Ophthalmology and Optometry Coding Alert

Some practices are seeing revenues that are half of what they were before COVID hit.

The COVID-19 pandemic has created a ripple effect throughout medical practices, prompting patients to avoid preventive visits in some cases because they are nervous about having face-to-face contact with other people. If your practice has lost money during this period, you may be looking for ways to boost revenue.

“I’ve seen revenues at ophthalmology practices down by 50 to 60 percent,” says Patricia Morris, MBA, COE, an ophthalmology consultant based in New York, New York. “Some eye care practices just aren’t able to go back to the volume they saw before. Even if patients return to the practice after the lockdowns, some physicians are having to space patients further apart due to social distancing and cleaning protocols, causing income to drop.”

To ensure that you’re bringing in as much cash as possible during this slower period, Morris has identified 10 ways that you can optimize reimbursements.

1. Don’t Overlook 99072

When creating your payment strategy during the public health emergency (PHE), don’t forget about 99072 (Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted  infectious disease), Morris says. The AMA created this code “in response to the significant additional practice expenses related to activities required to safely provide medical services to patients in person during a PHE over and above those usually included in a medical visit or service,” according to the 2020 Special Edition September Update of CPT^® Assistant

“I advised several eye care practices to try it and to start at about $125 or so, and initially Aetna was paying $40, Cigna was paying $50, and another practice got $150 from a Medicaid state plan,” Morris says. “However, Blue Cross started paying $6.72 because Medicare said they would price it that way, even though they haven’t started paying it yet. So a lot of practices need to start using that if they aren’t already.” However, you should not bill the patient if the plan denies the code, she notes.

2. Maximize Telehealth When Possible

Telehealth can be difficult in ophthalmology, Morris says, “although I’ve seen a lot of ingenuity in the programs that could bode well for the future — there may be a possibility of doing a slit lamp exam someday via telehealth although that’s still in the research and development phase.” She urges practices to transition from the types of telehealth technology allowable during the PHE and formalize a compliant telehealth strategy.

“We’ve been spoiled in the last few months with the relaxed telehealth rules, but it’s a good time to shore this up and be as HIPAA-compliant as possible and use the right systems,” she notes. “Right now, for instance, you can use FaceTime or other programs like that, but the rules won’t be this relaxed forever, so it’s important for providers to make telehealth a focal point.”

3. Check Your Managed Care Contracts

When it comes to your practice’s income, it’s important to review the reimbursement rates in your managed care contracts, and sometimes that means renegotiating those rates, Morris says. Have a panel at your practice, including clinicians and the billing team, review the contracts to determine whether any changes are necessary to boost your reimbursement.

4. Double-Check A/R, Fee Schedules

You should review the accounts receivables (A/R) aging monthly and pay close attention to the “over 90-day” column. Instead of just rebilling the claims, follow up by phone and build a rapport with the claim reps. Collect all patient copays, refraction fees, and the 20 percent on surgery cases when no secondary insurance exists, and update the practice’s fee schedule regularly.

“Sometimes a practice hasn’t updated their base fees for five years, so they’re leaving money on the table,” Morris notes. “The insurance company is not going to tell you they pay out more than you are billing. They will continue to pay you your rate while paying other providers 10 percent to 15 percent more for the same code.”

5. Perform Internal Audits

Although you might assume all of your services are being coded, the only way to know for sure is to perform an internal audit, Morris says. “I had a practice who told me their reimbursements were down despite seeing nearly the same number of patients that they saw pre-COVID, so I took a look,” she said. “Their biller had left during COVID, and they weren’t using an eye care-specific revenue cycle management company when they outsourced the billing functions. It turned out their OCTs and visual field tests were not getting billed and because that billing company wasn’t attuned to eye care coding, they just billed everything out with routine vision procedure codes and those reimbursements are much lower. So from July through the end of September, they were billing every patient with the routine exam procedure codes and diagnosis codes and none of their diagnostic testing was getting coded so they weren’t getting paid.”