Top 5 Challenges with Optometry Billing

Since people are in need of eye care in the last few years, technology and healthcare are also advancing for the problems pertaining to eye care. Healthcare providers are getting top-notch techniques to improve life expectancy and optometry is not an exception to it. Age related conditions like cataracts and presbyopia are getting complicated with the changing lifestyle and these conditions are impacting the cognitive, behavioural, and physical abilities of patients.

Optometry practices have the same goals as any other small business – when they try to thrive. A thriving business focuses on revenue growth while providing a better experience to its customers. Even patients of optometry practices need better experiences when it comes to payments, and insurance claims.

Improving payment collections is important for revenue growth. A healthy lifecycle of the optometry healthcare business depends on a healthy financial trajectory and optometry medical billing is a crucial part of the process.

Healthcare practitioners including optometrists are experiencing so many changes in the last 50 years which present various challenges, opportunities, and responsibilities. Talking about the challenges, a small practice like optometry may face challenges in their medical billing.

These challenges need to be addressed in time to enable optometry practitioners to provide the best services to patients.

A smart move of deinstitutionalizing and quick access is shifting the provision of care for people with multiple eye related problems. People are now getting more freedom while choosing optometry services of their choice with the advanced experience and care provided by the experts. While the patients now have higher expectations, optometrists are facing a few challenges while providing payment services, insurance claims, and more.

This article will help you with identifying the top challenges involved in optometry medical billing and its various aspects.

Since challenges in medical billing are forcing optometrists to skip on their daily practice and patient experience, they are also affecting their business growth like buying new equipment, upgrading their current services, and expanding overall business.

Let’s take a quick glance at the top challenges faced by optometrists

Inefficient staff for data recording: With EMR and EHR are getting normal day by day, medical staff inefficient in recording patient data in the real-time world is becoming redundant in the optometry care market. Collecting and recording required information with appropriate codes is a necessary step that may ruin the entire billing and coding process if you ignore it. Your optometry practice needs proper attention to collect data, maintain technical and front-end staff, solve popular conflicts and maintain a database of patient health records.

Medicare and Medicaid billing: With millions of patients getting covered under Medicare since 2015, optometry patients are also getting covered by government carriers. Although most private optometrists don’t cover services under Medicare and Medicaid provisions, they still need to manage their revenue cycle to make sure the claim settlement ratio is well-maintained.

Bad debts and Account receivables: About 30% of the annual revenue of an optometry clinic is lost to bad debts due to irregular follow-up and customer dissatisfaction. Optometry clinics and practitioners need to have regular follow-ups and fulfil data requirements to manage account receivables.

Medical Billing Service Providers: It’s a common picture that many optometrists outsource their medical billing and coding process to professional teams. Outsourcing optometry medical billing will surely avoid data recording errors and claim denials. But, this is not the case with every outsourced company. Every medical biller and coder cannot be equipped with equal capabilities and skills to deliver consistent service and specific needs of your optometry medical billing. Inefficient medical billing and coding company can be one of the challenges your optometry practice may face.

HIPPA Compliance: Following the rules and reforms of HIPAA for patient health information i.e. PHI protection is important for any covered entity. Sharing medical information with insurance companies and carriers like Medicare and Medicaid for claim settlement makes an optometry practice to be a covered entity. Adhering to HIPAA norms, thus, adds more pressure on the EMR and coding system of optometrists.

Claim Settlement: Many private insurance companies along with Medicare and Medicaid require some compliance standards and pre-authorization for optometry procedures. For an optometry practice to be financially stable and viable, a strong claim settlement ratio is important. Thus, any optometry practice needs to have careful data collection, HIPAA compliant data sharing, pre-authorization, timely resolution of queries, and follow-up of accounts receivables with claims must be managed to make sure all the claims are settled in time.

Here are some pro tips to manage and overcome such challenges in optometry medical billing:

  • Identify if the provider is approved by the insurance payer
  • Keep accurate records for coding patient visits
  • Avoid rejections, denials, and fines by using modifiers
  • Stay updated with LCD, MAC, and Listserv updates
  • Don’t delay in following up with denial claims
  • Review most common coding denials and adjustment reasons
  • Collect co-pays, coinsurance, and deductibles before the patient leaves
  • Know when to bill routine vision Vs. medical insurance
  • Always complete the interpretation and report (i&r) for specific procedures
  • Determine when to use an ABN for non-covered services

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