Medical billing for Optometry, like that for any field of medicine, is complex. Not only are the codes complicated, requiring a detailed knowledge of the practice in addition to understanding coding and billing, but they are changed every year. Additionally, insurers and government payers change their policies and plans frequently, and coverage rules may even vary according to the state you are in.
Coding and billing are complex tasks for optometrists due to the difficulties in meeting different levels of office visit, pressure of accurate documentation and lack of coding and billing experts. Time constraint makes it difficult for providers to handle the insurance reimbursement system due to which they don’t get paid for the services offered.
All this change makes it impossible for busy medical staff to keep up with the latest updates. Outsourcing to a professional billing company like ‘E2E Medical Billing Services’ has proven to be very successful for practices of all sizes. Improving collections is an essential strategy for revenue growth.
Modifiers must be used with basic medical billing codes to notate whether both eyes were affected, or if it was left or right. If a minor procedure is done the same day as an office visit, there is a modifier needed. Billers and coders must also know how to code for multiple procedures in the same setting, etc.
Many offices bill an OCT/GDX (CPT Codes 92133/92134) and fundus photography (CPT Code 92250) on the same visit. If you do not code this correctly, Medicare may deny both codes or only allow payment on the code with the lowest reimbursement.
Charges for services are often bundled together, which simplifies coding, but it also requires medical billers and coders to be aware of what is in each bundle because sometimes the physician may determine that something additional is needed or substitution is required. Billers must know how to document additions and exceptions properly, or those services will be considered unnecessary and rejected by payers.
A majority of claim denials are due to administrative errors. For example, the procedure code is inconsistent with the modifier you used or the required modifier is missing for the decision process (adjudication). Once you correct the errors, you can resubmit the claim to the insurance payer.
Optometry may be covered by insurance and it is covered by Medicare/Medicaid, but billers also have to be aware of which to bill. Before billing Medicare, the biller must make sure that no other insurance can be billed, including a spouse’s employer plan, Railroad Retirement, if the patient is a member of certain unions or has VA benefits, and even whether there is an injury covered by no-fault insurance.
Medical Billing Service Fee
Our average billing fee ranges from 2.5% to 7%. We offer add-on services like provider credentialing, old AR clean-up, and patient collection. We don’t have any start-up fee or software setup fee. We don’t use restrictive, long-term contracts. You can cancel your agreement at any time with only 30 days’ notice. You can call us at 888-552-1290 or request a customized quote by submitting the inquiry form below.
Our billing team has great expertise in following billing softwares. If you choose our billing services, you don’t have to change your current billing software. We will continue from the point where your last biller had left. So no claims or denials will remain unattended. In simple words, peace of mind for you.
Greenway Prime Suite
IMS – Intelligent Medical Software
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