11 Optometry Medical Billing Tips for a Positive Cash Flow

The financial health of your eye care practice depends on managing vision plans and medical insurance billing effectively, so you experience positive daily cash flow. Increasing collections and improving out-of-control accounts receivable (AR) is critical for revenue growth.

Follow these optometric medical billing tips to help your business thrive.

1. Enter accurate medical billing information during the charge entry process.

Charge entry is one of the most important steps in the medical billing cycle—it’s where you create the insurance claim.

Because even one mistake can lead to a rejected or denied claim and result in thousands of dollars in lost revenue, pay close attention to entering accurate medical billing information during the charge entry process. Assign correct diagnosis codes, procedures codes, and modifiers before filing a claim.

Check out these helpful billing tips in our Why is Charge Entry Critical to Medical Billing Guide and 2022 ICD-10-CM Codes Update Guide for Eye Care.

2. Know when to bill vision plans vs. medical insurance.

Many patients have both vision plans and medical insurance. It can be confusing and challenging to decide which one to bill, especially when patients are concerned with what they will have to pay.

While the best billing practice is to select which plan (vision or medical) to bill based on the patient’s chief complaint and diagnosis, sometimes it’s more complicated. It is critical to verify both vision plans and medical insurance before the office visit.

Review three case examples where patients have a vision plan and medical insurance in our Vision Plans vs. Medical Insurance: When Should You Bill Guide.

3. Take a refresher course on common medical billing and insurance terms.

Medical billing and insurance terms are confusing, and everyone in your practice needs a recap of what they all mean. We’ve got you covered with a glossary of insurance terminology and billing tips to help you improve collections, prevent rejected and denied claims, and focus on growing revenue for your eye care business.

4. Ensure all providers are credentialed and enrolled with insurance payers and CAQH.

One of the first steps in ophthalmology and optometry vision plan and medical insurance billing is making sure the healthcare provider has been credentialed and enrolled by insurance payers and the Council for Affordable Quality Healthcare (CAQH®).

If the provider isn’t properly credentialed or re-credentialed with the insurance company, the insurance payer will not reimburse the provider for services rendered. Our Critical Steps to Efficient Provider Credentialing and Enrollment Guide reviews steps you need to take.

5. Always verify a patient’s eligibility and verification.

Verifying a patient’s insurance eligibility for the date of service and benefits is another important first step before you submit an insurance claim to a clearinghouse, vision plan, or insurance plan payers. Always confirm pertinent information from the patient at check-in or during the data entry process for the claim. Even one required field missing will return a rejected claim.

See our Reduce Denied Claims With Proactive Insurance Eligibility Verification Guide for a few steps to perform before you provide any services to avoid the risk of rejected or denied claims.

6. Know when, why, and how to use an ABN form.

An Advanced Beneficiary Notice (ABN) is an informed consent document that informs the patient they may be financially liable for the costs should their insurance carrier deny the claim.

Failure to obtain a signed ABN form before providing the procedure or service could result in not being able to bill the patient and get paid for non-covered services.

Check out our Rules to Follow for Advanced Beneficiary Notice of Noncoverage Guide for when, why, and how you should use an ABN form.

7. Stay current with LCD, MAC, and listserv updates.

To ensure you are coding your eye care claims correctly, you must remain diligent with Local Coverage Determinations (LCD), National Coverage Determinations (NCD) and Medicare Administrative Contractors (MAC) in your area and sign up to receive payer listserv updates.

8. Use the correct modifier for Medicare cataract post-op management claims.

When you co-manage a cataract surgical procedure that a surgeon performed, be sure to use the correct modifier. If the surgeon has not filed the claim or files without using the correct modifier indicating surgical care only, your co-management claim will be denied.

In addition, it’s critical that you manage the patient’s transfer of care correctly and that it is medically acceptable (determination is made by the surgeon and the patient). Ensure that your billers use the correct Assumed Care Date (date postoperative care assumed by another provider) and Relinquished Care Date (date provider stopped postoperative care).

Review a patient case challenge and solutions in our Medical Billing Solutions for Cataract Post-Op Co-Management Guide.

9. Don’t confuse Medicare with Medicare Advantage.

If a patient has a Medicare Advantage plan, do not bill traditional Medicare. Medicare Advantage benefits vary from plan to plan, bill different out-of-pocket fees, and have rules for how you get paid for your services. That’s why having eligibility and benefits verification is a critical first step in the charge entry process.

For more billing tips, see our 10 Medicare and Medicare Advantage Billing Dos and Don’ts Guide.

10. Collect co-pays, coinsurance, and deductibles before the patient leaves the office.

One of the fastest ways to increase your cash flow is to develop (and follow) an upfront collection process in your eye care practice.

For instance, during check-in or check-out, if the patient’s vision or insurance plan includes a co-pay, coinsurance, or deductible, always collect before they leave the office.

Also, sending invoices before the due date reduces AR delays, helps avoid late payments, and increases your chances of getting paid on time. Open balances create a false image of your actual AR.

11. Calculate the ROI of outsourcing your eye care vision plan and medical billing.

Download our ROI to Outsourcing Eye Care Revenue Cycle Management Guide for a step-by-step guide to calculating the benefits and ROI of an end-to-end eye care medical billing service. With a complete eye care billing service, you can reduce office expenses, boost your revenue, and delegate critical medical billing tasks to a professional team.

Request a free practice analysis today and see how Fast Pay Health optometric billing consultants take a proactive approach to help you get paid faster and improve the financial performance of your practice. Spend more time focusing on your patients when they walk through the front door, during their visit, and after they leave.