KC Royals are 2015 World Series Champions!

11.3.15   In celebration of the Kansas City Royals winning the 2015 World Series, OBS hosted a Royals Spirit Day with lunch for the staff, complete with grilled hot dogs, hamburgers, chips, and slushies.  We even roasted marshmallows over bunson burners and made S’mores for dessert! We couldn’t be in Kansas City for the big parade today, but we had our own party right here! Everyone wore their favorite Royals gear and we had a “fan”-tastic time!

Congratulations to the 2015 World Champions, and thank you to Branda, Bob, and Kathie for a great lunch!

WAY TO GO, ROYALS!!

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OBS HALLOWEEN PARTY WAS A HUGE SUCCESS!

10.28.15   The annual OBS Halloween party was a huge success, just ask our kiddos!   Everyone dressed up in great costumes, and after dinner the children had a wonderful surprise–an after dark Halloween Hunt by flashlight for glow-in-the-dark skull eggs!  The OBS staff loves getting together with all our families, and Halloween is one of favorite holidays–you can tell from the pictures below!

More Halloween Pictures!

10/16/15.  The staff surprised Brooke and Branda on Bosses Day.  Nothing says we appreciate you like balloons and flowers!

There’s been much written to help doctors prepare for the ICD-10 deadline coming this fall, including upgrading your software, tracking your most common diagnosis codes, training your staff, monitoring your processes, checking your systems, etc.  The purpose of this article is not to repeat the laundry list but to add an important consideration that most experts are leaving out–practices need to prepare financially for delays they may see in insurance payments.

The implementation of ICD-10 means the entire medical industry and all its partners will participate in a gigantic systemized dance that must be perfectly synchronized to succeed.  The last time we saw this happen was the 5010 conversion of ANSI claim files in 2012, which created havoc in the industry and delays in claim payments for months.   ICD-10 has the potential to be even more problematic because of the gigantic scale of this massive overhaul.  Every doctor, staff member, software vendor, clearinghouse, and insurance company must be ready simultaneously and have done their due diligence in preparation, testing, and correcting any missteps before the deadline hits. If one fails, at least that part of the system crashes.

Hopefully, the insurance industry learned some important lessons in 2012–start earlier, test more thoroughly, have system backups and personnel ready to meet the challenge.  However, to be safe, doctors would be wise to lay back a cash reserve to help carry them through the transition if we see similar issues that delayed the transmission and processing of claims.

Here’s the good news for our clients, however.  Optometric Billing Solutions weathered 5010 very well, and we expect to do the same with ICD-10.  While we can’t control the preparation done by your office, software vendors, clearinghouses, or insurance payers, we have the processes and staff in place to ensure every claim gets paid as quickly as the system allows and that none get lost in the electronic chaos.  Because they had us as a safety buffer in 2012, most of our practices were not even aware of the turmoil that affected their colleagues, and we are already planning to make ICD-10 go as smoothly!

4/15/15  Update:  Last night the Senate passed the bill already approved by the House that prevents a 21% reduction in payments to Medicare doctors.  President Obama is expected to sign the bill into law.  Therefore, we are sending out all Medicare claims today.  They should now process correctly, and you should receive payment by month’s end.

4/3/15  Notice to our Clinics:  OBS is temporarily holding your Medicare claims from April 1 forward while Congress considers legislation to forestall a mandatory 21% decrease to Medicare doctors. Medicare’s sustainable growth rate formula has threatened automatic payment cuts to Medicare physicians for more than a decade. In the past, Congress has approved temporary patches to prevent these reductions from taking effect and is looking at similar legislation once again. Any Medicare claims filed after March 31 will process incorrectly if Congress acts to override payment reductions.  According to Congressional reports, we can expect to hear something by April 11th.  We will keep you posted on pertinent updates and file your Medicare claims once the situation is resolved.

Last year was a big year for OBS.  We simply ran out of room at our old building on West Central and had to make a decision.  We either had to stop helping any more doctors or make the decision to grow.  Of course we decided to continue to help doctors who needed our services!  We moved into our 20,000 square foot facility in August, and it’s been a wonderful adventure ever since!  Our new space and additional staff have allowed us to help more practices.  In order to ensure that we provide the same quality in our services with the new growth, we’ve added two more senior billers as Coordinators on our management team.  The role of the Coordinator is two-fold:  to assist our billers with questions as difficult claims arise and to help our clinics with whatever they may need.  Please know that these ladies are experts in their field and are here to assist you in any way that they can!

Below is a picture of our management team taken at a recent in-house leadership training.  The team meets weekly in our beautiful new conference room to plan and organize for the week.  We make sure to stay on top of  your billing so you don’t have to!

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EMPLOYER EXCELLENCE AWARD

On February 12, the Wichita Technical Institute presented Optometric Billing Solutions with their Employer Excellence Award in recognition of the work we do to support their Medical Billing and Coding program.  Many of our staff are graduates of WTI.  Brooke sits on their advisory board, and we serve as an externship site for some of their top students. OBS is honored to partner with WTI and are proud of our certified billers who are graduates of this outstanding program.

While WTI gives their students excellent training in medical billing and coding, when we hire one of their graduates we continue to expand their experience and knowledge. All new billers at OBS go through a rigorous eight week training program designed to make them experts in the field of optometric billing.  They must also learn very specific, proprietary billing processes to ensure accounts are worked correctly, efficiently, and timely.  After classroom training, all new staff members work with a mentor for another four weeks.  Mentors continue to monitor their performance and answer questions as they begin to work for our doctors, and new staff do not finish this training process until they can demonstrate a 95% accuracy rate or higher.  But to be fair, staff training never really ends.  All billers at OBS are assigned to a senior billing manager for continued help and support, and each month we provide in-service education to keep our billers abreast of changes in the industry.

Thank you, WTI, for recognizing Optometric Billing Solutions with the Employer Excellence Award, and we accept this honor on behalf of our staff.  We appreciate the strong education WTI has given so many on our billers and commit ourselves to continue providing our team members with the tools they need to be the best in our field!   For we know the tremendous success OBS has enjoyed rests in the high caliber of work and dedication of our staff!

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GO RED!   GO TEAM PUGA!

On February 6, Optometric Billing Solutions celebrated national Go Red for Women day in honor of our very own Brittany, aka “Puga.”  Brittany has been courageously battling heart disease since she was a young teenager and is currently a spokesperson for the American Heart Association.  We love Brittany and we love healthy hearts, so to show our support OBS went red!  Go Team Puga!

We are pleased to introduce our new OBS logo.  With the move to the new building, we felt this was the perfect time to complete our new look!  Our new logo symbolizes a rising profit line and represents our commitment to help our clinics increase their insurance revenues.  We file claims quickly and accurately for the best reimburse- ment we can get.  If an insurance company incorrectly processes a claim, we follow up in a timely manner.  We help put process in place to make our clinics more efficient and profitable, and we work insurance receivables each month to keep ARs at minimum.   In other words, we think our new logo of rising profit lines is a perfect symbol of our commitment to our clinics to help increase their bottom line!  

The move is over and we are in our new home at 10501 W. Hampton Lakes, Maize, KS 67101.  For those of you who don’t know, Maize is a suburb on the northwestern edge of Wichita.  Last Friday the mayor, city manager, and council members welcomed us with a ribbon cutting ceremony.  The city of Maize could not have been more gracious or helpful in facilitating our move, and we look forward to being a part of this community.

We took a picture of our staff to commemorate the move and thought we’d share the picture with you.  We could not be more proud of our dedicated team of billers!  OBS has enjoyed tremendous success since our beginnings in 2005, and we owe it all to this fantastic team!

As some of you know, OBS has been bulging at the seams for a while.   Therefore, OBS has found a larger home!   The renovations are now complete, and the entire staff will be moving into our new space on Friday, August 15th. 

We will not be available for phone calls from 7:00 pm Thursday night until 8:00 Monday morning.  We expect to be back online and fully functional by Monday, August 18.  In addition to our phone system, clinic spreadsheets and Information Request Forms housed on our server will also be unavailable.  We should be able to pick up any emails sent over the weekend on Monday.

Our new address will be 10501 W. Hampton Lakes, Maize, KS 67101.  Our telephone or fax numbers will not change.

Optometric Billing Solutions does insurance billing for optometrists in over 40 states, so we are very familiar with insurance payers in all parts of the country.  Because we deal with so many different payers, we’re accustomed to dealing with the occasional quirkiness that just comes with the territory.  It seems nearly every state has at least one carrier with a weird rule that’s outside of industry norms.  However, while an occasional commercial plan may have some random weirdness, a lot of state Medicaids have unusually demanding filing requirements that can make claim payment difficult if you don’t know how to traverse the red tape.

Not long ago, a large group our billers were in the break room when the subject of Medicaid came up, and many had horror stories about the lengths they have to go through to get their Medicaid claims to pay.  Common problems were rules outside of normal billing standards, short timely filings, website with antiquated software, difficulty getting representatives on the phone, long wait times, time-consuming forms to fill out for corrected claims, Medicare crossovers not working, and long wait times for payment–just to name a few.

However, if your practice has a Medicaid AR that is out of control, we have good news!  Regardless of how many rules your Medicaid payer has, our billers know how to get your Medicaid claims to pay.  We are experts at tracking down filing requirements, reading provider manuals, calling reps, and following procedures for even the most demanding Medicaids.  If you need help with your Medicaid claims, we invite you to call us.  We can help!

UPDATE: 

THIS EARLY BLOG HAS BEEN EXPANDED IN A MORE RECENT POST WITH A MUCH MORE COMPLETE DISCUSSION OF CODING EXAMS MEDICAL OR ROUTINE, AS WELL AS IMPLICATIONS FOR BILLING AND INCREASED PRACTICE REVENUE.  CLICK HERE.

When it comes to insurance billing, optometrists live in a unique world where they are forced to juggle both routine and medical insurances, and this duality of payers causes frequent confusion for both doctors and patients.  Over and over again we hear doctors ask, “When patients have both medical and routine insurance, who am I supposed to bill the office visit to?”

Over the years, we’ve heard all sorts of answers to this question.  In fact, if you ask a panel of experts, you are likely to get as many different answers as there are people on the panel.   Doctors who are seeking clarification on medical vs routine billing might be surprised to find a very good resource on this subject published by the largest routine payer in the industry, Vision Service Plan.  Per VSP’s policy manual, how you bill the exam is driven by the patient’s chief complaint. The chief complaint should be the primary diagnosis on the claim, and this determines whether you bill routine or medical.   For example, if patients present with no medical problems and report no medically-related symptoms and state the intent of their visit is to renew their glasses prescription, the exam is routine and should be filed to their routine carrier.  However, patients who come in because they have glaucoma or macular degeneration made the appointment to monitor their condition, and these exams are medical.  Here’s another important consideration:  Some patients’ medical insurance covers an annual routine eye exam.  What do you do in this case?  VSP guidelines say to bill the patient’s medical payer first and then coordinate with their routine plan. 

So if you are a VSP provider, VSP has given you some very helpful and fair guidelines to assist you in deciding whether to bill office visits as routine or medical.  Per their policy manual, you only bill VSP if the patient has no medical chief complaint and the patient’s medical plan does not cover an annual routine eye examination.  That’s pretty straightforward and serves as a good rule of thumb for doctors when trying to traverse the confusing world of medical vs routine.

The key to any successful billing strategy is understanding your options and obligations, solid documentation in your chart records, and excellent patient education and communication.

Medical insurances usually don’t cover contacts unless they are considered medically necessary–and even then, many don’t cover at all.  Contact lenses are defined as medically necessary when the patient has an eye disease or prescription that has to be managed with contacts  because glasses can’t provide sufficient correction. Examples of diagnoses that may qualify for medically necessary contact lenses are keratoconus, aphakia, post-corneal transplant, corneal dystrophies, ametropia, and anisometropia.

Many commercial medical carriers don’t cover medically necessary contacts.  If they do, you have to be careful about reimbursements on a commercial fee schedule. Sometimes insurance reimbursements are not enough to cover the office’s cost on specialty lenses because the newer technology is so expensive. Therefore, it is critical to call the patient’s insurance and verify benefits prior to ordering or dispensing contacts.  When checking benefit information, always get a dollar amount, not just coverage as a percentage of their allowance.  (For example, 80% can mean 80% of $150 or 80% of $1,200. You have to know!)  Ensure the insurance allowance is enough to cover your costs because you cannot charge your patient any overage.

Also, with commercial carriers you can file a claim for each office visit during the fitting process.   Routine vision carriers treat 92310 as a global fee; however, per CPT coding guidelines 92310 is not actually a global code.  Therefore, each time the patient comes into the office, create a claim with a per-visit fee when filing to commercial carriers.   NOTE:  If the patient’s diagnosis is keratoconus, some commercial companies require that the initial visit be filed with 92072. Follow up visits can then be billed with 92310 or some doctors use a lower level E&M code.

Please note that the rules for filing with routine payers like VSP or EyeMed are different and very clearly defined.  However, if you anticipate filing an insurance claim to a medical carrier, you’ve got to know the patient’s benefit before you start the process.  In order to help, we have attached a predetermination form your practice can use when verify benefit information with commercial carriers.  Just click on the link below!

Med Nec CL Predet for Commercial Ins