Paying attention to the details can increase your bottom line.
by Christine Schneider, VP of RevCycle Partners
Insurance billing is all about the details. Optometry practice billing mistakes can lead to a time-crushing, cash-sucking mistake. All billers—even the best of the best—will miss a few details. But your optometry practice can minimize the missed-details and maximize your efficiency by not making the following six billing mistakes.
1. Billers don’t verify patient eligibility and benefits prior to the patient visit. Is your patient in-network or out-of-network? Has their coverage been terminated or changed? Will the service you provide them be covered?
Establishing this basic criterion prior to a patient visit (especially a new patient visit) is important because it impacts how much a patient will pay. If you are not in-network, often the insurance will cover less than the patient expects. The disparity between what a patient expects and the reality of what insurance will pay can lead to untimely reimbursement by a patient who anticipated paying much less. Or your practice might report it as a loss.
Not to mention, billers will spend unnecessary time making calls explaining the disparity and collecting the payment.
2. Billers don’t obtain prior authorization and/or a referral. Many routine vision plans require an authorization to bill for services and materials. Similarly, many health insurance plans require a referral from a PCP to be seen by an optometrist. Not obtaining this information up-front might lead to unhappy patients who are asked to pay more than they expected.
3. Billers don’t take the time to verify and enter all patient information correctly. This might seem patently obvious, but always review your forms. Staff is often rushed to push the patient through the waiting list that they let details slip. Staff might abbreviate a field in the moment with intentions of correcting later; however, they forget to go back.
Issues with patient details, including the correct spelling of the name, date of birth, and policy number, will cause claim denials. These small optometry practice billing mistakes ultimately can result in delays in processing the claim as your biller corrects and re-files.
4. Billers don’t file in a timely fashion. Each payer has a timely filing period to accept a new claim. They also have a timely filing limit for any corrections, resubmissions, and/or appeals. Knowing these limitations and abiding by them will ensure that reimbursements are made. This may be one of the simplest optometry practice billing mistakes to correct.
5. Billers don’t dig for payer rules regarding ancillary testing. Many times, there are visit limits, medically necessary diagnosis, and modifiers needed. Rushing to provide a service without checking the details can lead to increased costs for the patient and delayed (or unpaid) payments.
6. Billers don’t follow up on denials. We might be trained to accept that “no means no.” But in the case of insurance denials, no’s aren’t always steadfast no’s. Take the time to call and question denials. Many times, something can be corrected and refiled rather than written off completely.