5 Optometric Billing Tips to Improve Practice Operations
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Running an eye care practice comes with a unique set of challenges. Effectively managing optometric billing is a critical aspect. It’s a balance between processes, resources, and technology.
There is always room for improving practice operations. To better manage your business, the following optometric billing tips will guide you toward long-term financial success.
1. Identify Challenges and Analyze Inefficiencies
To maximize cash flow and improve the financial health of your eye care practice, you must continually find ways to optimize your billing practices. Think about your current challenges with your vision plan and insurance billing. Pause to find the root cause for common inefficiencies.
Maybe you’re falling behind on daily billing tasks or dealing with late scheduling changes.
Perhaps prior authorization or patient eligibility and benefits verification is falling through the cracks, resulting in unpaid claims. Patient eligibility verification is one of the easiest ways to maintain clean claims but is often the most neglected process.
Is your accounts receivable out of control? If you aren't filing claims daily, claims are rejected or denied, and you are not posting payments daily, your AR reports will not be accurate. 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.
Does your staff need a refresher course on common medical billing and insurance terms? We’ve got you covered with a glossary of insurance terminology and billing tips to help you improve collections, prevent rejected and denied claims, and focus on growing revenue for your eye care business.
In addition to analyzing financials and data, your staff should come together and share feedback about areas for improvement. Together, create a plan of action to resolve those inefficiencies. Include a timeline for implementation, then determine if you need additional support from a specialized optometric billing services and revenue cycle management team.
2. Learn How (And How Not) to Use Common Medical Billing Modifiers
It's no secret that optometry practices tend to misuse medical billing modifiers, leading to returned payments to insurance companies and third-party payers.
Misusing medical billing modifiers might also trigger an audit, resulting in fines. Medicare audit fines run as high as $10,000 for each offense, which can add up quickly.
Over time, these mistakes will cost you more than you're likely willing to part with, affecting your bottom line. Our common medical billing modifiers guide will help you avoid future mistakes.
3. Make Sure the Provider is Credentialed with Insurance Payers
One of the first steps in medical and vision plan billing is ensuring the provider has been credentialed and enrolled by insurance payers and the Council for Affordable Quality Healthcare (CAQH®). One mistake during the credentialing process can lead to a delay, often resulting in having to start the process all over again.
4. Be Aware of Common Medical Coding Denial Reason Codes
Denied claims happen to the best of us. Claim denials typically fall into policy, clinical, and administrative categories. And more than half of denied claims are never reworked by providers.
Claim denials fall into three categories: administrative, clinical, and policy—most claim denials are due to administrative errors.
On average, the claim denial rate in the healthcare industry is 5–10%, and about two-thirds of denials are recoverable. Nearly 65% of denied claims are never reworked or resubmitted to payers. The good news is that almost 90% of claim denials are avoidable with proactive optometric billing and RCM solutions.
Focus on finding ways to prevent denied claims early on and save yourself the headache later. This blog about common coding denials gives you tools for establishing a proactive solution—and getting paid faster.
5. Partner with Optometric Billing and RCM Experts
Partnering with an optometric billing and revenue cycle management (RCM) service like Fast Pay Health is a smart option if your staff is overwhelmed whenever new coding, reimbursement, or staffing issues arise.
Managing claims submissions, eligibility and benefits verification, claims rejections and denials, payment posting, collections, and other revenue cycle management (RCM) tasks overwhelm your staff and impact productivity.
Is it time to outsource your optometry billing and revenue cycle management? To help you determine the true costs of your current billing and RCM process, see our blog, Calculating ROI for Outsourcing Optometric Billing and RCM, which focuses on four financial and operational questions critical to calculating your ROI for outsourcing.
Outsourcing optometric billing tasks means you'll have a team of specialists submitting claims quickly and accurately. Freeing up your time allows more space to focus on patient care.