"Are my vendors HIPAA compliant?" It's a question most physicians overlook. They're too focused on internal measures. However, ensuring HIPAA compliance beyond your practice is key to safeguarding patients' protected health insurance (PHI). In this episode, RevCycle Partners' experts Christine Schneider and Jon Kettner explain the importance of vendors in ensuring HIPAA compliance. They highlight the proactive steps RevCycle Partners takes and offer guidance to bolster defenses against...

A comprehensive guide for modifiers, payer portals, and timely filing. You’re the billing expert. But even experts come up against roadblocks. And when it comes to insurance billings, roadblocks crop up at unexpected times. When RevCycle Partners’ team of billers asked for you to share your toughest billing questions, we received a variety that boggle the best of billers, from misunderstood modifiers, payer portal logins, and timely filing best practices. Whether you’re a seasoned healthcare...

Are you an optometrist grappling with whether to outsource your Revenue Cycle Management (RCM) activities? Maybe you’re expanding to multiple locations. Maybe you’ve had a string of billers leave, wreaking havoc on your AR. Or maybe you’re merging or being acquired, have specific compliance concerns, or simply desire to focus more on patient care. Whatever your reason, outsourcing is a big decision—especially if you have never outsourced before. It's natural to have concerns. What will the...

CPT II Codes Required for Diabetic Diagnosis Important changes have been made to claim submissions with VSP and Eyemed that directly impact your insurance billing. Both payers now require the use of CPT II codes in conjunction with diabetic diagnosis codes. Here are the details you’ll need to adjust to the changes: VSP Claim Submissions and CPT II Codes VSP now requires the reporting of an accompanying CPT II code when a diabetic diagnosis code is used. The purpose of these CPT II codes is to...

Have you ever unintentionally billed a patient who wasn't responsible for specific charges? Such situations can be stressful for both you and the patient. In this video, we're zooming in on Qualified Medicare Beneficiaries, or QMB, a crucial aspect of Medicare billing that can prevent these hairy situations.

Insurance claim denials due to eligibility issues can cause significant delays. And that leads to frustrations for patients and your practice. Dealing with Medicare denials can feel like navigating a labyrinth – winding, confusing, and filled with dead-ends. But there’s a tool available to help you overcome these challenges so your practice is more efficient: the Medicare portal. If you’ve ever take this tool for granted, tune in so you can learn how helpful it can be for billing Medicare.

Do you ever feel overwhelmed when dealing with Medicare billing? It's understandable. Medicare comes in several types, each with their unique billing requirements. Understanding the differences between each is the foundation to successful Medicare billing. Here are 3 tips to help you correctly identify each Medicare plan.

A smart resource to tap into in addition to your clearinghouse. By Sarah Gray, RevCycle Partners When you have a clearinghouse portal to submit your claims, you may wonder why you would ever need to use an insurance payer portal. What’s the point of using payer portals? More portals create more pains: another system to learn; more passwords to manage; too many windows open on your desktop monitor. You might be surprised to know the hidden benefits of using payer portals in addition to a...

A Q&A with WeCredential Manager Dave Kegel From billing locum tenens to CAQH applications to when you can start billing under a new grad: there are plenty of misunderstandings about billing and credentialing. Dave Kegel, Manager of WeCredential, breaks down your most pressing questions to help you with billing and credentialing new providers. Q: I’m opening a cold start with only me as a doctor. Do I need a group NPI? DK: It depends on how your organization is classified. Usually, if it's...

Medicare is tricky. Our billing expert simplifies it for you. By Casey Squicquero, Staff Development Manager, RevCycle Partners Just when you think you have a grasp on Medicare, a claim is denied. Medicare has a dizzying number of exceptions that make billing not for the faint of heart. In a recent webinar, “Simplifying Medicare: A Start to Finish Process,” your toughest Medicare billing questions were answered. But our audience had more tough Medicare Billing questions after the presentation....

How to use Modifier 59 properly. By Melissa Jacobson, Operations Manager, RevCycle Partners Misuse of modifiers remains a consistent problem amongst optometric practices. They can be tricky to understand. And even trickier to know when to use. Misuse of common modifiers leads to inevitable claim denials (and headaches for providers). One of the trickier modifiers—the most misused modifier—is Modifier 59. What Is Modifier 59? Modifier 59 is used to identify procedures and services that are not...

Insurance billers asked. And we answered. Melissa Jacobson, Operations Manager, RevCycle Partners When a medical claim is denied, it’s often because of a missing modifier or a misused modifier combination. It’s easy to mix up modifiers. Unfortunately, mix-ups can lead to delays in payments or, in some cases, nonpayment. Worse, they might trigger an audit that can lead to hefty fines. RevCycle Partners recently presented a webinar, “Commonly Confused Modifiers: Common Scenarios of Misuse and...

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”...