Optometry Coding & Billing Alert

Result: Healthier, happier patients, and a more profitable practice

Referrals are key to good patient care and profitability. Don't let the front desk be a weak link in the referral chain.

During referrals, patients can get lost between doctor's orders, insurance policy guidelines and office staff asking them for authorization forms. You can help make the whole process easier on them -- and yourself -- by thoroughly understanding how referrals should work. With a little savvy and advance planning, you can make the paperwork shuffle a much smoother process for everyone involved.

Much of the responsibility for the referral process falls to the primary care physician's office, not the optometrist. For example, the PCP provides authorization numbers and ascertains which health insurance policies cover which specialist referrals.

"The primary care doctor is the 'gatekeeper,' " says Cathy Berto, CMM, CHRM, past president of the Professional Association of Health Care Office Management and assistant administrator for Osler Medical Center in Melbourne, Fla.

"When you are dealing with an insurance company that requires authorization to see a certain specialist, it is the primary care doctor's receptionist who should get that authorization," Berto contends.

The good news: Many insurance companies make the necessary forms accessible on the Internet. "Not only can you do authorizations online, but you can verify eligibility and check claims," Berto says.

The Web can also be a valuable resource for important information regarding your practice's preferred specialists and providers. You need to be aware of which insurance plans your practice participates in, and keep up-to-date on the referral and authorization procedures of those plans. Logging onto insurance company sites is a quick and easy way to stay in the know.

Despite all the responsibility on the primary care side, the optometrist's office plays an important role in following through to make sure they complete and approve all the necessary forms. Some optometry offices may be tempted to leave the task of providing authorization up to the patient, but that may not be in your best interest.

"You know that if you do it, you're going to get it done," Berto asserts. In other words: To be sure an insurance company has authorized a referral, the receptionist should get confirmation for each patient who comes to the office from another doctor. This way "you're not going to waste anyone's time if the patient shows up without that authorization," Berto adds.