Optometric Billing-Billing Medicare for 92250-Denials Reported

We have seen Medicare denying 92250 in some regions due to not having a referring provider present on the claim form. Putting the attending physician name and NPI in box 17a and 17b on the claim form (old and new) should fix the problem.

Click here to contact opticXpress to become your billing service. Stop worrying about these denials on your own!

Optometric Billing-Claims to Be Held by Medicare per Congressional Request

Information Regarding the Holding of April 2014 Claims for Services Paid Under the 2014 Medicare Physician Fee Schedule
The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1, 2014. That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013, which provided for a 0.5 percent update for services paid under the MPFS through March 31, 2014.

CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1, 2014. CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (i.e., through April 14, 2014). This hold would only affect MPFS claims with dates of service of April 1, 2014, and later. The hold should have minimal impact on provider cash flow, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any Congressional actions.

You can always contact opticXpress for help with your optometric medical billing and avoid having to worry about these things yourself. Please click here for more info.

Optometric Billing-Why I HATE Office Mate-Part 1

I have been meaning to write this for a long time but for some reason, all I have done is just collect evidence on the subject without actually pulling the trigger on the situation. Hell, I even sent the software designers some of the screen shots that I am going to share with you in an effort to get them to fix these important mistakes BEFORE releasing a new version of the software....it didn't work. So, I am here today to begin my attack on Office Mate.

Office Mate is by far, the worst piece of crap that has ever been sold to the optometric community. I can go into a million reasons as to why but for the purpose of these posts, I am only going to highlight the issues that I can explain to you visually. That is, I have photo documented proof of why you shouldn't spend your money on this piece of Sh88, and if you did these photos prove that you should not only stop using office mate, you should fight tooth and nail to get your money back.

Lastly, before I begin, I want to point out that after speaking to various high level technicians and programmers at office mate ( or eyefinity or who ever the hell owns these people), every single one of the issues that I am going to share with you has been acknowledged by office mate as "known of for quite sometime, program works as designed. No Immediate plans to fix." Did you hear that in your mind as you read that last sentence? OFFICE MATE DESIGNED THIS TO WORK WRONG AND HAS NO PLANS TO FIX IT!

Now, without further adue:

PROBLEM #1: FEE SLIPS DON'T CORRECTLY CARRY OVER TO CLAIMS

In the above image, this patient's exam was coded using  Exam Writer and each diagnosis code was correctly pointed to the respective procedure codes as the Dr. here wanted them submitted to the insurance company. However, when the exam was carried over to the fee slip by our secretary, only #2 diagnosis code appeared on the fee slip for her to choose from. When I received the claim in "3rd party processing" at the end of the day, the above is what I got. The Dr. had actually pointed 1,2,3,4 to proc code 1 when she charted that day and used #2 for the PQRS codes, yet how is it that the claim in the picture above was generated? 

WHAT DOES THIS PROBLEM MEAN TO THE AVERAGE OFFICE MATE USER?

The average optometry practice does not have a billing department and may not have an actual biller. The job of batching claims and submitting to the insurance company is usually left to a secretary, office manager, another un-qualified individual in the office or the doctor. None of these named individuals have the time, desire and in many cases, knowledge to properly research and correct the error above on a daily basis. In fact, most offices don't even batch and submit on a daily basis, many do it weekly. What if you had to fix EVERY CLAIM for 10,20,30 or even 50 patients at the end of a long week? The issue above is a primary reason why claims generated by office mate can't be trusted. 

CRAP CLAIMS LIKE THE ONE ABOVE LEAD TO A LOSS OF PRECIOUS REVENUE IN MANY PRACTICES IN THE UNITED STATES.

Optometric Billing at Saratoga Springs!

This weekend, March 22-24, opticXpress will be hosting an exhibit at the Saratoga Springs Coding Conference in Saratoga Springs, NY. We encourage you to come visit us and see what we have to offer and what we are all about.

We will also be joined at our table by the president of Liquid EHR which is our choice for clients that need high quality EHR software. Also, we will be highlighting our free billing software and EyeCor, coding software for OD's.

We hope to see you there!

For more info, please call us at 866-688-3335 x1.

Click Here to Let opticXpress Become Your Optometric Billing Service Today.

Optometric Billing-opticXpress Updates Web Page

opticXpress has updated their webpage. It now includes easier access to information about services, the ability for patients to logon and pay invoices they have revamped it throughout with cleaner, more concise text.

Click Here to Have a Look Today.

Optometric Billing-New 1500 Claim Form

In case you are not aware, though I am sure you are, there is a new 1500 claim format going into effect April 1. After looking over the attached manual there are many changes going into effect that you as a billing person or doctor's office should be aware of. Below you will find a copy of the most recent new 1500 claim form and a link to the intsruction manual for filling this out. It would be in your best interest to print out the form and fill it in with "dummy" information according to the attached instructions as many times as needed in order to familiarize yourself with the information and new form.

Instruction Manual Contained Here

As always, opticXpress can handle all your billing needs and help you ease the transition to this new format. 

Click Here and Call Us Today!

Optometric Billing-Vermont Medicaid Timely Filing Limits

As Per Section 8.1 of the Vermont Medicaid Timely Filing Manual:

1) When Vermont Medicaid is Primary the timely filing limit is 6 months (one of the shortest in the nation):

When the system indicates that Vermont Medicaid is the primary payer, the timely filing

limit for such claims is six months from

the date of service.  In no case will a claim be

considered if the date of service is greater than two years prior to the DVHA’s receipt of

the claim. If a claim has a date or dates of service past the timely filing limit, it may be

submitted for payment directly to HPES if one or more of the following conditions are

met:

•HPES denied the claim within the timely filing limit for a reason other than

exceeding the

time limit. A copy of the remittance advice showing the denial must be

attached to each

claim.

•Abeneficiary’s eligibility was made retroactive and the date of service is within the

retroactive period. The claim must be submitted within the first twelve months of

thedate on the Notice of Decision. Include a note with the claim stating the

retroactivedate

of eligibility.

•Inpatient claim, the timely filing limit is 180 days from the date of

discharge. 

2) Crossover Claims-you have 2 years (weird but true):

When a claim is billed to Medicare with Vermont Medicaid noted as the secondary payer

(using the crossover function), the crossover claim will be

considered timely if it is

received within two years of the date of service.

opticXpress specializes in Medicare and Medicaid billing for optometrists. We also handle the billing of ALL other insurance companies as well, espescially our home state of Vermont. 

Click Here now to let opticXpress be your optometric billing company or clearinghouse today!