Are you a healthcare provider who is beginning his optometry services and not sure about how to handle the optometry billing process? Or you can be a well-established optometry service provider with a huge amount of paperwork.
In both cases, you need optometry medical billing services to help you move forward through the paperwork and take better care of your optometry medical billing services.
It is only possible over time that one can become successful in optometry billing and coding. The biller must know what is the difference between medical plans and check-ups on a routine basis? The optometrist service can only be successful when you have well-organized optometry billing and coding services aligned. This ensures that your revenue cycle management is operating optimally.
Professional optometrists must know the importance of efficient optometry medical billing services for their healthcare practices. And those who understand this fact know that the most convenient way to streamline your revenue cycle is to outsource billing services to the experts.
Specialists like Unify Healthcare Services smartly take care of your administrative burden while you treat your patients with vision impairment.
Must-Follow Steps While Managing Optometry Billing
When you are doing billing and coding for your optometry practice, there are certain steps that you need to follow to get the most out of your revenue cycle.
To ensure you are following the right procedures, you must follow the following steps:
Wisely Select Insurance Panels and Their Credentials
It is important to do proper research on your end, before you select the insurance panels for your optometry practice. You need to find out who are the largest employers in your community. Along with that, you will need to know about the reimbursements on different vision plans.
The most important part that you need to take care of is that different states (and different carriers) have completely different credentialing rules. Therefore, you must have diverse approaches and you can’t apply one solution to different problems.
Judiciously Set Your Exam Fees
When you consider Medicare as your insurance provider, you can take assignments with that. As you accept assignments, it will increase the trust of your Medicare patients as their out-of-pocket expenses will decrease significantly. To get a good holdover on the charges of the medical exam fees, you must review the allowable of your state.
Properly Learn to Submit the Claim
To receive timely and smooth payments, it is important to know how to correctly submit your medical claims. One of the most efficient ways to submit your medical claim in Optometry is to use an EHR, a clearinghouse, and a reliable billing service provider like Unify Healthcare Services. When you have multiple tools, it ensures you can do a thorough inspection.
Know Thoroughly About Optometry Billing and Coding Procedures
It is a clear fact that the entire coding and billing procedure is best performed when it is outsourced to well-trained billing professionals. However, this doesn’t mean that you as an optometrist can entirely get rid of codes and bills. After all, it is your financials, and you must investigate it repeatedly.
Therefore, it is a doctor’s responsibility to get educated and updated on proper and ethical coding procedures. This ensures all claims are coded correctly. That starts with understanding which office visit codes that you are going to use in the entire procedure.
Let’s Break Down the Comprehensive Exam of Optometry CPT Codes
As soon as you set everything and are prepared for your claim submission, one thing that you must familiarize yourself with is optometry coding guidelines for medical and routine exams. A smooth revenue cycle means everything for your optometry practice. Therefore, it is important to keep detailed records along with following every rule and guideline.
Coding Guidelines in Optometry
Optometrists get the privilege to use both the 92xxx which are General Ophthalmological Service codes and the 99xxx which are Evaluation and Management codes. The 92xxx codes can only be used by eye doctors. These codes can be utilized for both medical and routine exams. On the other hand, 99xxx medical billing codes are utilized by all healthcare professionals. These codes are very specific to medical-only exams with other guidelines that you must follow.
CPT Codes 92004, 92014, 92002, and 92012
When we talk about the 92xxx codes, it has fewer guidelines to follow. It can easily be broken down into two levels, which are comprehensive CPT code 92004 and CPT code 92014, intermediate CPT code 92002 and CPT code 92012.
Description of CPT code 92004: Comprehensive, new patient, one or more visits. Medical examination and evaluation of diagnostic treatment program.
Description of CPT code 92014: Medical examination and evaluation with initiation or maintenance of diagnostic treatment program.
A retinal evaluation is included in the comprehensive exam. It is only performed once a year. The 92002/92012 eye exam CPT codes are more often used during follow-up visits.
The Procedure Codes in Optometry
Apart from the optometry CPT codes which are used during office visits, there are procedure codes that you must consider. It includes bilateral procedures 92250 Fundus Photos and 92083 Threshold Visual Fields. No matter how you perform the procedure on one or both eyes, there is a fee associated with them. In unilateral procedures like 65222 Corneal Foreign Body Removal a fee is charged for each eye when performing the procedure on both eyes.
Most Common Mistakes in Optometry Medical Billing Services
It is very common that optometrists who are extremely well-versed with the billing and coding procedures still make mistakes. Along with getting a detailed idea on how coding and billing practices impact your healthcare practice, it is equally important to understand the guidelines and various eye exams.
The most common mistakes that are committed in the entire procedure of optometry medical billing services are mentioned hereunder:
Not Understanding the Difference Between Routine and Medical
To ensure that you receive complete reimbursement for your optometry services, it is crucial to understand the difference between medical and routine exams. One thing that must be remembered is that there are more similarities between the two than the differences.
In most cases, it is the chief complaint and diagnosis which drives the exam. So, if the primary diagnosis is related to medicine and it also addresses the chief complaint, then there are high chances that it will be billed as a medical exam. You can’t assume that every patient complaining of blurry vision has a refractive issue.
Incorrect Use of Modifiers which Results in Denied Claims
The best way to describe a service is with the use of modifiers. However, if any modifier is used incorrectly, it can lead to denied medical claims for your healthcare practice. The most frequent modifiers for eye exams include:
- RT/LT for right and left eye/lid and E1-E4 modifiers. These modifiers differentiate right and left, inferior and superior lids.
- During an unrelated procedure, -24 modifier is used when a doctor performs an office visit. Example - when a patient had cataract surgery performed within the past 90 days and comes with an unrelated ocular issue in the other eye.
- When you perform two separate and unrelated procedures on the same day, the -25 modifier is used.
- When you manage a surgical procedure along with a surgeon, the -55 modifier is crucial.
Submitting Claims Before they are Fully- Credentialed
Another common error includes no proper credentialing or submitting claims before they are fully credentialed for an insurance panel. If the application is not processed and approved, it is not a great idea to see patients. If we talk about Medicare, here you can backdate claims, it is important that you establish a starting date before seeing Medicare patients. The starting date is typically the date when the application was processed in the first place.
Make sure that you properly identify patients and provide appropriate privacy measures for them.
How to Ensure an Efficient Optometry Medical Billing Process
When we talk about a smooth and seamless revenue cycle for your optometry practice, there are several steps that you must carry out vigilantly. Only then you’ll be able to receive your due payments for the services provided on your end.
Carrying out this cumbersome procedure along with diagnosing your patients is not feasible. You must have a team of experts that provide you with expert optometry medical billing services. Unify Healthcare Services are surely a great option for you to handle the entire process of billing. It is time to shift from the in-house medical billing team to the professionals by outsourcing medical coding and billing procedure to the professionals.
