It's now January 15 and pretty soon, if not already, patients are going to start walking through your door who got their health insurance through healthcare.gov. Many of these patients will be younger, as those with good jobs at firms with greater than 50 employees will retain the insurance they've already had. Also, ObamaCare does not generally affect the elderly or those that already have been on Medicare and Medicaid (although it will most likely affect any medicare plans or supplement plans they purchase privately). So, it can be safe to assume that the majority of your new ObamaCare patients will be younger, healthier individuals who have their own insurance for the first time or new Medicaid patients that qualify for this government program now where they may not have a year ago. So, what does this mean to you?
ObamaCare is not cut and dry. The influx, if you want to call it that, of new patients to your office is not going to be what you may have thought or hoped it would be. At its easiest explanation, you're going to be billing patients for more deductibles and out of pocket expenses. This is because the average person is going to have an annual deductible of at least $2,000.00. (This is going to spill over into employer sponsored plans as well as employers will begin giving similar plans to their employees in an effort to cut the increased costs that will be associated with ObamaCare)
Next, patients with Medicaid are going to start coming to you with vision riders like VSP, such as has happened in California over the past year. This may represent either in increase in your base pay for routine service or a decrease depending on the policies that were in place at your local Medicaid office. If this scenario were to play out here in Vermont, and it's looking like a very strong possibility, we would actually receive about 40% less for each Medicaid routine eye exam we perform...OUCH!
Another issue you may face is that it is beginning to progress to the point where optometrists are going to become primary care providers for patients with certain illnesses; the most likely one is Diabetes. Here in Vermont, to give an example again, we are part of an information exchange known as NNEAC. This exchange tracks our patients and requires us to maintain in contact with certain patients THEY deem we should be responsible for helping co-ordinate care with and awards us quality points as a result. This system is extremely convoluted and even after spending hours on the phone with various representatives at NNEAC I still don't get it. In fact, I got a welcome email from them today telling me my account had been activated and I have decided to ignore it until I have time to wrap my mind around the whole thing...again.
Here's another development that may take place in your state that is beginning to take shape here in Vermont already. Your state may decide that they want to provide a single payer system for its residents. In our case here, that payer has been deemed Medicaid. To us, and this is totally an educated guess, this means that when the single payer system takes over, presumably in 2017 as originally estimated, every one of our patients will either be Medicare or Medicaid. This means that our recall numbers are likely to decline because our Medicaid only pays for 1 routine eye exam every 2 calender years unless the patient is under the age of 12...again, OUCH! Also, it will be harder for us to prescribe medicines to our patients because Medicaid here has very rigorous policies regarding things like eye drops; the majority of our Medicaid patients require a pre-authorization in order for us to order them these drops and other necessary drugs.
I am sure that the list goes on and on and quite frankly, I am even more positive that you don't want to read it here on this humble blog. However, what we can take away from these issues is this: ObamaCare is most likely not going to make your practice more profitable at first, though that may change in the long run. In order for you to provide the best service possible to your patients it is going to be important to direct your staff to diligently verify patient benefits and COLLECT MONEY FROM YOUR PATIENTS UP FRONT! Make sure you are having patients fill out ABN's and HIPPA notices that clearly describes and defines these activities and makes them aware that they will be responsible for any out-of-pocket charges at the time of service. If you don't, the signs are pointing to higher Accounts Receivable numbers and that is a situation you don't want to put your self in.
opticXpress is an optometric billing company that provides a clearinghouse, billing service and software strictly for optometrists.
Wednesday, January 15, 2014
Tuesday, January 14, 2014
Optometric Billing-Thank You to The Optical Vision Site
In doing some Googling, I came across a link to our website from our friends at "The Optical Vision Site". We are very thankful to them for recommending us as it's nice to be recognized as a "valuable resource" in our field. Here is the link to their post which is very valuable in terms of providing links to various Eyecare Practice Management Resources. Check it out!
Remember folks, opticXpress is your one-stop solution for all your optometric billing needs. CALL US TODAY!
Monday, January 13, 2014
Optometric Billing-A Little Bit of Office Management Advice
This is probably one of the shortest posts I will ever make. I'm not going to explain the ins and outs of what this piece of FREE advice will mean to your practice because if you sit down and really process this one sentence thoroughly you will see that it makes monumental amounts of sense and your practice will benefit from it over and over again.
- IF SOMEONE WORKS FOR YOU AND DOESN'T PRODUCE THE RESULTS THAT ARE CONDUCIVE TO FURTHERING THE SUCCESS OF YOUR PRACTICE; IF YOU ARE PAYING THEM TO WORK FOR YOU BECAUSE YOU ARE SCARED OF WHAT IT WILL MEAN TO ALLOW THEM TO COLLECT UNEMPLOYMENT OR YOU HAVE SOME OTHER REASON FOR CUTTING THIS PERSON A PAYCHECK OTHER THAN AS A REWARD FOR A JOB WELL DONE...GET RID OF THAT PERSON, YOU WILL ALWAYS BE BETTER OFF IF YOU DO.
Optometric Billing-92225-Another Word
When looking over optometricmanagement.com this morning, an excerpt from an article caught my eye concerning the 92225 procedure code. According to the article:
Extended ophthalmoscopy is for serious retinal disorders, such as retinal detachment, and requires detailed color drawings with interpretation. Reimbursement for extended ophthalmoscopy has declined sharply and many practitioners prefer to take a photograph for documentation." (http://www.optometricmanagement.com/articleviewer.aspx?articleid=70838)
Here at opticXpress we run the billing department for Stowe Eyecare, in Stowe, VT, which is where we are now located. (If you have never been here...you should visit...trust me) So I went to the data and compared it to what the article said above. Sure enough, reimbursements have declined and my suspicion is because rather than making drawings to support the use of the procedure code, many optometrists are turning to taking photos as it is not only less time consuming and more accurate but makes it much easier to attach it to an Electronic Medical Record.
Document, Document, Document, Document! That is the key to proper billing...espescially if you are asking your billing department to submit 92225 for you. Don't worry about being audited for using this code if you are taking the time to properly document.
"7 DON'T ABUSE EXTENDED OPHTHALMOSCOPY (CPT CODE 92225).
This is the most abused, and audited, procedure code.Extended ophthalmoscopy is for serious retinal disorders, such as retinal detachment, and requires detailed color drawings with interpretation. Reimbursement for extended ophthalmoscopy has declined sharply and many practitioners prefer to take a photograph for documentation." (http://www.optometricmanagement.com/articleviewer.aspx?articleid=70838)
Here at opticXpress we run the billing department for Stowe Eyecare, in Stowe, VT, which is where we are now located. (If you have never been here...you should visit...trust me) So I went to the data and compared it to what the article said above. Sure enough, reimbursements have declined and my suspicion is because rather than making drawings to support the use of the procedure code, many optometrists are turning to taking photos as it is not only less time consuming and more accurate but makes it much easier to attach it to an Electronic Medical Record.
Document, Document, Document, Document! That is the key to proper billing...espescially if you are asking your billing department to submit 92225 for you. Don't worry about being audited for using this code if you are taking the time to properly document.
Friday, January 10, 2014
Optometric Billing-92072-Fitting of Contact Lens for Keratoconus-V2531
Admittedly this post should have been made in January of 2012 however, we are putting it up now because we have noticed large search traffic coming to our site specifically for the term "Keratoconus, Contact Lens"
That being Said, we bill for this procedure at Stowe Eyecare using a blend of guidance from EyeCOR and an article written by Gregory W. DeNaeyer, O.D., F.A.A.O, for optometricmanagement.com .When billed properly, most medical plans will cover not only the fitting but the actual materials/supplies as well. NOTE: IT IS EXTREMELY IMPORTANT THAT YOU CO-ORDINATE YOUR CARE WITH THE PATIENT'S INSURANCE AND VERIFY COVERAGE BEFORE YOU GO AHEAD WITH THE PROCEDURE AS IT CAN UNDOUBTEDLY COST THE PATIENT ALOT OF MONEY OUT-OF-POCKET. NOW THAT THE AFFORDABLE CARE ACT IS IN HIGHER EFFECT, MANY PATIENTS THAT YOU PERFORM THIS PROCEDURE ON WILL HAVE HIGH-DEDUCTIBLE PLANS SO, EVEN THOUGH IT IS COVERED, THEY WILL STILL HAVE TO PAY FOR IT.
The proper code for the actual initial fit of a Keratoconus Scleral Lens is 92072 and is either UNILATERAL or BILATERAL with potential modifiers being RT, LT, or 50 (I do not like using the 50 modifier for ANY bilateral procedure but that is admittedly a personal bias on my part).
EyeCOR Note: "This procedure code is new as of January 2012.
This procedure does NOT include the supply of lens. Use the appropriate V-code to separately report the materials.
To report subsequent visits, use 992xx or 920xx exam code."
You can then bill the insurance company for lenses themselves on the same day using V2531. Again, the materials are either Unilateral or Bilateral depending on the actual fit itself. (Another personal bias and GOOD CODING HABBIT: Always list exam procedures on a claim BEFORE materials. It's less messy looking, more precise and it actually does give your claims a chance at getting paid properly the first time, without human intervention at the insurance company.)
Claim Example:
That being Said, we bill for this procedure at Stowe Eyecare using a blend of guidance from EyeCOR and an article written by Gregory W. DeNaeyer, O.D., F.A.A.O, for optometricmanagement.com .When billed properly, most medical plans will cover not only the fitting but the actual materials/supplies as well. NOTE: IT IS EXTREMELY IMPORTANT THAT YOU CO-ORDINATE YOUR CARE WITH THE PATIENT'S INSURANCE AND VERIFY COVERAGE BEFORE YOU GO AHEAD WITH THE PROCEDURE AS IT CAN UNDOUBTEDLY COST THE PATIENT ALOT OF MONEY OUT-OF-POCKET. NOW THAT THE AFFORDABLE CARE ACT IS IN HIGHER EFFECT, MANY PATIENTS THAT YOU PERFORM THIS PROCEDURE ON WILL HAVE HIGH-DEDUCTIBLE PLANS SO, EVEN THOUGH IT IS COVERED, THEY WILL STILL HAVE TO PAY FOR IT.
The proper code for the actual initial fit of a Keratoconus Scleral Lens is 92072 and is either UNILATERAL or BILATERAL with potential modifiers being RT, LT, or 50 (I do not like using the 50 modifier for ANY bilateral procedure but that is admittedly a personal bias on my part).
EyeCOR Note: "This procedure code is new as of January 2012.
This procedure does NOT include the supply of lens. Use the appropriate V-code to separately report the materials.
To report subsequent visits, use 992xx or 920xx exam code."
You can then bill the insurance company for lenses themselves on the same day using V2531. Again, the materials are either Unilateral or Bilateral depending on the actual fit itself. (Another personal bias and GOOD CODING HABBIT: Always list exam procedures on a claim BEFORE materials. It's less messy looking, more precise and it actually does give your claims a chance at getting paid properly the first time, without human intervention at the insurance company.)
Claim Example:
(Be sure to take a look at an EyeCOR subscription by CLICKING HERE. We are not in partnership with them, nor do they pay for advertising through us. We are giving them FREE advertising on our site because we love their product so much, and we believe you will also.)
For help with optometric billing in your practice, contact opticXpress today!
Thursday, January 9, 2014
OPTOMETRIC BILLING-BILLING 92133/92134 AND 92250 ON THE SAME DAY
"-According to Medicare’s NCCI Mutually Exclusive Edits, Scanning Laser-Posterior (92133 and 92134) and Fundus Photography (92250) are considered mutually exclusive.
In order to bill them together on the same date of service, the NCCI Mutually Exclusive Edits do allow for the lesser component (92250) to have a different diagnosis and be modified with -59.
The patient could also return another day for the second procedure.
- According to Medicare’s NCCI Correct Coding Edits, Fundus Photography (92250) and Remote Imaging-Detection of Retinal Disease Under Physician Supervision (92227) are considered mutually exclusive and it does NOT allow for any modification to either procedure code." (taken from EyeCor by NTeon)
Want more info like this? Consider a subscription to EyeCOR...we love it!
You can also use opticXpress as your billing department and you will enjoy the same benefits of EyeCor! Call us today!
Optometric Billing-Certified Paraoptometric Coders-What the AOA Says and What You Really Should Do
Last Month, The American Optometric Association (AOA) published their 2012-2013 Annual Report. On pages 14 and 15 of the report, under the section titled "Practice Management", an excerpt piece was written concerning the growing problem of coding and claim errors and how they affect the bottom line. The AOA, by way of this article, suggests that you should have your entire staff trained as Certified Paraoptometric Coders (through AOA's Commision on Paraoptometric Certification, coincidentally) in order to help reduce the costs associated with coding and claim errors. Though I fully agree that coding errors are an issue for many practices, I am vehemently against training EVERY staff member in the area of coding and allowing THAT MANY hands to touch your claims.
First, some background information on my self. Yes, I am a medical biller that runs a medical billing company dedicated solely to the practice of optometry. However, my business is also part of a growing eye-care clinic located in Stowe, VT. Second, this article is not a result of my fear of loosing business because more staff members will be able to perform the same tasks that are outsourced to my business as a result of becoming Certified Paraoptometric Coders. On the contrary, I am all for a clinic choosing to keep their billing in house, if they can afford to do so. We are blessed in that the Dr. here in Stowe Eyecare CAN afford that expense. What this article is meant to address is why you don't want to train everyone in your clinic to become coders and why that is a bad business decision.
Now, some background information on the CPC program. A little research on the Google Machine turned up the AOA's website referring to the CPC program (actually, it is referred to as the CPOC program on the site not "CPC" as contained in the Annual Report). The CPC program is designed for professionals who not only have a minimum of a high school diploma or its equivalent but also " a Minimum of two (2) years' experience in the medical coding and billing field". So off the bat, this program IS NOT FOR EVERY member of your staff as the excerpt suggests. Next, there is, obviously, a charge associated with sending this employee through the program. The minimum cost is $265.00 to register the person for the test on top of which you, or the employee, may purchase study materials for a minimum cost of $500 if you are an AOA member or $750 if you are not a member. From what I can garner from the site alone, this is a completely self directed course, covered by a minimum investment of $765.00, that culminates in a 125 question multiple choice exam certifying the employee as a Paraoptometric Coder...not exactly a professional certification in billing and coding if you ask me. I agree, it is probably very helpful in terms of useful knowledge to a billing person but it is not what I would pin my hopes on if I was hoping to transform my ENTIRE staff into knowledgeable billing personnel like the AOA's article suggests it could.
So, with that background knowledge out of the way, and you can look at the AOA's website concerning the CPOC program and all their other programs by CLICKING HERE, why shouldn't you train every member of your staff as Certified Paraoptometric Coders? First, and probably most important, what business does every member of your staff have being involved with a patient's financial information? This is a very important question you should ask yourself if you are even considering this program.
Second, The programs calls for minimum requirements of a diploma or GED and 2 years experience in the medical coding and billing field. Let me ask you, and this is totally based on the size and amount of business you do each day, how many of your normal, every-day, non-management personnel have been or normally would be with you long enough to justify the investment of $765.00 into those employees' Paraoptometric Coding Certfication? 1 maybe 2 or none at all? Do they even have 2 years experience in billing and coding if they have been with you long enough to justify this expense or would this be throwing them into a completely foreign field of knowledge?
Third, and this question is probably just as important as the first question, why would you want to place the additional responsibility of coding and billing on regular support staff when they are most-likely maxed out in terms of their daily responsibilities to begin with? Don't you think that it is more important that they be focused on providing customer service to patients and potential patients when they walk through the door and not be bogged down with worrying about the billing also?
Here's what I believe you really should do. Do I think that the CPC program has some merit? I do. I think that it is a very beneficial thing for members of your billing staff. If you have a dedicated billing department, and any of them have experience and have been with you past a probationary period (IE 60, 90 or 120 days) then by all means, GO AHEAD AND MAKE THE INVESTMENT IN YOUR BILLING DEPARTMENT, ESPESCIALLY IF THAT BILLER DOESN'T HAVE AN EXTENSIVE BACKGROUND IN OPTOMETRIC MEDICAL BILLING. I also believe that you should also make this same investment in yourself and all other members of your medical team as well as in your office manager as these, along with your billing personnel, are the ONLY people that should be involved in the billing of patients and insurance. By doing this, you will be making sure that the coding is correct from the moment it leaves the OD's office to the moment it makes it into the biller's hand. Look closely at that last sentence; I am not suggesting you make these investements so that ALL THESE PEOPLE can be billers, I am suggesting you make this investment so that you can ultimately SUPPORT YOUR BILLING DEPARTMENT!
Let's face it, billing and coding errors have been around since the invention of insurance. THEY ARE NOT GOING TO DISAPPEAR, in fact, they may increase due to changes in the industry like The Affordable Care Act, ICD-10 implementations and changes in CPT requirements. Training your entire staff to handle billing is NOT the answer to minimizing these errors. On the contrary, having a dedicated billing department (whether that be in-house or outsourced) and training yourself, your management staff and and your support staff to properly record patient demographics is THE ONLY ANSWER to reducing errors as it is demographic errors that cause the most claim rejections, not coding errors. By providing your billing department with correct patient demographics and proper ICD-9/10 and CPT codes on YOUR PART, you will be arming them with the tools they need to get you paid correctly, the first time.
Don't waste your money on training the wrong people to do jobs they don't have any business doing like the AOA suggests you should, instead spend your money wisely on educating yourself and your billing department then train the rest of your office to get your billers the best information they possibly can. You will thank me if you do and you will see your bottom line increase exponentially as a result. I guarantee it.
First, some background information on my self. Yes, I am a medical biller that runs a medical billing company dedicated solely to the practice of optometry. However, my business is also part of a growing eye-care clinic located in Stowe, VT. Second, this article is not a result of my fear of loosing business because more staff members will be able to perform the same tasks that are outsourced to my business as a result of becoming Certified Paraoptometric Coders. On the contrary, I am all for a clinic choosing to keep their billing in house, if they can afford to do so. We are blessed in that the Dr. here in Stowe Eyecare CAN afford that expense. What this article is meant to address is why you don't want to train everyone in your clinic to become coders and why that is a bad business decision.
Now, some background information on the CPC program. A little research on the Google Machine turned up the AOA's website referring to the CPC program (actually, it is referred to as the CPOC program on the site not "CPC" as contained in the Annual Report). The CPC program is designed for professionals who not only have a minimum of a high school diploma or its equivalent but also " a Minimum of two (2) years' experience in the medical coding and billing field". So off the bat, this program IS NOT FOR EVERY member of your staff as the excerpt suggests. Next, there is, obviously, a charge associated with sending this employee through the program. The minimum cost is $265.00 to register the person for the test on top of which you, or the employee, may purchase study materials for a minimum cost of $500 if you are an AOA member or $750 if you are not a member. From what I can garner from the site alone, this is a completely self directed course, covered by a minimum investment of $765.00, that culminates in a 125 question multiple choice exam certifying the employee as a Paraoptometric Coder...not exactly a professional certification in billing and coding if you ask me. I agree, it is probably very helpful in terms of useful knowledge to a billing person but it is not what I would pin my hopes on if I was hoping to transform my ENTIRE staff into knowledgeable billing personnel like the AOA's article suggests it could.
So, with that background knowledge out of the way, and you can look at the AOA's website concerning the CPOC program and all their other programs by CLICKING HERE, why shouldn't you train every member of your staff as Certified Paraoptometric Coders? First, and probably most important, what business does every member of your staff have being involved with a patient's financial information? This is a very important question you should ask yourself if you are even considering this program.
Second, The programs calls for minimum requirements of a diploma or GED and 2 years experience in the medical coding and billing field. Let me ask you, and this is totally based on the size and amount of business you do each day, how many of your normal, every-day, non-management personnel have been or normally would be with you long enough to justify the investment of $765.00 into those employees' Paraoptometric Coding Certfication? 1 maybe 2 or none at all? Do they even have 2 years experience in billing and coding if they have been with you long enough to justify this expense or would this be throwing them into a completely foreign field of knowledge?
Third, and this question is probably just as important as the first question, why would you want to place the additional responsibility of coding and billing on regular support staff when they are most-likely maxed out in terms of their daily responsibilities to begin with? Don't you think that it is more important that they be focused on providing customer service to patients and potential patients when they walk through the door and not be bogged down with worrying about the billing also?
Here's what I believe you really should do. Do I think that the CPC program has some merit? I do. I think that it is a very beneficial thing for members of your billing staff. If you have a dedicated billing department, and any of them have experience and have been with you past a probationary period (IE 60, 90 or 120 days) then by all means, GO AHEAD AND MAKE THE INVESTMENT IN YOUR BILLING DEPARTMENT, ESPESCIALLY IF THAT BILLER DOESN'T HAVE AN EXTENSIVE BACKGROUND IN OPTOMETRIC MEDICAL BILLING. I also believe that you should also make this same investment in yourself and all other members of your medical team as well as in your office manager as these, along with your billing personnel, are the ONLY people that should be involved in the billing of patients and insurance. By doing this, you will be making sure that the coding is correct from the moment it leaves the OD's office to the moment it makes it into the biller's hand. Look closely at that last sentence; I am not suggesting you make these investements so that ALL THESE PEOPLE can be billers, I am suggesting you make this investment so that you can ultimately SUPPORT YOUR BILLING DEPARTMENT!
Let's face it, billing and coding errors have been around since the invention of insurance. THEY ARE NOT GOING TO DISAPPEAR, in fact, they may increase due to changes in the industry like The Affordable Care Act, ICD-10 implementations and changes in CPT requirements. Training your entire staff to handle billing is NOT the answer to minimizing these errors. On the contrary, having a dedicated billing department (whether that be in-house or outsourced) and training yourself, your management staff and and your support staff to properly record patient demographics is THE ONLY ANSWER to reducing errors as it is demographic errors that cause the most claim rejections, not coding errors. By providing your billing department with correct patient demographics and proper ICD-9/10 and CPT codes on YOUR PART, you will be arming them with the tools they need to get you paid correctly, the first time.
Don't waste your money on training the wrong people to do jobs they don't have any business doing like the AOA suggests you should, instead spend your money wisely on educating yourself and your billing department then train the rest of your office to get your billers the best information they possibly can. You will thank me if you do and you will see your bottom line increase exponentially as a result. I guarantee it.
"Anything you spend money on to save time, SAVES PEOPLE! People-time is the most expensive part of any practice."
If you would like help with your optometric medical billing, call opticXpress today and we will do whatever we can to help you.
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