Turning Problems into Profits

PRACTICE POINTERS: TIPS FOR SUCCESSFUL BILLING

We offer a regular feature on our Facebook page called “Practice Pointers,” where we provide helpful hints for insurance billing.  If you’ve missed some of our posts, we’ve included a few of them here for in the hopes that you will find them helpful.   Or follow us on Facebook!   In addition to billing tips, we also provide fun posts about what’s going on at OBS, news updates about what’s happening in the industry, and important notices to keep your practices in the know!

 

 

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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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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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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2018 MEDICARE REMINDERS:  Medicare Part B annual deductible will be $183 in 2018, the same as last year. As you start to see Medicare patients in 2018, 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. And finally, remember that Medicare patients will get new cards and ID numbers beginning in April. It will be critical for your staff to scan the new cards and update the new numbers in your software!

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OFFICE VISIT AFTER CATARACT SURGERY: Here’s a question we recently got from one of our offices: Their patient had cataract surgery with a surgeon who doesn’t co-manage, but the patient wasn’t happy with his vision and came in for a second option. Since the patient was still within the global period of the of the first surgery, our office wanted to know if they could still bill for an office visit? The answer is yes! Since the office isn’t co-managing and billing under a separate tax ID, they can bill a normal office visit and get paid!   (OBS also had a question:  Why are you referring to a surgeon who doesn’t co-manager?)

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NEW PATIENTS VS ESTABLISHED PATIENTS: We got a call today from one of our offices asking about new patients vs established patients, so we thought a reminder for everyone would be a great idea! You can bill a new patient exam if the patient has not been seen by the doctor or any doctor in your group within the last 3 years. The group is identified by tax ID, so for practices with multiple locations, if a patient sees a doctor at a different location within a 3 years time period, the patient would still be considered an established patient.

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EDUCATE YOUR STAFF!  Knowledge is power. Doctors who take the time to educate their staff reap the benefits in customer service for their patients. Everyone in the office should be able to explain the main elements of an eye exam and why each diagnostic test is performed. Staff members should be able to explain what a refraction is, why diabetic patients are at risk, or why the dreaded puff test is so important. Knowledgeable staff members are better able to answer patients questions and feel more a part of the important work provided by your healthcare team!

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INSURANCE WRITE OFFS ARE A GOOD THING! It means that your fees are above insurance allowables, so you’re not leaving money on the table. Every practice should evaluate their fee schedule periodically, but this is especially true if your EOBs are not requiring you to take a write off. Need help deciding where to set your fees? Since all Medicare jurisdictions publish their fee schedules, this is a good place to start, and the information is easy to find with a simple internet 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 40 states, we are very knowledgeable about what insurances allowables are for your area.

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DO NOT IGNORE YOUR MEDICARE REVALIDATION LETTER! We’ve seen it time and time again: the office gets a letter and somehow it doesn’t get anyone’s attention as critically important. When the doctor doesn’t respond by deadline, Medicare payments stop. If 60 days go by, the doctor is officially deactivated as a Medicare provider and has to go through the entire credentialing process all over again to get back on panel. The process can take a minimum of six months, and the doctor won’t get paid for any Medicare services while he/she is deactivated.  Alert your staff that you need to see all communications from Medicare. Doctors have to revalidate every five years. Not sure when you’re due for revalidation? Check on PECOS or look on CMS website: https://data.cms.gov/revalidation. Also, if you’re an OBS clinic, call Branda when you get your revalidation notice. She’s a good resource since these forms can be confusing!

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DATA ENTRY ERRORS MEAN CLAIMS DENY. 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.

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NEW MEDICARE CARDS WITH NEW IDs ARE COMING NEXT YEAR!  MAKE SURE TO ENTER THE NEW ID NUMBERS In order to prevent identity theft, Medicare will stop using patients’ social security numbers as part of their ID starting in 2018. Instead, all Medicare patients will be issued a new Medicare beneficiary identifier (MBI), and Medicare will start mailing out new cards with the new number in April of 2018. This means that starting next April, our offices should start asking Medicare enrollees for a copy of their new card and begin updating their software with the new ID numbers. Medicare plans to honor both ID numbers on claims until the end of 2019, after which they will only accept claims with the new MBIs. Please go to the CMS website for more information for providers about this upcoming change: https://www.cms.gov/Medicare/New-Medicare-Card/index.html.

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REMEMBER TO COLLECT THE REFRACTION FROM YOUR MEDICARE PATIENTS AT CHECKOUT! Because of the medical issues that come with age, most annual exams for our older patients are medical in nature, but the refraction is always considered routine. Medicare won’t cover routine services, and most supplemental plans follow Medicare’s lead and won’t cover the refraction either. Therefore, it’s a safe bet that the patient is going to owe for the refraction. However, even through you collect the refraction, still file it to Medicare just to give the patient’s secondary a chance to consider payment on the crossover.

A couple of instances in which you don’t have to collect the refraction is when the patient has Medicaid as secondary or a routine insurance like VSP or EyeMed to which you can coordinate benefits and get the refraction paid. So if you’re planning to coordinate, you don’t have to charge the patient for the refraction on date of service. You do, however, have to make sure it’s filed to Medicare for the denial so it can be coordinated. (Important Note: You do have to know the routine payers rules about coordination. There are only a few routine plans that don’t coordinate, but some of them like EyeMed have special rules on how you have to file to get your COB to pay.

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EXCLUSIONARY CODES. According to the National Correct Coding Initiative, doctors cannot bill OCTs and fundus photography on the same date of service. (You can’t bill two OCTs either.) Most insurances will pay the OCTs and deny the photos. However, in those circumstances where doctors feel they need both tests, we can append a modifier to see if both tests will pay. Your chart records have to clearly document the medical necessity for performing both, and OBS will request your consent before filing them together. Be prepared to submit your documentation for an insurance review. Because the overuse of this modifier has been known to trigger an insurance audit, some doctors find it easier just to perform these tests on two different dates of service.

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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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