Optometry Coding & Billing Alert

Hint: Compliance is as important as billing and coding when reviewing potential outsource companies.

If your eye care practice is considering transferring your billing and coding to an external company, you can’t simply close your eyes, point to a name in the Google search results and hope for the best.

Instead, you should think about three important factors that will ensure you’re hiring the most competent company that can increase your accounts receivables. Check out the following tips from Richard S. Kattouf, OD, DOS of Kattouf Consulting Services, Inc., to ensure that you find a great match when you select your billing and coding business.

1. Ensure That They Understand Vision Plans

Although the majority of medical specialties might be able to hire a generalized billing company, eye care practices should ensure that their potential billing and coding consultants have experience with vision plans.

“Most medical billing and coding companies will understand how to bill medical insurance, but if you want the company to do your vision billing in addition to your standard insurance coding and billing, you’ll want to find a company that has experience with that rather than just experience with medical insurance,” Kattouf says. “That’s because vision plans have their own nuances.”

2. Look for A Compliance Background

Ensuring that your practice is coding accurately is just as important as bringing in the optimal amount of reimbursement. “Many of the people trained in billing and coding are not trained in compliance, and if the doctor is found to be non-compliant, it’s a very big problem,” Kattouf advises. “When you’re evaluating billing and coding companies, this one factor can help you narrow it down, because so few are well-versed in the compliance issues.”

For example, ask the company what their HIPAA policies are, if they’re familiar with Stark and Anti-Kickback statutes, and whether they frequently monitor the CMS website for issues such as Correct Coding Initiative edits, changes to frequency guidelines, or information on new timely filing requirements, among other compliance issues.

3. Pair up With An Account Rep.

Rather than simply working with an entire billing company, Kattouf recommends that each eye care practice work directly with a specific contact at the billing company so you always know who you can get in touch with if you have questions about your account.

“It’s very important to have a check and balance system, whether your billing and coding are in-house or external,” he says. “We assume the billing company is looking at EOBs, and if the claim is denied we assume they’re resubmitting — but the only way to know for sure is to check in with them frequently. And if you have a key contact at the company, it’s much easier because you can call and say, “Hi Susan, can you tell me where we stand on A/R today?’” Otherwise the alternative is getting transferred from one person to the next before you determine who handled your claims that day.

“That type of follow-up is a big piece of the puzzle,” Kattouf says. “It allows the doctor to keep a pulse on their practice, which is very important to the success of your billing and coding program.”