How to Avoid Common Ophthalmic Billing Rejections: Part 3

New vs Established Patient Exams

Next up in our three-part series on “Common Ophthalmic Billing Rejections” is new vs established patient exams. One surprisingly common rejection seen by Fast Pay is, “This many frequencies is not allowed for procedure code billed.” The cause? Billing a new patient code on an established patient.

When is a patient new or established?

A patient is considered new if they have not been seen by any physician with the same specialty and sub-specialty within a group practice in the last three years. For solo providers, this is simple—if the patient hasn’t been seen in the last three years, they’re considered new. But for larger group practices, it can get tricky. Keeping proper records can help avoid this type of rejection.

In some instances, an insurance payer may incorrectly reject a claim for a new patient exam. Most of the time this can be cleared up with a phone call to the payer, though some cases may require an appeal with medical documentation.

Scrub those claims before submitting

Proper claim scrubbing can catch any coding errors before they are submitted to the insurance company. Fast Pay billers are experts at making sure medical claims are clean and free from errors. We know that preventing rejections in the first place is the best cleaning solution to receive revenue quicker.

About Fast Pay Billing Service: At Fast Pay, our billers take care of the billing hassle to maintain consistent cash flow and improve the turn-around time on your claims. We work with each of our offices to provide a solid billing solution. No two practices are alike and we pride ourselves on maintaining open communication between every office and their Fast Pay biller to stay in sync. Contact us for a free practice analysis to see how we can help you. Check out “our process” for more information and “customer insights” to hear what our customers are saying about Fast Pay.