What problems face today's OD's in regards to medical, vision and patient billing?"

The Meeting is Set! 

opticXpress is pleased to announce our first ever webinar! The event will be a Q&A session featuring the president of opticXpress and special presenter, Arnaldo Martinez, O.D. of True Vision Optical in Miramar, Fl. 

Taking place at 8pm on May 12th, 2013, the meeting will last for one hour and will be an opportunity for you, as an optometrist or office manager, to present to us the challenges you face on a daily basis in regards to medical insurance billing, vision insurance billing and patient billing. Not only will you be able to post questions to us on how to better manage these challenges, but we hope you will take this opportunity to share ways that you handle these challenges in your office as well. 

We invite you to click the link below to register for this unique opportunity today!

SEE YOU SOON!

CLICK HERE TO REGISTER. SEATS ARE FREE AND GOING FAST, SO RESERVE YOUR SPOT TODAY!

Optometric Billing-Choose Your Billing Company Wisely!!

     It is no secret that we live in a world where the complexities of the insurance billing process leaves upon the door for fraud to run amok. Let me give you a personal example of just one such instance.

     In August of last year, my wife was seen by an emergency room physician who was a member of larger group that was contracted with her insurance company, Aetna, but they were not contracted to accept Aetna's HMO. However, given the fact that it was emergency care, my wife's out-of-network benefits dictated that the group must accept her and send them the bill. Without fail, the bill was submitted to Aetna within 72 hours for which they received payment in the amount of $413.12. Upon receiving this payment, the billing company for this ER group, changed the original procedure code and re-billed Aetna using the new procedure code. (Now, unless you bill a corrected claim to Aetna using their central fax number, you cannot bill corrected claims to Aetna. They are not set-up to accept corrected claims into their automated electronic adjudication system used to process normal claims. ) After receiving two denials for my wife's "corrected" claim, they then billed her for the difference in charge between the new procedure code, $605.22, and what they were paid for the original  procedure code, $413.12,a total sum of $192.10!
     My wife, being the diligent and honest woman she is, paid the bill and then handed it to me to file away. Upon reviewing it I noticed that she was being balance billed, a practice that is not necessarily illegal. I decided to listen to my "sixth sense", as she would call it, and look at her EOB to make sure the charges were legitimate. Sure enough, the EOB clearly stated that she was, under no circumstance, to be balance billed for this procedure! So I promptly called them and demanded a refund. After being on hold for quite some time, I was finally allowed to speak to a nice young girl who informed me that a mistake had been made and that a refund would be processed promptly. She told me that my wife could expect to see the refund posted to her account within 30 days.
    31 days later, the refund had still not been received. Another phone call to the billing company and another hour long wait turned up another representative who refused to let me speak to a supervisor but informed me that the refund had in-fact been processed and that it was pending a deposit to my wife's bank account. After getting off the phone with the billing company my wife decided to call her bank and follow up on the supposed deposit. Surprise, surprise: a refund was not pending, AT ALL!
    At this point my wife decided to try and get her bank involved. She opened an investigation, and the bank did its due-diligence and tried to resolve the matter with the billing company. After another 30 days, she was informed by the bank that there was nothing they could do to help.
    So now, just a couple of days before this writing took place, we were back at square 1. I decided to get involved again and sure enough, after another hour-long-wait, I was allowed to speak to Benjamin R. Oh Benjie, poor Benjie, he didn't know what he was running into when he started spewing off at the mouth to me that day! You see, Benjamin told me, again, that no supervisor could speak to me. He informed me further, that not only was my wife's refund not processed but that AETNA HAD REQUESTED A REFUND OF THE ORIGINAL PAID AMOUNT OF $413.12 AND NOW MY WIFE WOULD BE RESPONSIBLE TO PAY THAT BALANCE! This is where I went into "thermo-nuclear" mode against the billing company.
     I promptly hung up with Benjamin R. and called Aetna's member services. I detailed the events to aetna and sent them copies of everything, it was then that they discovered the billing company had tried to double bill Aetna for the emergency procedure and billed my wife instead when they had recorded 2 denials of the claim. Aetna took it upon themselves to call the billing company at this point and then conferenced me into the conversation at which time we were told, " A refund has been processed to your wife's account but it can take up to 90 days for it complete"!
   One word was my reply to them, "Unacceptable"!
   Promptly, I filed a complaint with Aetna's Fraud unit, the FTC and the Better Business Bureau. I then sent a copy of the complaints to the owner of Physicians group in hope that he would see who he is allowing to represent him and that he would do something about it.

   There is a recurring theme above. If you, as a medical practitioner, have a billing agency, staff-member, department or other entity in your employ, the words "unacceptable, hour-long-wait, it's the insurance company's fault, refused to let me speak to a manager, and fraud" had better never be used in the same sentence with them...EVER!!! These people represent your business, YOUR LIVELIHOOD on a daily basis, THEY REPRESENT YOU! These are the people you trust to provide CUSTOMER SERVICE to your patients and like it or not your patients are YOUR CUSTOMERS and without your customers, you have no practice.
    What does this all mean? Choose your billing company or billing personnel wisely! If you outsource, stay on top of them, audit them from time to time or enter a fake person with your address into your management system and have them send you a bill and see how they handle the situation when you call in; do whatever you have to do to make sure that your name and your practice are being represented fairly. Trust me, even though the FTC and BBB don't do anything about a claim 99% of the time, the complaint gets logged in a searchable online database that patients, potential patients AND INSURANCE COMPANIES all check on a regular basis. The database may not cause you to loose many patients but if one of your top insurance payers decides to check up on you and sees one of those complaints, kiss your contract with them goodbye. 

    We live in the digital age and word of mouth is everything. Make sure the words being used to represent you are the right ones.

opticXpress is a reputable optometric billing company. We treat everyone fairly and we always make sure that your practice is represented in the best possible manner! Contact us today. 

Optometric Billing-Billing for an Exam on the Same Day as a Surgical Procedure Such as Dry Eyes or Epilation

It has always been my opinion that in order to bill for an exam on the same day as providing a surgical procedure, such as dry eyes, that one would have to have notated evidence that the examination portion of the encounter was not in fact related to the surgical procedure.  It turns out that after some further research into my coding guidelines this is not just my opinion, it is fact. Let's take a look at how this should be handled.

IE: The patient came into the office for a routine exam or yearly check-up and at that time it was decided that the patient qualified for punctal plugs or epilation. (The plugs would be rare in this instance as it is now necessary to try every other treatment possible BEFORE proceeding with inserting the plugs). 

So, in the example above, the physician would note that "the patient was in for a yearly check up and during the course of exam the patient described to the physician that though the drops he has been using for his dry eye syndrome help somewhat, they are still relatively ineffective at times and he would like to know if there is anything else he could try. At this time the physician offers the option of punctal plugs as they have been shown to be a very effective, though minimally invasive, method of treating the patient's condition. "

If  the condition above, or any other combination of supporting evidence, is present you now have a justifiable basis for billing the insurance company for 1) A comprehensive examination 2) Punctal Plugs. The example above would be billed in a manner similar to the following:

1) 92014-25 (25 modifier means the exam is a separate service from the actual plugs themselves)

2) 68761 (one plug in either eye) or 68761-50 (1 plug in both eyes) or 68761-51 (2 plugs in the same eye) or better still 68761 E1 (E1 meaning it was the upper left lacrimal duct E3 would be upper right and E2E4 are lower left and right respectively). SEE BELOW 

If the condition in the above example is not met, by no means should you bill an insurance company for an exam AND a surgical procedure.At this point, it is understood that the procedure for plugs or epilation etc. includes any examination that need be done. Furthermore,  UNLESS a patient comes into the office for an exam during the 10 DAYS subsequent to the punctal plug procedure for something UNRELATED to the previous procedure you cannot bill the patient's insurance for any further items. In this case, you would bill the proper examination procedure code, followed with a -24 modifier (unrelated E/M procedure during post-op period) SEE BELOW

CLICK HERE TO VIEW THE OFFICIAL MEDICARE COVERAGE INFORMATION FOR BILLING PUNCTAL PLUGS.

If you would like to make your billing easier and more effective, try contacting opticXpress today by clicking here!

OPTOMETRIC BILLING-INCREASE REVENUE, BY 50 PERCENT?!?!

I recently came across a website that specializes in medical billing for opthalmologists. The owners of the site, and likely the business, claim right on the home page that you can  "INCREASE YOUR REVENUE BY 50% WHEN YOU OUTSOURCE YOUR BILLING!" .

I CALL BULLSHIT!

I know, I know. It is unprofessional of me to curse on a professional blog site but can you honestly blame me? If you stop and think about it for one second, doesn't that make you feel a little bit stupid as a doctor to see someone advertise to you that they can increase your business by 50% if you just outsource your billing!?!? Maybe stupid isn't even the right word. Maybe foolish is better. Maybe you can think of a better word to describe the feeling that that statement evokes and post it in the comment section below. The bottom line, however, is that no matter how you slice it that is just false advertisement, PERIOD.

First of all some simple math. If your business bills $50k per year to medical insurance it's absolute fodder to believe that outsourcing that job will all of a sudden bring you $50k more per year in insurance business, how does that add up? Where is the logic there? Also, let's just say that the claim this advertiser is making means that you will simply just collect 50% more by outsourcing your billing and your current collection rate is 50%, you will now add $12.5k more money to your bottom line bringing your overall collection rate to only 75% which is the industry average, you can do better than that, why settle for less?

No matter what angle you look at it from, insurance just doesn't work that way. Quite simply, insurance is nothing more than a corporate lottery. These companies are in the business of making money and will do whatever they can to keep their reimbursement rates as low as possible meaning you, the provider, and the patient loose big time. Do you really think that outsourcing is going to improve your odds of DRASTICALLY improving your revenue?

Don't get me wrong. Outsourcing is a great thing and will DEFINITELY improve your revenue and your cash flow if you choose the right partner to outsource too. However, there is no way that I or anyone else can guarantee you that you will improve revenue by 50% if you just outsource your billing. The answer to improving your revenue begins and ends with you, the practice owner. You want to increase your current revenue? You should  outsource your billing to a company like opticXpress who focuses on increasing your collection percentage AND works with your patients. This frees up your office staff giving them the time and flexibility to focus on what matters most, your patients. Second, you should increase your business which is single handedly the only tried and true method to increase revenue. Last, TRAIN YOUR STAFF! A well trained staff who understands patient satisfaction and insurance eligibility procedure not only keeps your customers (patients) happy but it cuts down on billing errors and keeps you "in the black".

So, the next time someone tells you that you can increase revenue just from outsourcing, pipe up and call bullshit.

CHECK OUT OPTOMETRIC BILLING SERVICES BY opticXpress TODAY!

Optometric Billing-Getting The Most Out of Medicare

I received a letter from one of my doctors today concerning certain types of Medicare Rejections having to do with patients that have Medicare but are actually covered by another insurance company for vision services.  He asked me for some tips as to how to minimize these rejections and get more out of his services to Medicare patients. The following excerpt from my reply letter to him should efficiently help any optometric practice or optometrist who has the same questions regarding the billing of Medicare.

***Please note that you will see references in this excerpt to the opticXpress software system. Though most of you do not use it just know that if you do use it to bill Medicare we can virtually guarantee the payment of your Medicare claims provided you enter the required information into the system correctly.

Call opticXpress today for more information!

TIPS ON GETTING THE MOST OUT OF YOUR MEDICARE BILLING FOR OPTOMETRIC SERVICES

    Here are some things that you should follow when performing an exam on a Medicare patient:
1) Medicare does not cover refractions. Make the patient pay for the refraction after you complete
   the exam.
2) Make sure your staff collects ALL of the patient's insurance information and scans it into
   opticXpress. This includes ID cards, social security cards and driver's liscense. Many times
   a staff member sees one insurance card and then stops instead of proceeding forward with finding
   out whether the patient has other insurance. If the staff member collects all of this and enters it
   into opticXpress then it will be most valuable for us should a claim be denied...it allows us to
   work the rejection ASAP.
3) Every medicare patient is required to pay Co-insurance of 20% of the allowed amount of the service.
   This means that if your examination fee is $100.00 you should collect $20.00 in addition
   to what you are charging for the refraction. If the patient has secondary insurance that will cover
   co-insurances and deductibles then Medicare will usually "cross the claim over" to the patient's
   secondary if the patient has alerted Medicare of this additional coverage. If the patient has not updated this    information with Medicare or they don't have secondary
     coverage, than collecting these fees up-front assures cash flow from Medicare while you are
     awaiting final payment. Additionally, if your staff has entered all of the patient's insurance
     info into the system it allows us to "cross the claim over" to his/her other insurance
     on the patient's behalf. You will then receive this additional payment from the patient's secondary
     insurance company.
4)   Remember that Medicare's deductibles are a yearly payment each patient must pay. That means that
     most Medicare patients you serve during the first 4-6 months of the year will owe this deductible
     and hence, they will have to pay you for the service out of pocket after Medicare denies or
     any secondary (supplemental) coverage will cover it but it will add to the turnaround time on
     that claim. Just remember this when working with your Medicare patients and remind them while
     they are in the exam room with you or at another designated time. Most Medicare patients are
     elderly and it is imperative that you take your time to try and help them understand their
     benefits. In the long run, you will profit more.
5)   Finally, ask your patients the following before you begin the procedure:
     a) "Do you fully understand our policy concerning Medicare patients?"
     b) "Are you comfortable or able to pay for a refraction and/or your co-insurance today?"
     c) "Do you understand that Medicare requires you to pay a deductible out-of-pocket and
         you may owe this if you have not met it for the year and do not have supplemental
         coverage to take care of this for you?"

Optometric Billing-Mobile Blog

The Beauty of technology is that we can now perform our optometric billing blogging from our mobile phones using #siri on the #iPhone 4s! Isn't that great?!

Wouldn't it be great if your optometric medical billing were as easy as this is? IT CAN BE! Call opticXpress today!

CMS TO REVIEW PECOS ENROLLMENT PROCESS

This just in, IT WILL AFFECT OPTOMETRISTS AND OPTOMETRIC BILLERS ALIKE!

Medicare Working with Ordering and Referring Providers and Suppliers to Streamline Enrollment Process

The Centers for Medicare & Medicaid Services (CMS) is working with providers to address concerns about enrollment in the Provider Enrollment, Chain and Ownership System (PECOS) to ensure that Medicare beneficiaries continue to receive the health care services and items they need. PECOS is the electronic system used to enroll physicians and eligible professionals into the Medicare program.

As part of those efforts, CMS will, for the time being, not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010. While more than 800,000 physicians and other health professionals have enrolled and have approved applications in the PECOS system, some providers have encountered problems. CMS is continuing to update and streamline the process, and more providers have been enrolled in the past few days.

CMS issued an interim final regulation on May 5, 2010 implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) , and certain items and services under Medicare Part B. The new law applies to orders, referrals and certifications made on or after July 1. The comment period for the regulation closes on July 6, after which the comments will be reviewed and considered before a final regulation is issued.

The Affordable Care Act provisions and the regulation were designed as steps to prevent fraud in Medicare by ensuring that only eligible and identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.

Many physicians and other providers and suppliers have continued to make good faith efforts to comply with the requirements of the law and regulation. These efforts will be a significant factor in determining the procedures and processes that will be incorporated in the final rule.

While the regulation will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. However, until the automatic rejections are operational, providers should not see any change in the processing of submitted claims, they will continue to be reviewed and paid as they have historically been reviewed and paid.

Additionally, though CMS is taking a more deliberative approach to using the PECOS enrollment system, the agency will employ a contingency plan to meet the ACA requirement that written orders and certifications are only issued by eligible professionals effective July 1.

CMS will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will work with the provider community to provide guidance on enrollment and will process all applications expeditiously.

Free Medical Billing Software for Optometrists!

For the past few months RLR Consulting has been dropping hints that it has a product in the works aimed directly and solely at optometrists. Today that day has come!

As of this week, RLR Consulting officially announces the release of its FREE, Optometric Billing Software and optometric billing services known as, "opticXpress". With the opticXpress software at its core, RLR Consulting is now a full service optometric billing company. RLR Consulting now provides not only billing services for optometrists, but they are also a software company and Optometric Clearinghouse as well.

Moving forward, opticXpress software is and always will be a FREE software to the RLR Consulting client. Currently this software allows providers to focus on patients and quality of care while reducing the amount of time spent coding and submiting insurance transactions. This is because opticXpress's intuitive design and ease of use allow the Optometrist to only input information about the patient...RLR Consulting handles the rest!

Over the next few months, as government guidelines for EMR/EHR software become available, opticXpress will be updated and become a full featured office management software that will include the easiest interface to Electronic Medical Records and Electronic Health Records available to the Optometric Client. Best of all, opticXpress will remain...FREE!

How can RLR Consulting do this? The answer is simple: RLR Consulting is a DEBT FREE company and can compete with even the largest clearing houses (such as Emdeon and Mckesson) on claim submission rates. This allows RLR to focus solely on their clients and the needs of their clients while keeping costs low and competetive year in and year out.

More information can be found at: www.opticXpress.com

Twitter For Optometrists

One of the things that RLR Consulting strives to pass on to its clients is an appreciation for the latest and greatest technology. There is a reason for this, as healthcare advances it can only do so because of the advancement in technology...and so it stands to reason: If you as an optometrist are utilizing the latest and greatest technology to serve your patients then your support staff and support services should utilize the same up-to-date technology as well, or at least be willing to utilize it.

At RLR we are constantly upgrading our computer systems. We are always looking for ways to give our clients access to the latest and greatest information. We take advantage of cutting edge ideas like "cloud computing", which we will push once it starts to become more mainstreem because it will allow for a doctor to turn on any computer, any time, and access his information from all over the world and it will simply, "just work".

Recently we started using Twitter as a tool for updating our clients and prospective clients with information from RLR Consulting. We like it for one very important and basic reason: it answers the question "What are we doing?" which is something that all of our clients and prospective clients would and do want to know. As an optometrist who is utilizing our service or simply looking for a new service provider, you can always count on RLR Consulting to update you on exactly what we are doing and, if you sign up for twitter yourself, you will be able to answer back and even post comments that we read, INSTANTLY!!!

Twitter for Optometrists? One of the best things you can do for yourself, and your practice!
__________________________________________________________________________________________________
More information about RLR Consulting and thier optometric billing services can be found at: www.optometricbilling.rlrbillingsolutions.com

Optometric Billing....How I See It.

We here at RLR Consulting see optometrists as a rather un-represented profession in terms of the amount of software and services designed just for them. For example, if you were to Google the keyword "optometric billing", ther are only three companies in the first 10 listings that are committed solely to the art and practice of optometric billing. Of those three, only one is actually committed to helping the optometric field achieve more independence in terms of the software they can choose or the people they decide to outsource thier billing services too.

Now, one might ask why this is important. Let me ask you a question: If your child has an do take him to your family physician or do you take him to the pediatrician? Most likely, your answer will be. "the pediatrician". Why is this? Because, we tend to place more trust and respect in those that specialize in a service for a particular need. We want to take our child to a doctor that specializes in caring for children because we want our child to have the best care and likewise, an optometrist, or any other physician for that matter, should choose a billing service or software company that specializes in serving optometrists because they stand to offer the best service and have the most knowledge about optometry and the way and optometrist's office functions.

One of the things that I learned early on in my medical billing career was that today too many individuals are going to medical billing and coding schools because they were lured by the promise of fast money and the ability to work from home and be thier own boss. However, once they were enrolled and began learning, they soon realized that it wasn't cheap to attend these schools. Also, they were not really given the ability to specialize in any one field of medical billing. They received an expensive, broad knowledge, quick education but they were not really given the tools that they needed to succeed in thier own business. As a result, too many of these graduates went out and started thier own billing business without knowing just how difficult it was going to be to even get a doctor to agree to give them the responsibility of maintaining thier cash flow, let alone get business to begin with. Consequently, those that were good enough salesmen to sign doctors as clients ended up charging way too much money for a service that is supposed to save the doctor money to begin with. Also, and I have seen this way too often, they were fired or their contracts were canceled within one year after beginning to service the account because they just didn't know squat about billing, let alone the type of doctor they were billing for. Consequently, it has made it that much more difficult to even get business as a medical biller, let alone and optometric biller, because of the bad experiences many doctors have had and shared with their colleagues.

A valuable lesson can and should be learned from this example. IT IS IMPORTANT TO CHOOSE A BILLER BASED ON THIER EXPERIENCE AND TO LOOK FOR SOMEONE WITH KNOWLEDGE OF THE PARTICULAR MEDICAL FIELD THAT YOU, AS A DOCTOR, PRACTICE IN. By doing this and commiting yourself to this idealogy early on, one can reap the benefits of a rewarding relationship with the biller or service that you outsource to. You will be able to communicate with them openly, question thier methods as to why they perform a certain billing function in a particular way, and feel comfortable with the fact that every answer you receive from them comes from a wealth of knowledge that that individual possess based on thier experience in the field.

This brings me back to my original point and the mantra that I live by here in my office. We decided long ago to focus solely on Optometry as our chosen field of billing. Not because it is lucrative or easy but because it is an un-represented field of professionals among the medical billing and practice management realm. Sure there are plenty of people out there that offer billing and management services that CAN BE USED by an optometrist but how many of them have been DESIGNED FOR AN OPTOMETRIST?

If you are an Optometrist reading this, whether it be in a blog, in a journal or in some online article database, you should ask yourself, "Am I receiving the best level of customer service that I can receive from my biller?" "Am I even sure that the person or service I hired and entrusted my cash flow too has the correct knowledge to really even be considered the best for the job?" "Is my practice receiving the best level of care that it can be receiving or should I hire a specialist that knows my needs and my wants and is willing to help me fulfill my desires?"

This is just the business I am in, the career I have chosen, THE WAY I SEE IT, the question remains, is this how you want it to be seen as a professional that I represent?*

______________________________________________________________
Andrew Roy owns and operates RLR Consulting which is a medical billing firm that specializes in Optometric Billing. You can find out more about RLR Consulting by visiting their websites: www.rlrbillingsolutions.com or www.optometricbilling.rlrbillingsolutions.com. You can also subscribe to RLR's blog and news feed to stay current on thing are happening in the billing field and optometric billing field as well.

Optometric Billing- What We Are Up Too!

RLR Consulting Announces New
Optometric Billing Website

""RLR Consulting has re-vamped their Optometric Billing Website:
www.optometricbilling.rlrbillingsolutions.com. MORE CHANGES STILL TO COME!""

RLR Consulting, of Vineland, NJ announces today that they have updated their Optometric
Billing website. The updates are part of a new marketing campaign set to begin in June of
2009 aimed at creating brand recognition for their name and new software created
specifically for optometrists and optometric billing professionals.

The official name of this software has not yet been released but all indications are that it will
be released as two separate types of software one for just claim and patient management
and the other will be a full optometric office management solution. Both pieces of software
are guaranteed to be compliant with the government's EMR and EHR guidelines and will be
offered to clients FREE FOR LIFE!

More information about RLR Consulting, their Optometric Billing services and this exciting
new software can be found on their website at www.optometricbilling.rlrbillingsolutions.com
in the coming weeks and months. Also, information about government EMR and EHR
guideline implementation can be found there as well, so be sure to check the website often
for these exciting and important updates!

http://www.optometricbilling.rlrbillingsolutions.com

Welcome!

Hello out there! This is the first official post on the Optometric Billing Spot. It is my intention that this blog become a popular place for interested individuals and corporations to come and voice their opinions and concerns about this field of medical billing. Over time I also hope that this site will become a valuable resource of information concerning anything and everything that relates to the Optometric Billing Field.

First things first though, let me introduce you to myself and my organization.

My name is Andrew Roy and I own and Operate RLR Consulting. I inherited the business from my father after he died in 2005 and continued his time honored tradition of focusing on niche markets in business. Ever since its inception in the early 1990's, RLR Consulting has specialized in Optometric Billing and now, almost 20 years later, we have a website dedicated to optometric billing, a website dedicated to medical billing news, our own software, and this blog! I truly hope that everyone that comes across this will enjoy it and find it useful.

For more information about RLR Consulting and our services, please visit:
The RLR Consulting Medical Billing Home Page and,
The RLR Consulting Optometric Billing Home Page .

And please, don't forget to bookmark this page, subscribe to our feed and contribute to our content as well. We look forward to hearing from you, TODAY AND IN THE FUTURE!