Ophthalmology and Optometry Coding Alert

Question: We performed a self-audit two months ago and identified over a dozen denied claims that we didn’t actually realize had been denied. We’re trying to put processes in place so this doesn’t happen in the future. What tips do you recommend?

New York Subscriber

Answer: As you’ve clearly discovered, it’s important to catch denials before they pile up. The cost to follow up denied claims is very high, which increases billing costs and negatively impacts the bottom line.

Do this: Set a schedule when you’ll run reports to identify unpaid claims in the system. Utilize both activity reports and claim date reports to ensure all claims are worked. You can even configure the reports to run from the oldest date of service to the newest, or you can group them by payer to see where you’re recouping the most and the least reimbursement.

Remove untimely claims from the workflow: Once you identify claims that are delayed or on appeals, you should set them aside. This will allow you to address those issues directly rather than just leaving them in the pipeline with the paid claims.

Perform month-end closeouts: Always post payments on time to patient accounts and perform a month-end close out. That way, you are always timely in letting the patient know their balance. If you fall behind, then the whole system falls apart.