5 Ophthalmology Billing Tips You Can’t Afford to Miss

Getting claims paid is an important part of the financial health of your practice. Unpaid claims are a huge drain on your bottom line. These easy tips will help ensure that your claims are paid quickly.

1. Collect the correct insurance information.
It seems overly simple: Incorrect insurance information means claims won’t get paid. However, one of the most common causes for claim rejections is the wrong insurance. This can happen because a patient gives an outdated card or because a Medicare patient has signed their benefits to a Medicare Advantage plan (in this case, the billing should go to the selected plan).

So, what can you do?

Get a copy of the card — front and back. Make sure the insurance info is entered correctly into the practice management system. Double check that the doctor is in network with the patient’s insurance plan. If your system has the functionality, confirm eligibility electronically. Finally, make sure insurance carriers are set up, with the correct payer ID, in your system to send electronic claims.

2. Code correctly and document medical necessity.
Claims must include the correct diagnosis codes and modifiers. Make sure the person preparing and submitting claims is well-versed and up-to-date in ophthalmology coding and unique payer policies.

Don’t forget to document medical necessity in the medical record. Insurance carriers are requesting medical records and auditing more often so it’s important that they are complete with a compliant physician signature.

3. Submit claims in a timely manner.
Every insurance carrier has a timely filing period. It can vary from 60 days to one year. Make sure your practice staff is aware of these deadlines, as stated in your payer contract, and is submitting well within the range. Claims billed after this period will be denied.

Submitting claims timely improves your cash flow and accounts receivable (A/R). Additionally, patients get statements (showing any co-pays or deductibles owed) in a timely manner. Sending statements for old services to your patients can come as a surprise, even if they know they owe money because they’ve received an explanation of benefits (EOB) from their insurance. Keeping up with your claims submission process is a big win for your practice.

4. Collect patient copays up front.
The first and most important step is to inform the patient of your financial policy ahead of time or during check-in for the first appointment. It is recommended that practices have a financial policy that the patient signs before their appointment.

A best practice is to collect patient copays while the patient is in the office. This reduces costs in sending patient statements, especially because sending patients statements does not guarantee they’re going to pay. So, you can see how collecting balances while the patient is in the office can really improve cash flow and A/R.

5. Follow up on accounts that are outstanding.
This should be part of your daily routine. Even if you follow up on a few claims every day, this is a win for your practice.
Common errors for unpaid claims include modifier use and insurance carrier request for records. These are easy fixes, so don’t miss out on money earned by not following up.

And yes, it’s true, you’ll likely be put on hold when calling insurance companies. If available, check claims on their portal, or take advantage of the time by multitasking. This is a great time to respond to emails or tasks from co-workers in your PM software.

About the Author

Lindsay Stratton, MHA, OCS is director of operations at Eye Med Management Solutions, an ophthalmology-focused outsource billing and practice management company. She has her BA in political science and history from the University of Colorado and a master’s in health care administration from Chapman University. She can be reached at lindsay@eyemedmanagement.com or 760.451.6412.