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  • Proper Coding Begins With Commercial Payer Policies, Part 2

    “The secret of change is to focus all of your energy, not on fighting the old, but on building the new,” according to Socrates.

    To embrace changes that impact coding and reimbursement we must be mindful of payer policies and when they are modified. Failure to follow payer guidelines can lead to delayed claims or worse, lost income. Considering the current demand for medical care, decreased reimbursement rates and inflation, practices cannot afford another roadblock in the revenue cycle. Patient care and practice profitability depend on following the fastest route to reimbursement.

    How can you stay up to date on payer policy changes before they lead to revenue delays?

    Sign Up for Payer Education Emails

    Depending on the terms of your contract, once a commercial payer has notified you of policy changes via the agreed method, they are not obligated to make sure you are aware of the change. Notices can be posted on webpages, sent via email or U.S. Postal Service or included in regularly issued payer newsletters. Having more than one person in the practice receive notices can ensure they are not missed. Designated staffers can flag incoming emails to be stored in certain folders and require review. Set aside time each week to skim each notice for relevant ophthalmic information.

    Attend Payer Education Sessions

    These are often shared in newsletters or on payer websites. Although in-person events can occur, most are web offerings. If they are scheduled at an inconvenient time, check to see if the recorded versions will be shared. In many cases you must register to receive the recording.

    Read Academy Newsletters

    Academy and AAOE® member benefits include weekly news collaborations in Academy Express, Practice Management Express and Washington Report Express. These e-newsletters include important alerts and essential information on trending topics as well as trusted coding and practice management advice.

    Participate in AAOE-Talk

    AAOE members can participate in an online community where payer updates are frequently shared in real time. Find fellow administrators and coders that are familiar and can assist with payer information needs. You can find instructions for accessing the community and rules of participation on the website.

    Reference Proper Coding Begins With Commercial Payer Policies, Part 1 for tips on mapping out commercial payer guidelines.