Optometric Billing-Some Coding Tips, OCT, GDX, Fundus Photos, ETC

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-Billing For Punctal Plugs

This was burried in our internal notes and is article written by  John Rumpakis, O.D., M.B.A., Clinical Coding Editor. You can find the original text for this article by clicking here.

"Signs and symptoms of dry eye syndrome are often discovered during a comprehensive exam. When further testing is indicated, this may be best done as a follow-up evaluation. This evaluation for dry eye syndrome most likely involves several examination techniques and ancillary tests. These tests, which do not have separate procedure codes, include:

• Patient history (dry eye surveys, symptoms, circumstances, etc.) 

• Tear film break-up time (TFBUT) • Schirmer testing (I&II)  

• Cotton thread or phenol red thread testing 

• Sodium fluorescein, lissamine green and/or rose bengal staining  

• Tear prism evaluation  

• Evaluation of lid wiper epitheliopathy

• Biomicroscopy and examination of ocular surface and lid margins

These tests help you formulate the diagnosis. The appropriate diagnosis code is usually dry eye syndrome (375.15) or keratitis sicca (370.33). Sjögren’s syndrome/keratoconjunctivitis sicca (710.2) is also a possibility, although you should be familiar with your carrier’s requirements prior to initiating any therapy.

In general, before contemplating either surgical or prescriptive treatment, you should have a well documented record of palliative therapy with an artificial tear protocol. The failure of the artificial tear treatment is what provides the medical necessity to proceed to more invasive treatment.

Once you’ve made the diagnosis of dry eye and formalized a treatment plan, several subsequent visits are typically necessary to evaluate the treatment plan. Both the diagnostic and treatment visits are billed using the appropriate office visit codes only. Keep in mind that if you perform the diagnostic examination on the same date as the comprehensive exam, it is not billable as a separate/distinct visit in addition to the comprehensive examination. Follow-up visits to assess the effectiveness of treatment, to alter or to add to the treatment plan are billed using 99212, 99213 or 92012. 

If you decide the patient requires punctal plugs, the billing is the same for temporary diagnostic plugs and permanent plugs. The supply of the punctal plugs is typically included in the insertion code. The insertion procedure is billed per plug in one of two ways. Here is the first method: 

• One plug: 68761  

• Two plugs, different eyes: 68761-50 (billed at 200% of one plug) 

• Two plugs, same eye: 68761-51 (billed at 200% of one plug) 

• Three plugs: 68761-50 (billed at 200% of one plug) and 68761-51 (billed at 100% of one plug) 

 • Four plugs: 68761-50 (billed at 200% of one plug) and 68761-50-51 (billed at 200% of one plug) 

The “multiple surgery rule” applies, so the payment is typically 100% for first plug, 50% for the second plug, and 25% for each of the third and fourth plug. The -50 modifier indicates a bilateral procedure on the same eye and the -51 modifier indicates multiple procedures on the same eye. See Appendix A in your CPT book for further details. 

The second method for billing punctal occlusion is adding the E modifiers to the surgical code to designate which puncta are being occluded. Bill for each plug on a separate line using the appropriate E modifier: 

• E1: upper left  

• E2: lower left  

• E3: upper right 

 • E4: lower right 

The global period for punctal occlusion is 10 days. So, if a patient returns within that period for a follow-up visit related to the punctal occlusion, then that visit is included in the insertion fee. However, if a patient returns for an unrelated problem, then that office visit must be billed using a -24 modifier (unrelated evaluation and management during a postoperative period) in order for you to be compensated for that encounter. "

We would like to thank Dr. Rumpakis for his continued contributions to Medical Coding. His work has proved to be very valuable to our cause as well as many OD's around the country.

CHECK OUT OPTICXPRESS TODAY AND TAKE THE NEXT STEP TO MAKING YOUR BILLING MUCH EASIER! 

Optometric Billing- Does Medicare Cover Routine Eye Exams?

I get this question all the time, sometimes doctors even demand that I "respect their authoritah" (Eric Cartman pun intended) and trust them when they tell me that Medicare Pays for Routine Eye Exams.

Simply put, MEDICARE DOES NOT PAY FOR ROUTINE EYE EXAMS, EXCEPT FOR PATIENTS WITH DIABETES. 

"Medicare Part B (Medical Insurance) covers a yearly eye exam for diabetic retinopathy by an eye doctor who is legally allowed to do the test in your state." link

That being said, if you try to bill Medicare using a V72.0, 367.21, 367.0, 367.4,367.1 DX Code as your primary DX code, expect not to get paid; and if Medicare doesn't cover it, chances are the patient's secondary may not pick it up either, although this is not a definite rule as it varies by payer and patient plan.

By the way, for those docs and staff out there that think you are being paid for routine work because the EOB says you were paid for a "92004 and 92015"....YOU ARE MISTAKEN AND YOU MUST LEARN TO RESPECT MY "AUTHORITAH" !

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-Free Optometric Billing?

That's right! opticXpress is working on a way to provide optometrists with a FREE* method to perform optometric billing that centers around their office management software. More info is coming soon, but check their software page for more info about how the ground breaking opticXpress software might be a fit for your practice.

You can also CLICK HERE for software info.

RELATED:

What is Optometric Billing? 

Optometric Billing-Today Funny Video-Sorry Walmart OD's!

This goes out to all of the Walmart Vision Center O.D's and their staff...Clearly, you have it rough!

Dont forget: opticXpress for all your optometric billing needs!

Optometric Billing-Today's Funny Video-04/04/2012

As usual, we here at opticXpress enjoy a good laugh. Watch the video below and remember to clean the glass at your offices regularly!!!!

Contact opticXpress Today For All of Your Optometric Billing Needs!

Optometric Billing-How To Properly Bill For Visual Fields

Using Medicare's Local Coverage Determinations (LCD's) as a guide to billing ALL  insurance companies is a good strategy to employ. Though it does not guarantee payment across the board, it is, in my opinion, a key way to increase reimbursements. This is because Medicare is, by far, the most stringent payer in terms of rules for coverage.

As an optometrist, one of the most important procedures you give your clients is a Visual Field (92081,92082,92083) but it is also one of the most commonly misbilled procedures in the optometric billing field. The biggest reason for this is that it is commonly not paired with a correct diagnosis code which means you loose money because it is denied as "medically unnecessary". You can avoid this by first determining whether or not it is deemed medically necessary to perform a visual field by check the attached chart to see if the diagnosis you are suspecting qualifies for a visual field. If it does not then you need to explain to the patient that you feel it is necessary to perform the procedure and CHARGE THE PATIENT! You would then bill the insurance company with a "-GY" modifier. MAKE SURE THAT YOU INCLUDE THIS INFORMATION IN THE PATIENT'S ADVANCE BENEFICIARY NOTICE (ABN) !

CONTACT opticXpress TODAY FOR HELP WITH YOUR OPTOMETRIC BILLING 

Optometric Billing: Digitally Active Contact Lenses!

Just makes me wonder how we would start billing for this!!!!


"Digitally Active Contact Lenses – Are We Near It's hard to trace the active contact lens' birth date, but the year might be 1973. , researchers at the National Environmental Research Center created a contact lens with a thermocouple built in. The sensor-cum-contact was arguably the first digitally active design to be realized. As the electronics revolution commenced in the 1970s and 1980s, though, little work was done to expand on this precocious design. Interest revived in the late 1990s, but it was not until 2001 that the device began to step from concept into commercial reality. Researchers used micro-electro-mechanic sensors (MEMS) to create a contact lens that monitored ocular pressure -- an important indicator of Glaucoma. The research was presented at the New Directions in Cellular and Tissue Biomechanics conference in Les Diablerets, Switzerland. In 2009, a company Sensimed AG launched the world's first commercial digitally active contact lens. The design, dubbed "Triggerfish", used an embedded a MEMS strain gauge sensor and microprocessor inside a soft silicone contact lens. The circuit elements were exocentric, out of the line of sight. The device received power from and ferried signals via a circular antenna around the eye socket. In the last decade several devising and even more ambitious designs were introduced in this hot field. Among the most noteworthy is Professor Babak Parviz of Seattle's Washington University, who added pixel displays to the mix. Perhaps inspired by Triggerfish - medical sensors, such as a glucose sensor (monitoring tear glucose, an indicator of blood sugar in diabetics), are also inculcated into the design. But creating a contact lens display has been a major obstacle for focusing the image. In short, we need miniature lenses to focus the image on the eye. Ultimately the digitally active contact lens of the future aims to be a high resolution display, which can assert an augmented reality, including text and images over human vision. Such a design would work for business (work displayed right in your eyes), communications (text messages, emails), and pleasure (imagine watching movies or "tripping" without drugs via in-eye vision). The lens will also likely optionally incorporate glucose, occular pressure, and possibly other sensors to monitor eye health and overall body health. , it may be a few decades before the perfected contact lens product is released commercially, but in just 10 years we may have crude commercial contact lens text displays, if you're willing to wearing a bulky wireless power device around your eye socket." (full article here)


Talk Back! Let us Know What You Think!

OpticXpress Handles Optometrists’ Billing

From Elaine Rose at "Press Of Atlantic City"
Full Article Here

OpticXpress provides medical billing services and office software for optometrists. We give them the software to help comply with records requirements and to connect with patients as part of doing the billing.

We have multiple clients nationwide that use our service and our software.

I work with companies in Vineland for developing software, creativity and for printing forms. I try to work with local companies when practical.

Optometry is an underserved specialty in the medical billing world. There are a lot of nuances in the codes that most generic medical billers are not familiar with.

Entry: Until the early 1990s, optometrists weren't considered to be providing medical services, and dealt with vision insurance. But then the government opened the opportunity for them to provide medical services, which are covered by Medicare and Medicaid.

We were able to capitalize on the change, and could educate doctors. We post a lot of information we get from our community and various articles[ to our blog ] as a resource to help in their practice.

We specialize in post-operative cataract billing. It's an issue that's very hot among optometrists. A lot of them have patients who go to ophthalmologists for the surgery, and then come to optometrists for after care. We can virtually guarantee that an optometrist will get paid for those services.

The average optometrist's practice is small, about $500,000 to [$1.5] million a year in revenue. The biggest challenge is to educate practitioners that it's better to outsource their billing, so they don't have to do it anymore. They often can't afford to hire a billing department, so they rely on untrained staff to bill patients and deal with insurance companies.

The future: We want to become synonymous with optometric medical billing nationwide. We want optometrists seeking to take their practice to the next level to think of OpticXpress.

Staff writer Elaine Rose

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WHAT OPTICXPRESS BELIEVES

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Optometric Billing-Californa Optometric Association Integrates VSP

Recently the California Optometric Association voted to support the inclusion of VSP in the California Health Insurance Exchange.

Read the Letter Below and tell us what you think by using the comment section to talk back! We want to know what you feel!

Optometric Billing- What opticXpress Believes

In this day and age it is hard to find a person, let alone a company, that acts in a moral and ethical manner. Yesterday, for example, it was released that Apple is ordering the investigation of it's manufacturing partners plants in China so as to eliminate harsh working conditions and become the first "fair trade" manufacturing company in the world. However, though this looks great on the outside, a deeper look at the company's profit margins will show that though this is a benevolent undertaking, the roots of this effort have their taps in the lore of marketing. Apple stands to make billions off this approach to becomming "fair trade" as it will undoubtedly give them just the marketing edge they need to justify their higher than average prices on their product. Can't you see the waves of "Apple Nerds" now, wearing their "Apple Fair Trade" t-shirts shouting at you from the top of their lungs while they stand in line waiting to fork over their hard earned cash for the iPad 4?!?!

This being said, I want to tell you exactly what we stand for here at opticXpress. opticXpress is a Christian company. We are a second generation Medical Billing Company owned solely by family members since 1991. Though we are not perfect in all that we undertake, we strive to be honest and loyal; not just to our customer but to The Lord from whom we believe our company has been made possible. We want every single one of our clients, readers and potential clients to know that 10% of our gross revenue is donated Monthly in the form of Tithe and offerings to the local Spanish Seventh Day Adventist Church in Vineland, NJ. With this money, the NJ Conference of Seventh Day Adventists helps fund schools and mission work throughout the state. Specifically, one of the newer and more successful of these schools is the Vineland Regional Adventist School for which we have been a supporter of since its inception just a few short years ago.

"We are God's stewards, entrusted by Him with time and opportunities, abilities and possessions, and the blessings of the earth and its resources. We are responsible to Him for their proper use. We acknowledge God's ownership by faithful service to Him and our fellow men, and by returning tithes and giving offerings for the proclamation of His gospel and the support and growth of His church. Stewardship is a privilege given to us by God for nurture in love and the victory over selfishness and covetousness. The steward rejoices in the blessings that come to others as a result of his faithfulness. (Gen. 1:26-28; 2:15; 1 Chron. 29:14; Haggai 1:3-11; Mal. 3:8-12; 1 Cor. 9:9-14; Matt. 23:23; 2 Cor. 8:1-15; Rom. 15:26, 27.)" (Entire Quote Here)

Though we do not advocate forcing one's religion or beliefs upon another human being it is our goal to be a beacon of light to our customers. To minister to them by our actions so that they can see we truly are moral and ethical. 

If you feel that you too would like to make a donation in the form of tithe, contact your local church and ask them how to go about doing it. If you would like to become a supporter of the Vineland Regional Adventist School, Please click here and contact Carlos Torres. Maybe your donation will help to train future optometrists! 

Optometric Billing-The State Of Optometry

In her "State of Optometry" Address, President of the American Optometric Association, Dori Carlson, discusses, among other things, :

1. The Affordable Health Care Act (Obama Care)
2. Children's Eye and Vision Benefits
3. Mandatory Vision Care being included in the AHCA
4. How organized healthcare resisted these efforts by the AOA and lost
5. The American Recovery and Reinvestment Act
6. How the AOA has fought for increases in reimbursements from Medicare for Vision Care Providers while reimbursements for other specialties have been lowered. 

Take a look at the video below and use the comment section to talk back and tell us what you think. How will these advances affect you as a vision care provider?

REMEMBER, opticXpress IS HERE TO HELP YOU WITH ALL YOUR OPTOMETRIC BILLING NEEDS. CONTACT US TODAY!

Optometric Billing-Do Your Patients Suffer From Lens "Sticker Shock"?

Do your patients buy designer frames from you but cringe when they find out how much the lenses are? Check out what Micheal Block has to say about this. Don't forget to talk back to us and tell us what it's like around your office!

Optometric Billing-What Tasks Should My Staff Do?

What should your staff be in charge of ?

In short, the answer to that question is everything but insurance billing, credentialing and A/R. Micheal Sutton of Bloomfield, NJ said it best when he said " Anything you spend money on to save time saves people, and people are the most important part of any practice."

Dr Sutton was smart when he said this. He realized that his budget was limited, his practice was small and he looked hard to find the people that he had working for him. Why would he want to risk loosing them by tasking them with work they had no business or time to be doing?

Apply this to your optometric practices when it comes to your insurance billing, patient invoicing and patient collections. Most optometry practices don't have the budgets it requires to hire a full time billing department so they hire an office manager thinking that person can not only run the office and deal with patients all day but also bill insurance, invoice patients and take the time out of thier busy days to work insurance denials and speak to patients who have questions about thier invoices or account status. STUPID THING FOR ANY PRACTICE OWNER TO DO! The funny thing is that these optometrists sit back and wonder why they are not getting paid the amount of money they feel they should be getting paid by insurance companies and why thier A/R is so high!

IT DOESN'T MATTER IF YOUR OFFICE SECRETARY HAS EXPERIENCE IN BILLING INSURANCE! SHE DOESN'T HAVE THE TIME TO DO THE JOB PROPERLY, DON'T ASK HER TO DO IT!

IT DOESN'T MATTER IF YOUR OFFICE MANAGER HAS A MEDICAL BILLING DEGREE! IF YOUR MANAGER HAS A BILLING DEGREE WHY ISN'T HE/SHE YOUR FULL TIME BILLER INSTEAD OF YOUR OFFICE MANAGER?

IT DOESN'T EVEN MATTER IF YOU CAN AFFORD A FULL TIME BILLING DEPARTMENT! WHY PAY TWO OR THREE PEOPLE A FULL TIME SALARY PLUS BENEFITS THE MONEY THAT IT REQUIRES WHEN YOU COULD OUTSOURCE THIS WORK TO A COMPANY LIKE opticXpress FOR A FRACTION OF THE COST AND ENJOY A HIGHER RETURN ON YOUR INVESTMENT?

The bottom line is this: your staff in office should have one job and one job only, TAKE CARE OF PATIENTS. Leave insurance and patient invoicing to people that don't need to put patient care first, leave it to opticXpress!

Call opticXpress today and let your staff take care of your patients...we'll take care of insurance!

Optometric Billing-All About Vision Plans

I stumbled across this blog post by Al Clenimann. This is a wonderful write up on the evils of Vision Plans. I sincerely do not advocate an optometrist's use of vision plans. I believe that optometrists are legitimate doctors that need to provide legitimate medical care to their patients and vision plans are not the way to go about it.

Read Al Clenimann's article,The Dealer and the Junkie. I guarantee you will agree with every word he says.

Optometric Billing-Retain Customers and Broadcast Legitimacy

One of the most important aspects of owning an optometry practice is customer service. This  is ever more important to those optometrists that rent space from a franchise store. The more customers you bring in, the more the franchise benefits. It also helps to cement your "legitimacy" as a primary vision care provider which can be hard to do under this business model because patients tend to view you as more of a provider of "screening" services, rather than medical care providers.

My esteemed colleague at Mirro, Inc. wrote a piece about motivating your employees in order to motivate your customers...which is the essence of customer service. Take a look at his article below.  

Motivated Employees Create Motivated Customers! 

"The best way to ensure everyone around you is motivated is to get rid of the people who aren't motivated." ~ Lou Holtz 

This statement couldn't be truer! Have you ever walked into a restaurant or retail store and talked to an employee who wasn't excited to be at work? I have. It sucks. The only thing I can ever think about is why is that person here and how fast can I leave. If you have employees working for you that could qualify as "not motivated" I have to ask you one question: How many of your patients feel the same way I do in the example above when they encounter that employee? Probably most. Employees who are motivated to be at work create a positive environment, for other employees and most importantly, PATIENTS. 

When patients are having a good time or enjoy their environment, they spend more money! If in 2012, one of your practice's goals is to increase your profits (which should be a goal every year), than you need to take a detailed audit of your staff and follow Lou Holtz's advice. You just might see immediate results!

Remember, in this economic environment, fire fast and hire slow!

(Mike Rolih is the President of MIRRO, Inc. a cutting edge consulting firm focused on providing eyecare professionals with training, marketing, and human resource solutions. For more information, you can visit MIRRO at www.mirroinc.com. )

Are there any techniques that you employ in your office that helps you provider top customer service? Talk back in the comment section below and let us know!

Remember, opticXpress is your one stop for all your medical billing needs. We provide full revenue cycle management and excellent customer service to your patients. Please, CALL US TODAY!

Optometric Billing-Funny Photo For The Day!

Here is a great photo to lighten the mood around your office! 

Remember, optometric billing is serious work...we have to post this stuff to lighten the mood sometimes!

CALL opticXpress today!

Optometric Billing-One More Way to Bill for Contact Lens Bandages

Here is one more possible way to bill for the contact lens bandage. This was found at the Review of Optometetry and written by Dr. Sorrenson. I would save this method only in the event that 92071 is not covered. Not because I don't think it is good but because it doesn't make great business sense from a Return on Investment (ROI) standpoint...it is just too time consuming. This is definitely a last case scenario in that respect.

"Billing problems can arise in both diagnosing and fitting keratoconus patients. Diagnosis is typically suspected during a routine exam, then confirmed with corneal topography. Medical carriers vary considerably in topography reimbursement. Unfortunately, many wont pay for the procedure, regardless of your appeals.

Once you confirm the diagnosis and counsel the patient, finalize your decision to fit the patient in contact lenses. This is the first step where many offices fail to bill properly. The code for bandage lens fitting and supply [92071] is a poor choice for keratoconus fits because the reimbursement$60 to $85 for the fit and lenses, per eye is a fraction of the proper amount for a case of such complexity.

A better approach: Bill the code for contact lens fitting (92310) and append modifier -22 to alert the carrier to the greater amount of time and complexity for this proceduretriple the usual rate is not uncommon. Expect to submit further documentation to the carrier to justify this higher fee. A letter of explanation including full color topographic maps often fulfills this requirement." Read the Entire Article Here

Do you have any experience trying to bill for Contact Lens Bandages? Have you tried either of the methods listed above? Use the comment section below to talk back and let us know!

CONTACT opticXpress TODAY FOR ALL OF YOUR OPTOMETRIC BILLING NEEDS!

Optometric Billing-Mobile Devices Changing Healthcare

"As healthcare costs continue to rise, tablet and smartphone apps are steadily entering the mainstream as appealing and less expensive alternatives to non-invasive procedures and tests. People can now test their vision, count calories, send microscopic images, and more, all using mobile devices."

Our Friends at Noble Vision believe it and so do we! Get on board in your office with mobile devices today! (read entire article here)

Are you using mobile technology in your office? Why or Why Not? Tell us below!

Optometric Billing-Today's Hillarious Video

Today's Hillarious Video for all to enjoy! Please share this with everyone you know!

Remember, opticXpress doesn't take your optometric billing as a joke!

CONTACT US TODAY!

Optometric Billing-Dry Eye and the Schirmer Test

Laurie Barber, MD, University of Arkansas Ophthalmology Professor, Interviewed by Sharon Kleyne about the Schirmer Test for Dry Eye, Eye Drop Allergies, Eye Mist, and Water.

You can read the article here.

CONTACT opticXpress TODAY!

Optometric Billing-The OpticXpress Facebook Page!

Take A Look At Our New Facebook Page and Like Us Today!


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Optometric Billing-Another Hilarious Video!

Another Hilarious "optifog" video...were gonna have them make us an optometric billing commercial I

think!  Enjoy and don't forget what we were all taught as children...SHARE!

DON'T FORGET TO CHECK OPTICXPRESS.COM FOR MORE OPTOMETRIC BILLING INFORMATION TODAY!

Optometric Billing- 25% Of All U.S Physicians Own a Tablet!

At least twice per month it seems that we bring to light just how important it will be for optometrists to "Jumb on the iPad bandwagon"! Well, today, our friends at Noble Vision have said the same thing. They posted an article today that highlighted just how important these new tools are/can be.

"Today, 25 percent of all US physicians own a tablet device, while average consumers can use mobile devices asdiagnostic tools and share healthcare information via social networking. Mobile devices also provide consumers with the concept of “quantified self,” helping them monitor and improve their health."
Read the entire article here


We believe whole heartedly that tablets are the new "PC" and will become more mainstream this year and into 2013. In fact, it was announced yesterday that Apple is now the leading provider of "PC's" thanks to record sales of the iPad in the last quarter '04 having toppled the once dominant Hewlett Packard. 


Here at opticXpress we test our optometric billing software and services on tablet devices regularly and encourage clients and non-clients alike to implement tablets into their office structure whenever possible. We encourage you to do the same if you haven't already. 

CONTACT opticXpress TODAY FOR MORE INFORMATION!

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Apple Leading the Way In Mobile Computing

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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-Funny Optical Video!!! Must Read!

From our friends at McLeish Optometrists comes this hilarious video! Share this with friends, family, colleagues and co-workers!

 Don't forget, opticXpress is your one stop for all your optometric medical billing needs!

Optometric Billing-Apple Leading The Way In Mobile Computing

Take a look at this article from ZDnet. It's just one more reason to choose iOS products as your mobile device
of choice to fuel your optometric practice!

"via ZDNet for iOS
Enterprise iPhone 4S activations spike, highlight Apple's halo effect

Apple sold more than 37 million iPhones in its December quarter and apparently a nice chunk of those went to the enterprise, according to Good Technology. Tim Cook, Apple CEO, gave his quarterly nod to the enterprise and highlighted enterprise accounts and Fortune 500 adoption stats of iPhones and iPads. In a nutshell, Apple is seeing a halo effect in its corporate, consumer and education account...(Read more)

RELATED POSTS:
Optometric Billing-More Mobile Platform Information

Another Optometric Billing NO-NO!

"A New Whiteland optometrist could retire any time he wanted, but he keeps going because he likes the work and the patients, some of whom he has treated for decades. Joseph Claudy began his practice after graduating from Indiana University School of Optometry in 1968. He began his career working from the New Whiteland home he still shares with his wife, Mary Jo, before moving to the current office a short distance away on U.S. 31.

Claudy, 75, works nearly full time. Patty Towles has worked for him for 23 years, scheduling appointments, billing patients and helping repair glasses.  (entire article)"

I want to congratulate Dr. Claudy for finding and doing something he loves, it is a rare thing to be able to do that these days, it seems. However, I want to rebuke him for what he has put poor Patty Towles through for 23 years. Dr. Claudy has given a perfect example of the BIGGEST mistake I find being made in optometrist's office day and day out; USING ONE STAFF MEMBER TO DO TOO MANY THINGS.

When we go to Walmart and ONE cashier is ringing out customers don't we get agitated when no one is sent in to open another line and help relieve the traffic at the check out? WE ALL GET AGITATED AT THIS, so doesn't it stand to reason that when we run our practices shouldn't we provide the best customer service possible by not assigning one staff member too much work?

I understand that alot of times this decision is driven by economics. However, it is a proven fact that medical practices whose billing departments are made up of regular office staff routinely post lower collection amounts from insurance than their out sourced counterparts. So, with this in mind, doesn't it make more financial sense as a BUSINESS OWNER (notice the emphasis on business ower) to pay a few extra dollars in the short term to hire someone that specializes in insurance and patient billing than to loose more money in the long run relying on "Patty Towles" to do it all by herself for 23 years?

CALL opticXpress TODAY. WE WILL BILL INSURANCE AND PATIENTS FOR YOU SO PATTY TOWLES NO LONGER HAS TOO!

RELATED POSTS:

Optometric Billing-The REAL Way To Simplify Insurance Billing

Optometric Billing-Programs Provide the Tools Needed for Practices to Significantly Increase Their Reimbursements.

Optometric Billing-Why Good Billing Can Alleviate Your Fears

Optometric Billing-Scientific Fact Of The Day-01/24/2012

A recent study of business school graduates found that people who are 20% or more overweight make approximately $4,000.00 less per year than thinner graduates!

Also...

On Average, women cry 5.3 times per month while thier male counterparts cry only about 1.4 times per month!

Optometric Billing-Insurance Fraud

One of our biggest request from potential clients is for us to do things that we believe might be construed as "inusrance fraud". It is our goal as optometric medical billers to provide the best possible service and help optometrists recoup money from insurance as best as possible, but not un-ethically. Take a look at what happened to this Caldwell, ID optometrist:

"A federal grand jury has charged a Caldwell optometrist with swindling more than $1 million from health care benefit programs.

Christopher Card, 59, of Caldwell, allegedly lied and submitted false material to several programs, especially to Medicaid and Medicare. He dishonestly billed the programs, the indictment says, for false diagnoses, including glaucoma, color blindness, tension headaches and treatment of eye injuries.

This went on from as early as Sept. 1993 to Aug. 2010, the indictment claims.

The indictment further alleges that — although Card treated only 3.9 percent of Idaho’s Medicaid clients from Jan. 1, 2004 to May 8, 2009 — he reported diagnosing 99 percent of all acquired color deficiency cases among Idaho Medicaid patients. He also diagnosed 92 percent of all glaucomatous atrophy (optic cupping) cases and 86 percent of all chronic angle closure glaucoma cases.

It is also alleged that, in 2008, Card learned about the federal investigation, abruptly stopped submitting claims for glaucoma-related services and began billing for a variety of new diagnoses."

(You can read the article in its entirety by clicking here)


Apparently this Optometrist can see up to 10 years in prision, a fine of $250,000 and an additional 3 years of supervision after his release! It just doesn't pay to bill insurance incorrectly, NO MATTER HOW CROOKED YOU MAY THINK THE INSURANCE PLAN MAY BE!

By hiring a good and knowledgeable optometric billing expert, however, you don't have to worry about finding creative methods to bill insurance. For example, the industry average for collection from insurance is 70% while the average for collection using in-house staff is closer to 60%. opticXpress averages 75% collection rates from insurance. Did you realize that even this doctor and all his fraudulent billing yielded him only about 60-65% collection rates based on those statistics and HE USED FRAUD TO ACCOMPLISH THIS?!

CALL opticXpress TODAY AND SEE YOUR COLLECTION RATES RISE THE LEGITIMATE WAY!

Optometric Billing-Tips For Great Marketing

We here at opticXpress are primarily engaged in medical billing for optometry, otherwise known as "optometric billing". However, we know a thing or two about eye care practices and we are always trying to stay on top of the latest technological trends and advances as it pertains to the optometric practice (see our articles on mobile computing).

Below is an copy of an article written by Peter Ghali, iContact Senior Manager, Product Management, that was reposted and sent to us by our good friends at Mirro, Inc. Mirro, Inc, for those of you who don't know, is a firm that specializes in helping optometric practices better market themselves. Mirro uses advanced education techniques and of course, EMAIL Marketing, designed to get the most out of a practice and it's staff. Please give them a call by clicking here for more help marketing your practice. 

Now, without further Ado I present to you the article by Peter Ghali.

CONTACT opticXpress TODAY FOR HELP WITH YOUR MEDICAL BILLING! WE ARE STANDING BY! 

TOP FIVE 2012 EMAIL MARKETING TRENDS

-By Peter Ghali

For many businesses, 2011 proved to be a challenging year. They had to do more with less while customers became even more demanding. With new online channels emerging and the challenges they bring, marketers will have to improve their email marketing in order to stay relevant and remain effective. Below are five email marketing trends that can help you accomplish your 2012 marketing goals.


Social media and email marketing go hand in hand these days. It is now commonplace for marketers to add social sharing buttons to their emails and to use email marketing to grow their own social network following. The advantage of combining your email and social media marketing is that it gives your subscribers an opportunity to hear from you the way they want to hear from you. Everyone benefits, and this trend will continue into 2012.



Email marketers are realizing that more and more emails are read on smartphones. Over time, this trend has been increasing. In 2012, email marketers will look for guidance and best practices to help them ensure that smartphone users still receive appealing content that engages them while they’re on the go.



While email marketers will still focus on list growth (as they should), 2012 will see email engagement become even more critical. Consumers are faced with overcrowded in-boxes, so you’ll need to establish a connection with your subscribers so your message can stand out. Additionally, many email programs (Gmail, Yahoo, etc.) are adding tools to help their users filter out messages that aren’t important (e.g., Gmail’s Priority Inbox), so it will be imperative for email marketers to increase their focus on engaging users via opens/clicks.



Email marketing is all about delivering value to your subscribers. In 2012, email marketers will need to evaluate their content strategies as they try to increase email engagement. Email marketers also have to consider how their email content can be leveraged for other marketing channels (e.g., social, web). It’s very easy to get overwhelmed with the need to create content to keep your marketing fresh and relevant. In 2012, email marketers will look for better ways to create, curate, and re-purpose content to resonate across channels and drive higher engagement.


2012 will continue to see email marketing garner quite a bit of attention from marketers. As you grow your email marketing, keeping these trends in mind will only help. What other email marketing trends will make a difference in 2012? Feel free to share!