Tips to improve Ophthalmology Billing and Collections

How would you explain the word ‘efficient’? It can be defined as giving minimum expense or effort to achieve maximum productivity. In the field of ophthalmology, having an efficient ophthalmology billing and collections practice will help the facility enhance the patient’s experience. It would mean reducing the wait time for the patients, having easy claim policies, and not having to repeat the information to the patients, staff, doctors, or other staff members.  Though an efficient practice is vital for the successful running of the hospital, effective Ophthalmology Billing Services are essential for your practice and the patients.

If you are wondering why efficient ophthalmology billing and collections are essential for your practice, consider the following:

  • You would not want patients to churn due to claim rejection or denial because there have been reporting errors on your part.
  • Frustrated and dissatisfied patients would give negative reviews, which would mean a decrease in practice and loss of revenue.
  • Delayed claim approval means slowing down the revenue flow
  • Missed claim file deadlines mean unrecoverable claims, thus not getting paid for the services rendered.

Unless you have an efficient ophthalmology billing and coding system in your practice, you are moving toward revenue loss.

So, what can be done to improve your ophthalmology billing and coding along with 100% collections? Here are some tips that can make your practice efficient with proper ophthalmology billing and collections:

1. Check with the insurance company

When a patient contacts you for services, the first step is to verify whether the provider has a license from an insurance company. You must check the file and follow the guidelines given by the insurance company for the plan for the provider. Take a step further, i.e., contact the insurance company to check whether the provider is covered within the network to ensure you get paid for the ophthalmology services on time.

2. Using the Right Modifiers

Often by mistake or just to get paid more, ophthalmology practices use CPT codes such as 92133 – 92134 and the CPT 99250 – the fundus photography code used for a single visit billing. All this would result in denying the codes and the claims or paying for the code with the lowest reimbursement rate by Medicare or other insurance companies.

Since there are three categories of codes, which have five characters and modifiers with two characters that describe the changes in CPT codes procedures as published by AMA (American Medical Association), it is essential to use them correctly. While under-coding will cause a loss of revenue, over-coding can bring in the medical governing bodies to investigate your practice for fraud. Hence, the importance of using correct codes and modifiers for ophthalmology billing and coding cannot be over-emphasized.

3. Stay Updated

Monitoring the Medicare Administrative Contractors (MACs) and Local Coverage Determinations (LCDs) updates should be closely monitored when it comes to coding the claims for ophthalmology. It would ensure no errors in the coding, as it will help you stay up-to-date with the payers’ list.

Staying prepared for the changes in the ophthalmology coding and documentation rules and regulations for evaluation and management (E/M) is vital for every ophthalmologist and the staff of a facility. In fact, part of the ophthalmology billing and coding would require you to select the E/M codes that are appropriate instead of the physical examination of the patient’s history.  

4. Practice on-time Settlement

Checking whether the patient’s insurance plan is based on deductibles or co-payments is a must. Using an online form for the payment option for the patient at the time of enrolling would allow you to incorporate on-time payment settlement. The process will help in speeding the admission process and enhance the patient’s experience. It will also warrant timely payment without hassle for the services rendered, thus improving the revenue flow.

5. Choosing the Right Billing Plan

In ophthalmology, it is common to come across patients with an insurance plan with both health and vision insurance. The process of selecting the right plan for a patient can be challenging. An efficient ophthalmology practice would understand both the plans when the patient makes an appointment and before their visit. Next, select the plan and bill it based on the medical diagnosis of the patient and their chief complaint.

6. Better Collection Process

Any ophthalmology practice should have a well-established and defined collection procedure. It would require the practice to collect the patient’s information correctly and verify it. Training the staff to conduct every step correctly and confirm it is essential. It will also allow you to identify if there are any deductibles or co-pays upfront, which will save time in collection and create a maximum reimbursement.

7. Finding the Right Billing and Collection Partner

It can be challenging to go through the collection of patient information, verify them, keep up-to-date with the codes, and train the staff with the latest rules and regulations. The best way to ensure efficient ophthalmology billing and collection for practice is by partnering with the correct ophthalmology billing and collection partner. 24/7 Medical Billing Services is one such outsourcing ophthalmology billing company that guarantees maximum reimbursement for the services rendered.

Read more: Impact Of Choosing The Wrong Medical Billing Partner

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