denials. If you think getting EFT payments means you can wait to post, think again. Some payers have strict refiling rules, which limit your time to appeal a claim from the remit date.

By handling remits within one to two days, you can move the balance to the secondary insurance and bill much quicker. Or, you can transfer the balance due from the patient and generate a statement. It becomes increasingly difficult to collect payments the longer it’s been since the patient’s visit.

7. Scrub your claims to confirm you assign the correct medical billing codes and modifiers.

Not only do you have to adhere to strict state-specific coding and audit guidelines, but you must also evaluate medical documents and physician notes to ensure claims are not under or over-coding services and procedures.

For instance, always ensure the diagnosis and procedure codes are correct, or the patient identifier and/or provider identifier (NPI) isn’t missing or incorrect. Don’t forget to indicate the number of units performed.

It’s not uncommon for optometry and ophthalmology practices to frequently misuse billing modifiers. When insurance and third-party payers determine you incorrectly used a medical billing modifier on a claim, this can become a costly mistake. Misusing medical billing modifiers can trigger an audit that can lead to hefty fines—audits can go back many years.

Related: Medical Billing Tips: How (and How Not) to Use Common Modifiers

8. Download and review the explanation of benefits (EOBs).

An EOB is a statement the insurance company sends after processing a claim received from the healthcare provider. The EOB lists the total charges (amount billed), allowed amount, non-covered charges, the amount paid to the provider, and any co-pay, co-insurance, and deductibles the patient pays.

By reviewing EOBs when they arrive, you can determine if you need to perform a more in-depth investigation into a claim or determine what further actions are required.

Empower Your Eye Care Practice with Complete Optometric Billing Services

A full-service optometric billing and revenue cycle management (RCM) solution that includes an efficient charge entry process eliminates worrying about entering error-free patient demographics, procedure and diagnosis codes and modifiers before you file vision plans and medical insurance claims.

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.