Beware of the security concerns before you outsource your billing and hire a freelance insurance biller. The Covid 19 crisis reshaped work in America. According to recent polls, one by the Pew Research Center and another by the Becker Friedman Institute for Economics at the University of Chicago, the majority of Americans prefer to work from home—and the majority of workers are at the very least partially working from home. Even though the percentage of work-from-home workers is slightly lower...

When insurance payer denials continue to wreak havoc By Amanda Kissinger, RevCycle Partners Billing Service Group Manager The best insurance billers are tenacious. They have to be. And yet insurance payer denials continue to wreak havoc. Think of the number of times an insurance payer denies payment. You did your research. You used the right CPT codes for the service provided. You reported the necessary additional information, such as the referring provider. You know it was posted within the...

Reasons Optometry Practices Outsource By Melissa Jacobson, Operations Manager While there are many reasons optometry practices outsource, it’s never an easy subject to discuss with staff. When the subject of outsourcing comes up, the office mood can tighten. Staff can feel threated as they wonder, Will my role be eliminated? Am I not doing a good enough job? In some cases, the job simply isn’t getting done, and outsourcing every aspect of the function is a necessity for practice survival. High...

MODIFIERS ARE COMPLICATED By Melissa Jacobson, Operations Manager Using the incorrect procedure modifiers—or missing them altogether—can lead to denials. Denials, of course, mean delays in payment, or worse, non-payment. As a refresher, below are commonly misused coding modifiers for optometry insurance billing. MODIFIER 25:“Used for significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.” This is most...

IS YOUR OPTOMETRY PRACTICE IN TRANSITION? By Amanda Kissinger, Billing Services Group Manager Maybe you’re growing and buying up a practice or two. Or maybe your practice is being purchased. Or maybe because of the pandemic-induced staffing shortages, you’re having trouble hiring staff. Whatever the reason for the transition, it likely will be a chaotic time for your practice. If you outsource your insurance billing, even for a brief period, you can alleviate some of your stress. If you’re...

MEDICARE DENIALS By Amanda Kissinger, Billing Services Group Manager Medicare denials are perplexing. And frustrating. One small detail missed—and a service won’t be covered. Particularly frustrating are Medicare denials for glasses after cataract surgery—even though you are credentialed with Medicare. What’s going on? Here Are Some Helpful Tips To Keep In Mind To Ensure You Don’t Have To Deal With Medicare Denials For Glasses: Glasses after cataract surgery are considered medically necessary...

MAIL DELIVERY IS SLUGGISH Blame it on the Covid pandemic or the politicization of the system, but the United States Postal Service’s delivery rate bottomed out at 62 percent—the lowest in years. It rebounded a bit by March of 2021 to 84%. But even that number falls short of the agency’s target of 96%. If your optometry practice receives a bulk of its payments or processes claims by snail mail, your AR could suffer. You can improve your AR with electronic payments. When you process claims...

ABN Update By Melissa Jacobson, Director of Insurance Billing In January 2021, the Centers for Medicare and Medicaid Services (CMS) revised the Advanced Beneficiary Notice of Non-coverage (ABN) Form. The ABN Form CMS-R-131 is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. The biggest change to the ABN is the special guidance that was added for people who are dually enrolled in both Medicare...

Optometry coding changes By Casey Squicquero, Billing Support Group Manager, RevCycle Partners The new year always brings new coding guidelines. Here are a few coding changes for 2021. Rather than using history, examination, medical decision-making and time to determine the level of E/M service, like providers have always used, the update to the E/M coding guidelines will be determined based on 1 of 2 factors: 1. Level of service is defined by medical decision-making for the service. Medical...

common insurance billing questions that stump the best of us By Christine Schneider, VP of Operations If you’re an insurance biller for an optometry practice, you’re a master problem solver. Each patient is unique, their needs and their coverage. But even the most experienced billers run into vexing billing questions. Here are a few common insurance billing questions that stump the best of us — and their answers to help you provide better optometric patient care. Insurance Billing Question...

HOW REVCYCLE PARTNERS IS CHANGING AND IMPROVING THEIR AGING CLAIMS PROCESS. By Melissa Jacobson, Operations Manager of RevCycle Partners Transparency translates to accountability. And accountability translates to better service. That is why we are improving our aging claims process. Our goal, each month, is to touch every aging claim, and place them in front of you in an easily digestible format. At the beginning of each month, you will receive a spreadsheet of all aging that is 46 days and...

DO YOU HAVE QUESTIONS ABOUT HOW TO ACCOUNT FOR A MEDICARE PRE-PAYMENT? By Christine Schneider, Vice President Do you have questions about how to account for a Medicare pre-payment? Read below for some helpful tips. Create a Medicare Invoice The best way to account for a Medicare pre-payment in RevolutionEHR is to create a Medicare invoice (inside of a dummy patient) and apply that payment to the invoice to generate an invoice credit. Process EOB as Normal, But Apply Same Total as a Negative...

THREE THINGS TO KEEP IN MIND TO EASE CO-MANAGING CATARACT CARE. By Melissa Jacobson, Operations Manager Co-managing cataract care with ophthalmologists is one way you can provide continuity of care to patients before and after surgery. But the logistics of transfer of care can be tricky, and, if not addressed correctly, can slow down the billing process. Here are three things to keep in mind to ease co-managing cataract care: 1. Completely and accurately fill out the patient consent form. All...

WHAT YOU NEED TO KNOW ABOUT MEMBER IDS, DEDUCTIBLES, AND MEDIGAP PLANS. By Christine Schneider Billing Medicare can be dizzying work because of the multiple updates to policies from year to year, and sometimes even from month to month. In 2020, there are changes to Medicare that will affect your billing if not handled correctly. Below are three changes to make note of now, so you hit your stride on January 1st. Changes to Medicare Member IDs on January 1 You must submit claims with the...

A START-TO-FINISH PROCESS. By Christine Schneider, VP of RevCycle Partners Billing Medicare and Medicaid can be a messy process. If not handled correctly, it can affect payment and even patients—who might be billed more than expected. There are multiple pain points that begin the moment the appointment is made and end with payment collection. Here are 7 Tips to simplify billing Medicare and Medicaid from start to finish: Stay on Top of Your Credentialing. You might be sick of hearing it, but...

QUESTIONS TO ASK TO DETERMINE IF IT WILL BENEFIT YOUR EYECARE PRACTICE. In “The Review of Optometric Business,” Peter J. Cass, OD claims that you could improve the cash flow of your practice by outsourcing your billing. But will it really? In “Improve Cash Flow by Outsourcing Billing and Coding”, Coss offers a series of questions to help you determine whether outsourcing will really help to improve the cash flow at your eyecare practice. Questions include: How long do claims sit in your...

TIPS TO CUT TIME SPENT ON ADMINISTRATIVE WORK AND INSURANCE OBSTACLES. Staying on top of administrative tasks and insurance billing is key to making a more efficient eyecare practice. And that means you’ll likely be more profitable. There are a bundle of tasks to do so your practice stays on top of the rapidly changing healthcare system. When you’re on top of the administrative tasks, your patients actually reap the benefits. In a recent article, “5 Ways to Make Your Practice More Efficient”...