Is your practice good about sending out patient statements on a regular basis? Do you have a process in place that ensures your patient accounts receivable is under control? If patient statements are a struggle for your practice, you might consider using an outside service. For example, if your clearinghouse is TriZetto, they can do your patient statements cheaper than you can usually do it in-house! You still have to review patient balances and upload a file, but then TriZetto takes over from there, saving you tons of time from mundane tasks like stuffing envelopes and running postage. Whatever your routine, having a good process in place for patient statements ensures you won’t miss out on money owed your practice!

We all know that HMO plans won’t pay for medical care without a referral, but you’d be surprised how often we get denials from insurance companies because the office saw the patient for medical care and no one got a referral. How can you avoid this? Always check the patient’s card! If it says “HMO” or has a primary care physician (PCP) listed, then the plan requires a referral for medical eye care.  Many of your insurance contracts put the burden for obtaining a referral on the provider, and the EOB shows the denial as a contractual write off. Even if your contract doesn’t stipulate and it’s your office’s policy that patients are responsible for getting all referrals, a courtesy reminder to patients can go a long way in gaining goodwill and saving the patient from a large bill they didn’t expect.

In a busy office, it’s inevitable that data entry mistakes are going to happen. Typos are going to happen. But every time a patient’s information gets entered incorrectly, it means the claim will reject or deny, and someone is going to have to do additional work to find the mistake. How do you keep this from happening? A few simple processes can help eliminate the majority of these errors!

First, at check-in always double check basic demographic information: Is the name spelled correctly? Is the address right? Do you have the correct date of birth? Next, ask for a copy of patients’ insurance cards, even if they say their insurance hasn’t changed, and always check that policy ID numbers are entered correctly into your system with alpha characters included but no spaces or dashes. Does the name match the card; is the spelling right? Is the relationship between the subscriber and patient correct? Always get both the patient’s medical and routine vision insurance information since you don’t know where the claim will be filed. Finally, scan the card into your system for future reference should the need arise.

Starting July 1, 2022, Aetna no longer requires precertification for cataract surgeries for any of their commercial or Medicare plans, with the exception of their Medicare Advantage plans in Georgia and Florida.  This is great news for optometrists. Not only are preauthorizations costly and time-consuming for the office, but waiting on the approval causes unnecessary delays in patients’ access to care.

Do you need help with your billing but have concerns about turning it over to an outside company?   You are wise to be cautious!  We get frequent calls from optometrists who have had bad experiences with outsourcing–for a variety of reasons.

• Medical billing companies don’t understand the hybrid world we live in that combines medical and routine vision.  Some companies hire employees with little experience and don’t give them the training and support they need to do the job well.  Some companies spread themselves too thin, taking on too many clients without the resources to adequately devote to each account.  Some companies outsource their accounts to off-site employees–some of whom are home-based and some who are located overseas, making it difficult for billing companies to control the quality and consistency of their work.

There are some things you can do to help protect yourself and reduce frustrations!  Recently we came across a great article published in AAPC’s The Coding Edge, a healthcare magazine for medical coders and billers.  The article was called “Ask the Right Questions Before Outsourcing Your Billing.” *  Here are the questions they suggest doctors ask billing companies before signing up for their services–and our answers to the questions!

1. What credentials/experience does the billing service have? 

• Optometric Billing Solutions has been in business since 2005.  The company is owned by Brooke Armstrong and Branda Barton, two sisters with degrees in Healthcare Administration who worked their way through college working as insurance billers at an optometric practice.  Before starting OBS, both managed large practices.

2. Does the billing company have experience in your specialty?

• OBS specializes on in optometric billing. We understand the unique demands of optometric billing that requires a knowledge of both medical and routine vision. We serve practices in over 40 states, so we know your insurance payers. We understand the rules that govern optometric billing and know how to help you increase your practice’s revenue, including coordinating benefits for maximum insurance reimbursement. Because we specialize, you benefit!

3. What kind of training does the staff have and receive?

• Optometric Billing Solutions currently employs over 120 billers, all of whom have received 3-4 months of intense training in optometric insurance billing. After training, new employees are assigned a mentor who assists and monitors their performance. Each biller meets weekly with a senior billing manager to review problem claims, and we have very specific billing processes to ensure your accounts are worked correctly, efficiently, and timely. We continually invest in our staff’s training because we know they are the backbone of our company’s success!

4. What is the procedure to protect the privacy of information?

• We log on to our client’s own system to file and post claims, so protected patient information never leaves their office!  Rather than using email, which can be compromised, we request and receive information from our clinics through  a secure Internet portal.  All employees receive training in HIPPA compliance and sign a confidentiality agreement.

5. What are the company’s technical capabilities?

• We live in a world of technology!  We currently work in six of the industry’s leading practice management softwares:  OfficeMate, MaximEyes, Revolution EHR, Crystal PM, My Vision Express, and CompuLink.  Before starting OBS, Branda worked as a practice management software consultant, so she has a unique working knowledge of how softwares work and utilizing them to their fullest potential.  OBS currently submits claims through the most popular clearinghouses, including TriZetto/Gateway, OptumInsight/Ingenix, Emdeon, Vision Web, and Apex.

6. How does the biller handle claim changes?

• If we encounter a coding error on a claim that will keep it from processing, we send the claim back to the doctor for review. OBS will never change the doctor’s CPT or diagnosis code without the approval or direction from the doctor. If the error is simply clerical in nature–missing IDs, incorrect insurance, incomplete demographic data, etc.–OBS will correct the information and file the claim.

7. What type of financial reporting does the billing company provide?

• Because we work directly through the clinic’s own software, the practice always has complete, real-time access to their insurance data.  There is no delay in waiting for an outside billing company to send information back to you.  Each month we compile reports on your AR trends and your optical staff’s errors in collecting on VSP glasses.

8. How is the billing company’s follow-up practices?

• OBS works unpaid claim on your AR report each month, and we’re experts at filing appeals if payers have processed the claim incorrectly.  Our goal is to collect every penny from insurance companies that your practice deserves.

9. How much will everything cost?

• Our fees are based on a percentage of your insurance allowable payments, not your billed fees, which is fairer to our clients since the latter requires you to pay on write-offs you can’t collect.  NOTE:  Practices need to be careful when comparing billing company fees to make sure they are comparing apples to apples, i.e., full billing services (auditing, filing, posting, AR, and follow-up appeals) vs claim submission only.  Companies who quote fees significantly below the industry average are usually not providing full services.  A la carte billing can be expensive, not to mention less effective if the company is not required to follow up on their own work.  Protect yourself by making sure the billing company’s fees and responsibilities are clearly outlined in a contract.

The staff at Optometric Billing Solutions are experts in our field, and we only serve optometrists. We know your profession and your payers, and because we specialize, you benefit.  We have a proven track record in maximizing insurance revenues, and a long history with each of our clients.  We still serve the first four clinics we started business with in 2005, and would be happy to provide you with references from our clients.  If you have questions, we invite you to call us at 877-727-3695.   We’ll be happy to discuss our services with you in greater detail and help you determine if OBS would be a good fit for your practice!

OBS was the first billing company in the country dedicated solely to optometry, and we’ve remained the industry leader since our beginnings in 2005. With clinics in over 40 states, we already know your insurance payers and their billing rules. Our staff of over 100 experienced billing specialists are unsurpassed in their knowledge and expertise.  Our clinics often see a significant increase in revenues, and because they’ve turned their billing over to professionals, the doctors and staff can now get back to the important business of taking care of patients.

Our experience in handling difficult claims, our expansive knowledge of insurance, and our know-how and tenacity in digging into a mountain of Accounts Receivables all mean a bigger bottom line for your practice!  You’ll also see improved cash flow with fast turn-around times for your claims.  Eighty-five percent of our claims pay within the first 30 days, and by 60 days 95% of all claims have paid!  And we continue to work on the remaining 5%, calling insurance companies and writing appeals.  Our goal is to collect every penny due to our doctors!

• Are you struggling to maintain control over your insurance billing and account receivables?
• Trouble finding or keeping trained billers who understand the confusing maze of insurance billing?
• Is your staff too busy to follow up on unpaid claims?
• Are you writing off thousands of dollars in uncollected money because you don’t have the expertise to get insurance companies to pay?

If so, you’ve joined the ranks of untold other optometric practices that are losing thousands of dollars in lost revenues and mounting ARs.

Optometric Billing Solutions can help!

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We‘re experts at:

• Submitting claims to ensure maximum insurance reimbursements

• Posting insurance payments accurately and quickly

• Managing Account Receivables, working EVERY unpaid claim

• Following up on problem accounts, researching and reprocessing so they pay out

• Serving as a professional resources for billing and insurance questions

• Helping set up procedures for effective billing processes

• Compiling monthly AR reports for the practice to track trends and monitor receivables

• Increasing the practice’s insurance reimbursement

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THE OBS ADVANTAGE:

Our services pay for themselves.

• We’re professionals who know how to collect every available dollar.
• We know your insurance payers, so we know how to maximize reimbursements.
• We can help you identify claims in which you’re consistently leaving money on the table.
• Claims go out clean the first time, leaving fewer unpaid accounts.
• When we do have an unpaid claim, we know how to follow up to get it paid.
• We’re experts at tackling your AR.
• You won’t have to worry about staff turnover, covering vacation time, or unpredictable cash flow because you’ll always have full-time professionals working on your accounts.

We’re experts in the field of insurance billing for optometrists.

• We only serve optometrists, so we understand the unique demands of a profession that requires a strong knowledge of both medical and routine billing and how to meld the two for the greatest financial benefit.
• We have practices in forty states, so we already know your insurance payers and their rules.
• We’re not an optometric department within some large medical billing company who mainly serves MDs; we are optometry, and we keep abreast of what is happening in the optometric field.
• Because we specialize, you benefit from our wealth of knowledge and expertise arising from a company who has been in business over 12 years.

We become a committed part of your practice.

• You’ll have a team of trained billers assigned specifically to your office, so we really get to know your clinic, your staff, and your patients.
• You can trust our billers to be absolutely reliable.  They’ll make sure your claims are filed within 3 business days, your weekly insurance payments are posted by deadline, and your month is balanced and closed on time.
• We’re accessible; you can reach us any time you have a question.  But most important, we take an honest ownership in your practice by doing the best job we can.  That’s just the nature of our company; we can’t give you anything less than our best.  We may be remote, but we are definitely not detached!

We’re a valuable resource for your practice.

• We’ve prepared training videos for your front desk and optical staff. (See the Office Training tab.)
• We’ll help keep you abreast of important insurance changes in the industry that can affect your practice.
• If we see common errors your staff is making, we’ll notify you and are available for staff training.
• If we see that your fees are under insurance allowables for your state, we can advise you and help you work up a fee schedule for maximum reimbursements.
• We track VSP errors on what your staff is collecting from patients and prepare a report so you can train your optical staff.
• Is your staff having trouble collecting patient copays or explaining the difference between medical and routine vision care?  We can with scripting to improve how they communicate with patients.
• Our clinics rely on OBS to help make their practice the best it can be!

At the end of the day, the bottom line is your cash flow, so improving your revenue cycle is critical for your business. Here’s a formula that has the power to turn your practice’s finances around:

Control Equals Cash Flow!

Simple, but very effective. If you have control over your claims, filing quickly and accurately for the best reimbursement you can get, you’ll increase your cash flow.

If an insurance company incorrectly processes a claim and you follow up in a timely and efficient manner, you increase your cash flow.

If you have collection and billing procedures in place to control your account receivables and keep denials to a minimum, you increase your cash flow.

Let us get you in control again and increase your cash flow!

Optometric Billing Solutions was founded on a mission to help doctors regain financial control over their insurance billing.  Our team of over 100 experienced billing specialists currently serve practices in over 40 states, and we believe they are the best trained in the country. Many of our staff have received medical coding and billing certification, and all OBS billers go through a 2-3 month optometric billing curriculum when they start at OBS to ensure they’re specialists in the optometric field.

We provide insurance billing for optometrists using all major practice management softwares: OfficeMate, Crystal PM, MaximEyes, Revolutions EHR, Compulink, and My Vision Express.  All OBS billers work in-house at our 20,000 sq-ft facility in Wichita, Kansas, because, unlike other companies, we do not feel we can maintain consistent quality if we outsource our accounts to off-site or overseas contractors.  Every OBS staff member is part of an in-house billing team headed by a senior manager whom they can go to for questions or assistance with difficult claim, and we consistently invest in staff training to keep our billing specialists up-to-date with changes in the industry.

Maybe it’s because we’re in the Heartland where a strong work ethic and personal integrity are so highly valued, but we know we couldn’t find a more qualified or hard-working staff.  OBS has enjoyed tremendous success since our beginnings in 2005, and we owe it all to this fantastic team!

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OBS is owned by Brooke Armstrong and Branda Barton, two sisters who have each worked in the optometric field for over 20 years.  Both started working as insurance billers during college as they earned their degrees in Healthcare Administration, and then each went on to manage large practices.  With the growth of electronic medical records in the early 2000’s, Branda changed career paths and spent several years traveling throughout the United States as a practice management software consultant. Over and over again, she found the same problems facing optometrists all over the country–the need for better control over the practice’s finances and specifically, their insurance billing.  In-house billers were often poorly trained and didn’t understand the sometimes complex rules required to get specialized claims to pay.  Doctors and staff members were busy seeing patients and no one had time to follow up on unpaid claims, so accounts receivables grew into a mountain of lost revenue.  And there were very few resources in the field of optometry to help.

It was out of this need that Optometric Billing Solutions was born.  In 2005 Branda and Brooke combined their wealth of knowledge and experience to start OBS, the first billing company in the country to specialize in optometry.  The response was tremendous and the need has never changed.  Today, OBS serves optometric practices in 40 states.  Our clinics range from small, one-doctor start-ups to ten-doctor practices in multiple locations. Our wealth of knowledge and proprietary billing practices have allowed us to help hundreds of doctors nationwide–and we’re still growing!  But our mission remains the same:

OBS Mission Statement

Regardless of your circumstances, if you have billing problems, we have answers!  

Practice Pointers is a series we recently published with great billing tips for busy practices. We’ve included some of the most popular posts here.

PATIENT STATEMENTS: Is your practice good about sending out patient statements on a regular basis? Do you have a process in place that ensures your patient accounts receivable is under control? If patient statements are a struggle for your practice, you might consider using an outside service. For example, if your clearinghouse is TriZetto, they can do your patient statements cheaper than you can usually do it in-house! You still have to review patient balances and upload a file, but then TriZetto takes over from there, saving you tons of time from mundane tasks like stuffing envelopes and running postage. Whatever your routine, having a good process in place for patient statements ensures you won’t miss out on money owed your practice!

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CO-MANAGES FOR SURGICAL POST-OPS. Co-manage post-ops have a 90-day global period, and you’re paid one time for all care related to the surgery in the ensuing 90 days, regardless if you see the patient two or ten times. So how do you bill out multiple post-op visits if you’re only paid once? We suggest that you create a fee slip with charges to be filed to the patient’s insurance on the first post-op visit. Then on all subsequent visits, create a fee slip with the description “Continued Care” with a zero charge. How much should you charge for a post-op? Medicare generally attributes 20% of their surgical reimbursement to follow-up care. Therefore, a good rule of thumb is to look at Medicare’s fee schedule and set your post-op charge above that 20% mark since commercial insurances usually have higher allowables.

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MEDICALLY NECESSARY CONTACTS.  When you see patients with high prescriptions (10 dioptors or greater) or anisometropia (a difference of 3 dioptors or greater), don’t miss the opportunity to file medically necessary contacts to their routine vision insurance. Most doctors know routine payers like VSP and EyeMed will cover med nec lenses for medical conditions like keratoconus or corneal dystrophy, but not everyone is aware that high scripts will also qualify their patients. Medical contacts reimburse practices well and patients appreciate that you’ve significantly increased their benefit to cover a year’s supply of contacts. It’s a win-win!

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THINGS TO CONSIDER BEFORE CHANGING PRACTICE MANAGEMENT SOFTWARES. Branda is always getting calls from doctors or office managers who are considering switching their practice software, hoping to eliminate the annoying quirks and irritations in their current system. OBS works with six of the largest practice management softwares in the industry as well as several others in the past, so we have a lot of experience. Here’s the first thing you need to know: there are no perfect softwares! They all have their own unique foibles and frustrations, so you may be just trading one set of problems for another. Also, changing softwares is a huge investment, not just in money but also in time. A new software creates a large learning curve for your staff, causing additional errors, considerable downtime, and lost production as everyone gets up to speed. So if you’re an OBS client considering a software change, please get on Branda’s calendar before you make your final decision. She can give you the pros and cons of each and help you make a good decision about that’s right for your practice!

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BILLING RELATIONSHIP FOR CHILDREN ON MEDICAID.  When entering children on Medicaid into your software, please remember to mark the “relationship to insured” box as SELF! We often see these children marked as “child” because it just seems to make sense. However, a child Medicaid patient is technically his/her own insured, and almost all state Medicaids will deny claims if this relationship is not marked correctly.

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HIRING THE RIGHT PEOPLE is critically important to any company, but too often it seems things can go wrong. However, there are some steps you can do to increase your chances of getting the right people hired for the right positions.  Some of our best new hires come to us as referrals from current employees. We find that good people usually refer other good people. There is truth to that old saying “birds of a feather”– bright, reliable people tend to associate with other bright, reliable people and can be a great resource for your practice. So if you’re getting ready to hire, put the word out among your current staff and ask them to recommend any one they think would be a good fit for your opening. You may very well find your best recruiters are already on your payroll! 

GROUP INTERVIEWS AND ASSESSMENT TESTING are two great ways of getting good information about a lot of different people in the shortest amount of time. Based on their resumes, we invite the best potential candidates to an evening group applicants’ meeting. We also ensure we have 4 or 5 OBS managers attending because the more input we have afterwards on the job candidates, the more reliable our mutual consensus. The group interview consists of three parts. First, we talk about our company and answer common questions about the position, saving us time by doing this once rather than repeat the same process over multiple individual interviews. Second, we have the applicants complete two short assessments related to skills important to a billing position: simple math and basic reasoning. These assessment tools help us identify who will likely be the most successful in the position, especially the reasoning test that pinpoints people with good critical thinking skills. In a practice, your needs may be a little different, but try to assess whatever skills are necessary for the position. For example, a brief personality survey could help identify self-confident, task-oriented individuals who won’t be afraid to ask for money at the checkout position. And finally, we give the applicants a short tour of our facility, allowing us time to visit with each individually in small groups of 2-4 people. We don’t ask interview questions at group meetings or put the applicants on the spot in front of other people. The whole purpose of the group interview is just to gather information. Within a space of two hours we are able to assess 15-20 people simultaneously and reduce the field to the best 4 or 5 candidates whom we want to bring back for working interviews. 

ONE-ON-ONE WORKING INTERVIEWS are the best way we’ve found to see how a person will actually perform in the position. The group interview allowed us to compile a short list of best candidates; the working interview allows us to narrow the field to the final one or two. We strive to make the working interview as real-world as possible. At OBS, we show the applicant around the billing software, talk them through the claim auditing process, and then ask the candidate to file actual claims. At an optometric practice, however, you might have the job applicant answer phones, enter patient data in the computer, and schedule appointments. The point is to allow the applicant to hop in and interact with patients, watching how well they retain information and how well they handle themselves. At the end of the day, you will be able to identify which candidate performed better than the others, and by now you’ve also spent enough time with each one to evaluate other employment considerations such character and personality. Now you are ready to offer the position to your top choice with the confidence of knowing you have done everything possible to ensure you’ve hired the right person for your position!

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FEES CAN’T VARY BASED ON INSURANCE. One important rule of insurance billing is that you have to charge all patients the same way regardless of their insurance coverage. We’ve seen offices who have decided not to charge their Medicare patients for the refraction because they know Medicare doesn’t cover this service. While wanting to help out their older patients is admirable, practices could be in serious trouble when they go through an insurance audit. You cannot write off a service for Medicare patients unless you’re writing off the service for all patients. You cannot treat a refraction as content of service to the exam for Medicare and not treat it as content for all other insurance carriers. If you have any questions about this or other billing considerations, do not hesitate to call your coordinator! We’re here to help!

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EVERY DAY SHOULD BE A STAFF APPRECIATION DAY! Successful practices know how important enthusiastic staff members are to their overall success. Employees who are excited to come to work each day make an invaluable contribution to your patients’ positive experience in your office. And it is a wise doctor and office manager who understand that what keeps many of their best employees motivated and enthusiastic is a feeling of appreciation. Frequent words of praise and genuine expressions of gratitude for work well done lets employees know you recognize their contributions and consider them a critical part of your healthcare team!

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ONLY DOCTORS CAN CODE THEIR EXAMS! Sometimes when we audit claims prior to submission, we come across obvious coding errors that need to be sent back to the doctor to review. Generally it should always be the doctor who reviews and updates the chart record. We’ve seen instances in which staff members have taken it upon themselves to correct the coding, always with the best intention to save the doctor time. However, only the doctor has the authority to authorize changes in the official record. Even in those cases where the practice has hired a certified coder, it is still the doctor who is legally and financially responsible.

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GLASSES AFTER CATARACT SURGERY. We see a lot of confusion about where to file glasses after cataract surgery. If your patient is insured by traditional Medicare, then the glasses are filed to DMERC, not Medicare, but you have to be credentialed with DMERC, a separate credentialing altogether. However, if your patient has a Medicare Advantage plan, then the glasses are filed to the replacement plan, not DMERC.

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MEDICAL TESTING DURING A ROUTINE EXAM.  We recently had a good question from one of our offices. A patient came in for a routine eye exam without any medical symptoms or complaints. However, during the exam, the doctor identified a potential medical issue and ran some additional medical testing. The office wanted to know if they could bill the exam to the patient’s routine vision plan based on the patient’s chief complaint but still bill the testing to his medical carrier. The answer is yes! Depending on your software, you may want to enter the testing on a separate fee slip for ease of billing,

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CODING YOUR PRIMARY DIAGNOSIS:  It’s important for doctors to order their diagnosis codes so that their claims will process correctly. The first diagnosis should always be the main reason for performing the exam based on the patient’s chief complaint or symptoms, and the exam should always be pointed to the first diagnosis in position A. We see some docs who point the exam to a diagnosis in a secondary position, but these claims can deny since some insurance companies just look at diagnosis position and not pointers.  So if doctors please remember to list the primary diagnosis in the first position and point the exam to A, you’ll avoid a lot of unnecessary denials!

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NEW INSURANCES:  Always ask for patients’ insurance cards at each annual visit. Patients don’t always remember they’ve switched insurances or understand that a Medicare Advantage plan is not the same as Medicare. If you do find a patient’s insurance has changed, please scan a copy of the new card, enter the new insurance in your software, and deactivate or delete the old. However, you cannot deactivate the old insurance if there are still outstanding balances attached to it, so move it to the bottom of the list. The new insurance should always be in the first position under the insurance tab so that it is clear it is now primary. This will allow OBS to file the claim to the correct payer and avoid unnecessary delays in claims processing!

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LOCAL COVERAGE DETERMINATIONS, OR LCDS. Medicare, Aetna, and some Blue Crosses will not pay for medical testing unless it’s pointed to an approved diagnosis that they consider establishes medical necessity. Medicare calls their approved diagnosis lists LCDs, or Local Coverage Determinations. Please ensure when you do medical testing for these payers that you have an approved diagnosis in the record to avoid unnecessary denials. If you do not have a current list of LCDs for your area, please ask you coordinator to email these to you!

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MEDICARE SUPPLEMENTALS. It’s hard for checkout staff to know what to collect from Medicare patients if they don’t understand coverage for Medigap, or supplemental plans. So we put together the chart below to help! Medigap C and F plans (refer to patients’ cards) are the only supplemental plans which will pick up the Medicare deducible, but all of them pay patients’ coinsurance, with these exceptions: Plans K and L only pay a percentage until a max limit is satisfied,and N plans have a deducible that has to be met first. Of course, routine services like refractions are not covered on either Medicare or Medigap plans. Hope this chart helps you know what to collect the next time you have a Medicare patient in your office!

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TRADITIONAL MEDICARE VS ADVANTAGE PLANS:  A reminder for front desk personnel: Patients cannot have both traditional Medicare and a Medicare Advantage plan. Over 25% of seniors have opted for a replacement Medicare policy managed by a private insurance company, but they often don’t understand this distinction. If the new card says “Medicare” or “Advantage,” then it’s probably a replacement plan, not a new supplemental. Deactivate Medicare and enter the new insurance. Advantage plans eliminate the need for a supplemental insurance so you can deactivate their former secondary insurance as well. Not sure? Most Medicare websites or IVRs can tell you if the patient has opted for a Medicare replacement plan. One last thing to keep in mind: some Advantage plans are HMOs so you may need a referral.

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SCANNING INSURANCE CARDS: If your practice doesn’t currently scan patients’ insurance cards, please make this a priority in 2018! Offices frequently have to refer back to insurance cards to correct ID numbers, verify name spelling, locate claims address, find EDI payer IDs, or determine if the policy is an HMO.  A scanned card always ensures your staff has this information at their finger tips and don’t have to waste time trying to contact patients to confirm information.

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MEDICARE REMINDERS:  When you see Medicare patients at the beginning of the year, you can check how much of their deductible has been met on most Medicare websites or IVR. Clearinghouses like Trizetto also offer this service, and you can often sign up to get this information on Availity. Secondary Medigap B, C, and F policies usually pick up the Medicare’s deductible, but collect the noncovered refraction!  Also, remember to always check seniors’ insurance cards at the beginning of the year since they may have changed to a Medicare Advantage plan.

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DOES YOUR OFFICE VERIFY BENEFITS? It’s always a good idea to know patients’ insurance coverage and what they will owe prior to seeing them. This is the only way you can collect correctly at checkout. We know this takes time, but offices who don’t verify benefits usually end up spending just as much time and even more resources on the back end trying to collect from patients whose testing applied towards their deductible or exams denied as not covered. In some cases, billing the patient after insurance processes may mean you won’t collect at all. We all know it’s easier to get payment at time of service rather than weeks later.

If your office is struggling to find the time to verify benefits, here are some suggestions that may help: Pretesters often have downtime late in the morning after the doctor sees his/her last patient before lunch. This is a great time to start calling on benefits. Utilize web sites. Most insurance companies allow you to look up plan benefits, deductibles, and copays online. Most clearinghouses like Trizetto provide this service.  When you do have to call insurance companies for benefits, inquire about several people at once to save time. And finally, if your staff is too busy throughout the day, have you considered hiring a part-time person, like a reliable college student, to work a couple of hours every day.

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ALWAYS CHECK THE INSURANCE CARD TO SEE IF IT’S AN HMO!    We all know that HMO plans won’t pay without a referral, but you’d be surprised how often we get denials from insurance companies because the office saw the patient for medical care and no one got a referral. How can you avoid this? Always check the patient’s card! If it says “HMO” or has a primary care physician (PCP) listed, then the plan requires a referral for medical eye care.  Many of your insurance contracts put the burden for obtaining a referral on the provider, and the EOB shows the denial as a contractual write off. Even if your contract doesn’t stipulate and it’s your office’s policy that patients are responsible for getting all referrals, a courtesy reminder to patients can go a long way in gaining goodwill and saving the patient from a large bill he/she didn’t expect.

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MEDICALLY NECESSARY CONTACTS ARE A WIN FOR PATIENTS AND PRACTICE ALIKE!   If your clinic doesn’t do medically necessary contacts, you really should take a look at your processes. These can be a huge benefit for both you and your patients. Also, did you know that med nec lenses are not just for keratoconus or corneal dystrophy/transplant patients? Most routine payers like VSP and EyeMed extend medical contact benefits to patients with high prescriptions (>10 dioptors) or anisometropia (>3 dioptors). The process for filing with VSP and EyeMed is pretty straightforward and simple. (Not so with medical payers, however!) For patients who qualify, you’ve not only maximized your patients’ benefits and gained their gratitude, but you’ve also opened an important new revenue source for the practice since these lenses reimburse well.

If you’re an OBS clinic, we have a training video on our website that covers medically necessary contacts with VSP that you and your staff may find helpful. Also, don’t hesitate to call your coordinator for more information!

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NEW AOA GUIDELINES RECOMMEND ANNUAL EYE EXAMS FOR ALL CHILDREN. Based on new research, the American Optometric Association now recommends school-aged children have an eye exam every year. How frequently are you seeing your youngest patients? Children’s vision can change quickly, and with each progressive year the visual demands in the classroom increase significantly. If you’ve been hesitant to ask children to return to the office each year because of the old guidelines, you can now have the confidence to tell parents that you need to see their children on an annual basis, even if they’re not in a script.

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Glasses after cataract surgery can be really confusing for some of our practices, so let’s see if we can help you out! If your patient is insured by traditional Medicare, then the glasses are filed to DMERC, not Medicare, but you have to be credentialed with DMERC. However, if your patient has a Medicare Advantage plan, then the glasses are filed to the replacement plan, not DMERC. If the patient’s primary insurance in a commercial insurance, file there.  Hope that helps!  And please remember, any time you have a billing questions, don’t hesitate to call your coordinator.  We love sharing our expertise.

The beginning of the year is a great time for clinics to review their fee schedule to ensure they’re getting reimbursed fairly from insurance payers.  Every practice needs to periodically review their fees to make sure they’re charging enough. One of the best ways you know it’s time to increase fees is if you’re not taking a write-off when we post your insurance payments. If insurance companies are allowing everything you charge, it means they’d actually pay you more if your fees were higher! For practices who need help deciding where to set their fees, Medicare is a good place to start. All Medicare jurisdictions publish their fee schedules, and the information is easy to find with a simple Google search. Commercial medical payers usually won’t give you a copy of their fee schedules, but their allowables are generally higher than Medicare’s. Many practices set their fees 25-30% above Medicare allowables. If you’re an OBS client, don’t hesitate to ask us to review your fee schedule with you! With clinics in 41 states, we are very knowledgeable about what insurances allowables are for your area, and we can do an analysis and let you know where you may be undercharging based on your insurance payments.

March 2022.  For several months, VSP has been experiencing a glitch with the way they process dual benefit coordinations for glasses. Even when opticians files the COB correctly, VSP has been processing the coordination wrong. On the VSP remit, the patient will have two back-to-back claim entries, but both process as primary, costing the practice money. As OBS billers come across these errors, we are calling VSP and asking them to correct it.

As many optometrists are aware, the CDC and AOA have both recommended all routine eye exams be rescheduled because of the coronavirus outbreak.  Medicare has also issued three new coding options to help address the challenges COVID-19 is presenting to optometrists.

First, optometrists are now allowed a VIRTUAL CHECK-IN with patients for follow-up visits.  If the physician has not seen the patient within the last seven days and will not see the patient again for 24 hours, they can use this option.  Virtual check-ins are 5-10 minute visits over the phone or using captured video or images that are billed with G codes.  Physicians can’t bill this option if they decide to have the patient come in within 24 hours.  G2012 is used for telephone follow-up visits and G2010 is for captured video or images. The reimbursements for these G codes are generally low, around $15.

The second option, called ON-LINE DIGITAL EVALUATION, is communication with patients through the physician’s online portal. If the patient initiates the portal contact, the physician can bill for the cumulative time they spend communicating with the patient over a seven day period, provided they don’t see the patient for a medical visit within 24 hours. Previous HIPAA requirements or the capabilities to store these patient communications have been waived during the COVID-19 emergency. The billing codes are based upon total time spent answering the patient through the portal: 99421 is for 5-10 minutes and reimburses around $15.52; 99422 for 11-20 minutes, $31.04; and 99423 for 21 or more minutes, $50.16.

Finally, Medicare’s new COVID-19 guidelines allow for TELEHEALTH SERVICES. These are office visits conducted over video applications such as Facetime or Skype and are billed with the 99-series evaluation and management codes, such as 99212 or 99213.  The 92-series eye exam codes do not apply.  Unlike previous telehealth guidelines, this option is no longer restricted to remote or rural areas, the patient can be at home, and providers do not have to use a HIPAA compliant software, only any real-time audio and video for live, interactive telecommunication between the provider and patient.  Billing for telehealth exams requires some software setup for required modifiers and place of service, so if any of OBS doctors decide to utilize this option, please notify your coordinator or Branda so that we can ensure the claims have the proper coding.

So far these three billing options have only been approved by Medicare, but because Medicare sets the gold standard in billing, other commercial payers often follow. Some commercial carriers may already have other remote billing options in place for telephone evaluations. We can only advise providers to check with their local commercial insurance carriers to see what options they may have to continue to provide medical eye care to patients throughout this emergency.

Here are links to the AOA webinar held on March 17 that covers Medicare’s changes in more detail:   AOA Recorded Webinar     Link to PowerPoint