12 Optometric Billing Tips for Positive Cash Flow
/
Every time you think your optometric billing is under control, new reimbursement, coding, or staffing roadblocks appear. Increasing collections and improving out-of-control accounts receivable (AR) is critical for revenue growth.
You won't see a positive cash flow if you don’t regularly file vision plan and medical insurance claims, ignore rejected and denied claims, or delay processing and posting payments.
Follow these optometric billing tips to help your eye care business thrive.
1. Enter accurate patient demographics and medical billing information during the charge entry process.
A majority of claim denials are due to administrative errors. Charge entry is one of the most important steps in the medical billing cycle—where you create the insurance claim.
Ensure that all patient information, including insurance billing details, is accurately recorded before the patient leaves the office. A single mistake can result in a rejected or denied claim, leading to thousands of dollars in lost revenue.
Be diligent in entering accurate medical billing information. Assign correct diagnosis and procedure codes and modifiers before filing a claim.
For more helpful billing tips, check out our guides Why is Charge Entry Critical to Optometric Billing and How (and How Not) to Use Common Medical Billing Modifiers.
2. Know when to bill vision plans vs. medical insurance.
Many patients have both vision plans and medical insurance. Deciding which one to bill can be challenging, especially when patients worry about out-of-pocket costs.
While the best billing practice is to select which plan (vision plans or medical) to bill based on the patient’s chief complaint and diagnosis, sometimes it’s more complicated. Always verify your patient’s vision plan and medical insurance before the office visit.
Read our blog, Vision Plans vs. Medical Insurance: When Should You Bill, which reviews best practices for billing and provides case examples of patients with both vision plans and medical insurance.
“Before we outsourced billing to Fast Pay Health, a substantial number of outstanding claims were aging beyond 120 days. Claims are now processed faster, which means we get paid more quickly. Our net collections increased by over 90% in the first few months. ”
3. Give your team a refresher course on common medical billing and insurance terms.
Medical billing and insurance terms are confusing, and everyone in your practice may need a recap of what they all mean.
We’ve prepared 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.
4. Calculate the ROI of outsourcing your optometric billing and revenue cycle management tasks.
Determine the actual costs of your in-house billing processes and examine critical financial and operational processes. For instance:
Calculate determinate (fixed) costs: These include staff wages, payroll costs and taxes, workers’ compensation insurance, employee benefits, billing software, clearinghouse fees, and stationary, postage, and statement fees.
Review indeterminate (variable) costs: These costs focus on increased rejections and denials rates, decreased cash flow and net revenue, and unplanned staff turnover, sick leave, and vacations.
Assess and identify key decision points for outsourcing billing: Are your accounts receivable over 50 days? Is your percent of AR over 120 days greater than 15%?
5. Ensure all providers are credentialed and enrolled with insurance payers and CAQH.
One of the first steps in ophthalmology and optometry vision plan and medical insurance billing is making sure the healthcare provider has been credentialed and enrolled by insurance payers and the Council for Affordable Quality Healthcare (CAQH®).
If the provider isn’t properly credentialed or re-credentialed with the insurance company, the insurance payer will not reimburse the provider for services rendered.
Our Critical Steps to Efficient Provider Credentialing and Enrollment Guide reviews the steps you need to take.
6. Always verify the patient’s eligibility and verification before you submit the claim.
Verifying a patient’s insurance eligibility for the date of service and benefits is another important first step before submitting an insurance claim to a clearinghouse, vision plan, or insurance plan payer.
Review the patient’s eligibility at least 5–7 days before the patient’s initial visit. Don’t wait to check eligibility until you file the claim since many issues can’t be resolved after the exam.
Review the patient’s insurance card when they check in to confirm you have the correct insurance plan listed. In addition,
Confirm vision plan coverage is active for exams and materials if the patient has vision insurance coverage.
Even one required field missing will result in a rejected claim. Our guide, Reduce Denied Claims With Proactive Insurance Eligibility Verification, provides steps for eligibility verification and a practice case study.
7. Know when, why, and how to use an Advanced Beneficiary Notice (ABN).
An Advanced Beneficiary Notice (ABN) is a document that informs the patient they may be financially liable for all or a portion of the costs should their insurance carrier deny the claim.
Failure to obtain a signed ABN form before providing the procedure or service could result in being unable to bill the patient and get paid for non-covered services.
Check out our Rules to Follow for Advanced Beneficiary Notice of Noncoverage Guide for when, why, and how to use an ABN form.
8. Stay current with LCD, MAC, NCCI edits and listserv updates.
Always check with your area’s Medicare carrier or other insurance company policies for up-to-date coding rules to ensure you are correctly coding your eye care claims. These rules can change as frequently as every quarter.
Payer Listserv Updates (subscribe to receive updates)
9. Use the correct modifier for Medicare cataract post-op management claims.
When co-managing a cataract surgical procedure a surgeon has performed, you must use the correct modifier. Your co-management claim will be denied if the surgeon has not filed the claim or files without using the proper modifier indicating surgical care only.
In addition, it’s critical that you manage the patient’s transfer of care correctly and that it is medically acceptable. Ensure that your billers use the correct Assumed Care Date (date postoperative care assumed by another provider) and Relinquished Care Date (date provider stopped postoperative care).
Review a patient case challenge and solutions in our Medical Billing Solutions for Cataract Post-Op Co-Management Guide.
10. Understand the difference between Medicare and Medicare Advantage plans.
If a patient has a Medicare Advantage plan, do not bill traditional Medicare. Medicare Advantage benefits vary from plan to plan, bill different out-of-pocket fees, and have rules for how you get paid for your services. That’s why having eligibility and benefits verification is a critical first step in the charge entry process.
Need more Medicare and Medicare Advantage billing tips? See Medicare Advantage Billing Tips That Boost Your Revenue and 10 Medicare and Medicare Advantage Medical Billing Dos and Don'ts.
11. Collect co-pays, coinsurance, and deductibles before the patient leaves the office.
One of the fastest ways to increase your cash flow is to develop (and follow) an upfront collection process in your eye care practice. For instance:
During check-in or check-out: If the patient’s vision or insurance plan includes a co-pay, coinsurance, or deductible, collect payment before they leave the office.
Send invoices before the due date to reduce AR delays: This helps avoid late payments and increases your chances of getting paid on time. Open balances create a false image of your actual AR.
12. Scrub your claims before you submit them to reduce rejections and denials.
Are you focusing on scrubbing those pesky medical claims that don’t go through? When claims are sent correctly from the beginning, it significantly reduces your AR and saves you time. This is crucial, especially if you have a pay-per-claim plan with your clearinghouse. Review all rejected and denied claims, make necessary corrections, and resubmit them.
Fast Pay Health billers often see rejected claims due to the following reasons:
Invalid insurance information
Invalid member ID numbers
Invalid insured information
The patient is not eligible for the service date
Improve the financial health of your practice with Fast Pay Health’s optometric billing and RCM services
Fast Pay Health ensures your claims are clean and error-free before we submit them—delivering positive cash flow for your practice. We analyze unpaid claims and then take the necessary steps to recover the amount due.
Request a free practice analysis today or book an introductory call. Start enjoying the advantages of cleaner claims that focus on improving the financial health of your eye care practice. We work with ANY eye care practice management software.