Ophthalmology and Optometry Coding Alert

Keeping track of how Medicare wants you to file claims can be difficult, but when it comes to commercial HMOs, employer-sponsored plans, and indemnity plans, it's even harder. And once you do nail down a company's requirements, the requirements seem to change.

It's a bowl of Jell-O, says John S. Bell, CEO of Maine Eye Care Associates in Waterville. Everything is always shifting. Follow these steps to keep denials down:

1. Write a letter. Bell's solution is to find out how to file a claim before it gets denied. The best way to do that, says Bell, is to get it in writing from the carrier. Because few carriers will actually put something like this in writing, he does it for them. Most of the time they make a phone call to tell us how to file, so we take notes and send a letter back to them, he says. In the letter, you can say something like, Per our phone call, this is how you want us to file this claim. This way, you can file future claims correctly and minimize the extra time and money spent trying to recoup on denialsor worse, just letting denials stand and never getting paid.

2. Follow up on denials. The other recommendation is to follow up every denial expeditiously. A lot of practices don't do a good job of following up on denials, he says. They never collect for the services and never find out what they did wrong, so they can't correct it before similar claims are submitted.