Ophthalmology and Optometry Coding Alert

Stop leaking money by instituting a few quick fixes.

As COVID-19 cases continue to rise, more patients are cancelling their eye care appointments for fear of exposure to the illness. This has caused some ophthalmology and optometry offices to see dramatic financial losses, which they’re looking to overcome.

To ensure that you aren’t missing any hidden sources of cash, we sat down with Kashuna Hopkins, CPC, president of Favored Medical Billing in Phoenix, Arizona, who provided the following tips on areas that many practices may be missing, which can cause financial losses.

1. Ensure That Your Biller Has a Firm Grasp on Benefits

“There are some practices that just send out bills based on the patient’s insurance card, but that’s a quick way to lose money,” Hopkins says. “Make sure your biller and/or billing department really and truly understands insurance benefits and how they work, and you could avoid issues down the road that could cost you a lot of money.”

For example, she notes, a patient may tell you they have Blue Cross Blue Shield of California, but may not mention that they are covered under a medical group, and if you’re not with that medical group, “you basically are performing that visit for free.”

Here’s why: Patients who are assigned to medical groups (for instance, Kaiser) within their insurance plans typically can’t go outside that group, Hopkins notes. “So if you haven’t done your due diligence to figure out ahead of time whether you’re in network for a particular medical group that the patient is part of, you’re doing that visit for free.”

Therefore, it’s imperative that your billing staff not only performs pre-authorizations, but also verifies all coverage and network eligibility, she notes.

2. Get a Handle on What’s Billable

“I see a surprising number of practices that don’t bill for all the care they provide,” Hopkins says. “One exercise I have all providers do is walk through a visit and they tell me what they do each visit.”

She then draws up a list of all the billable services they perform, which can be shocking to practices that are simply reporting low-level E/M codes without understanding how their documentation can support higher codes or that they can also bill for things like tests and ancillary services in some cases.

“Once I see everything they’re missing, I create a superbill or cheat sheet,” she says. “If they do something and it doesn’t get written down, I remind them. So really be mindful of what happens at each visit.”

She suggests that practices should have their billers (whether in-house or outsourced) shadow their providers for a day to see if anything is missing. “You may find that the providers are doing a lot of things that they don’t actually dictate or record at all, and knowing what’s billable can be very eye-opening for a lot of practices,” Hopkins notes.

She recalls one of her clients that had a lot of progress notes that just said “postop visit” on them, all of which had $0 in charges on them. But in some cases, the provider was performing billable services during those postoperative visits. “I did some research and was able to increase our postop reimbursement by about $5,000 a month, where we had been getting zero.”

She also notes that you should stay on top of what’s payable, because something that wasn’t reimbursable last year may be payable now. “With the world changing and things like telemedicine becoming more common, everyone should be doing their homework to make sure they aren’t missing opportunities,” she notes.

3. Scrub Those Claims

Before sending out your claims for payment, you should be running them through a claims scrubber and even checking them manually, Hopkins notes. “I look over what was submitted quite often because I know providers forget things,” she said.

If you see anything missing on claims, you can correct the claim even if you’ve already submitted it. “Maybe the provider forgot something and didn’t document it. Everything they do is second nature; they’re not always thinking step by step what they’re doing. The same is true for coders and billers, so an extra once-over gives everyone that chance to capture anything additional.”

4. Run Aging Reports

Medical practices should perform rolling aging reports at least every 60 days to ensure that all payments have come in, Hopkins says. “The good rule of thumb is 60 days because it gives insurers time to process the claim. If you do it sooner than that, you may find you’re wasting time to call and follow up because the claim could still be in processing.”

Once you perform the aging report, you can identify which claims haven’t been paid and follow up on those. “If you are diligent about running your aging reports, you won’t have to write off charges because you’ll be sure that you’re collecting everything that’s owed to you,” Hopkins notes.