For help understanding the new form, contact opticXpress today at 866-688-3335
or Click Here!
opticXpress is an optometric billing company that provides a clearinghouse, billing service and software strictly for optometrists.
Friday, January 24, 2014
Optometry Billing-NEW CMS Form required April, 2014
The new CMS form will be required to submit claims beginning in April of this year. If you are a programmer, you can click this link to find mapping and layouts for the new form in order to update your software. If you are a biller, you should also click the link in order to familiarize yourself with the new form.
Optometry Billing-G8553...EXPIRED!
- G8553 code is no longer being accepted by Medicare (or other insurance companies for that matter), and will cause your claims to reject. This was the code to report E-rx incentives, which has been ended.
If you have been using this code and seeing claim rejections (espescially if you are using Gateway EDI) check for this proc code and Delete it then resubmit your claims as normal.
For help with your optometry billing, Contact opticXpress today.
Optometric Billing-Windows XP not HIPPA Compliant as of April 8,2014
According to an email sent out by 1st physicians:
"As of 4-8-14 Windows XP will no longer be HIPPA compliant. Microsoft has announced that as of April 8, 2014, they will not release any security patches for the Windows XP operating system. Without this support, Windows XP will be non-compliant with HIPAA. This leaves just 12 weeks for you to replace any PC's on your network currently using Windows XP. Please note that this will not only affect health care, but also all business and government agencies, so it could result in a shortage of equipment available, or shipment delays."
Over the coming days, opticXpress will be listing links on our website where you can buy high quality, HIPPA compliant PC's. For now, you check out two that are sold in our amazon store by CLICKING HERE.
Call opticXpress today for help with replacing your non-compliant PC's.
"As of 4-8-14 Windows XP will no longer be HIPPA compliant. Microsoft has announced that as of April 8, 2014, they will not release any security patches for the Windows XP operating system. Without this support, Windows XP will be non-compliant with HIPAA. This leaves just 12 weeks for you to replace any PC's on your network currently using Windows XP. Please note that this will not only affect health care, but also all business and government agencies, so it could result in a shortage of equipment available, or shipment delays."
Over the coming days, opticXpress will be listing links on our website where you can buy high quality, HIPPA compliant PC's. For now, you check out two that are sold in our amazon store by CLICKING HERE.
 |
| This is the opticXpress Hal500 fully HIPPA compliant PC |
Call opticXpress today for help with replacing your non-compliant PC's.
(866)-688-3335 x1
Friday, January 17, 2014
Optometric Billing-Increase Reimbursement From Vision Insurances (VSP, DAVIS, EYEMED, SUPERIOR, ETC)
Yes. It's true. You can increase your reimbursement from vision plans that you participate with. There is no special trick to doing this. No special coding that you are required to learn. It's such a big secret, the vision company execs would probably kill me if I let this get out...but I'm gonna take the risk.
It's not hard to make this happen, in fact, it's actually quite simple. All you need is an individual working for you that is talented on the phone and the "cohones" to say "Cancel my contract"!!! Don't believe me?
Here at our clinic, we have successfully negotiated will ALL BUT ONE of our vision plans for an across the board increase of base pay for exams. Where we were receiving $38-$45 before for eye exams, we are now receiving $75 per exam FROM EACH COMPANY and many of the vision insurance companies have been gracious enough to raise our materials reimbursements as well, in most cases without us asking! The only company that didn't want to "play ball" was N.V.A and guess what? I just faxed them our notice of termination.
The bottom line is this: you don't have to continue to accept these low-ball reimbursements from vision plans! You can do something about it...especially if you are in a market where allot of employees utilize a particular plan or if it is a "high rent district".
It's not hard to make this happen, in fact, it's actually quite simple. All you need is an individual working for you that is talented on the phone and the "cohones" to say "Cancel my contract"!!! Don't believe me?
Here at our clinic, we have successfully negotiated will ALL BUT ONE of our vision plans for an across the board increase of base pay for exams. Where we were receiving $38-$45 before for eye exams, we are now receiving $75 per exam FROM EACH COMPANY and many of the vision insurance companies have been gracious enough to raise our materials reimbursements as well, in most cases without us asking! The only company that didn't want to "play ball" was N.V.A and guess what? I just faxed them our notice of termination.
The bottom line is this: you don't have to continue to accept these low-ball reimbursements from vision plans! You can do something about it...especially if you are in a market where allot of employees utilize a particular plan or if it is a "high rent district".
Not sure you are ready to try this on your own? Want some help from an optometric billing specialist ? Call us today and we can help you get paid what you deserve from vision insurance companies!
Call Toll Free: (866)688-3335 x1, ASK FOR ANDREW!
Thursday, January 16, 2014
Optometric Billing at Vision Expo East
You can reach me by calling Andrew Roy at opticXpress/Stowe Eyecare or emailing me. My contact info is below! I look forward hearing from you and hope to be of service to you as an optometric billing specialist at this years vision expo east!
Toll Free: 866-688-3335 ext 1
Desk: 802-253-7201
Fax: 802-253-7522
E-Mail: rlr.consulting@gmail.com
To learn more about opticXpress and Stowe Eyecare please click below!
Wednesday, January 15, 2014
Optometric Billing-Keeping It Legal After ObamaCare-The Affordable Care Act
Good Morning,
As exchange plans continue limiting provider networks and ramp down compensation, it’s not surprising that more professionals are exploring or pursuing different options. Some physicians are conducting a concierge or retainer practice that offers upgrades to cash-paying patients. Some have decided to “opt out” completely of insurance programs. Others, who continue to participate in governmental and managed care arrangements, however are considering whether going “out of network” makes more sense financially and operationally, than remaining network providers.
The Affordable Care Act has imposed new requirements that impact the ability to accept and charge patients for concierge (retainer) service, even if they are participating in exchange plans, or in Medicare and traditional commercial plans. The law also requires every citizen to obtain insurance, meaning that many “cash” patients will in the future be covered.
Providers who seek to “opt out” have to follow a set of procedures to extricate themselves from Medicare or managed care plans. They will need to enter into agreements with Medicare patients regarding future care. Further, payer requirements and state laws also impose limits on doctors or groups establishing a cash or a concierge practice.
Join us for this Live Audio Conference - "Concierge Practice: How To Keep It Legal Post Affordable care Act" on Thu, Jan 16, 2014 at 1 pm ET | 12 pm CT | 11 am MT | 10 am PT where expert speaker Wayne J. Miller, Esq. will discuss the current limitations on a concierge practice and how it may still be viable in the new environment.
Highlights of the session:
If interested, please click the following link to register and get your early bird discount:-
CLICK HERE TO REGISTER
Please apply discount code "SAVE20" at checkout to get an additional $20 discount on registration.
Looking forward to your participation here.
Thanks,
Jennifer Smith
As exchange plans continue limiting provider networks and ramp down compensation, it’s not surprising that more professionals are exploring or pursuing different options. Some physicians are conducting a concierge or retainer practice that offers upgrades to cash-paying patients. Some have decided to “opt out” completely of insurance programs. Others, who continue to participate in governmental and managed care arrangements, however are considering whether going “out of network” makes more sense financially and operationally, than remaining network providers.
The Affordable Care Act has imposed new requirements that impact the ability to accept and charge patients for concierge (retainer) service, even if they are participating in exchange plans, or in Medicare and traditional commercial plans. The law also requires every citizen to obtain insurance, meaning that many “cash” patients will in the future be covered.
Providers who seek to “opt out” have to follow a set of procedures to extricate themselves from Medicare or managed care plans. They will need to enter into agreements with Medicare patients regarding future care. Further, payer requirements and state laws also impose limits on doctors or groups establishing a cash or a concierge practice.
Join us for this Live Audio Conference - "Concierge Practice: How To Keep It Legal Post Affordable care Act" on Thu, Jan 16, 2014 at 1 pm ET | 12 pm CT | 11 am MT | 10 am PT where expert speaker Wayne J. Miller, Esq. will discuss the current limitations on a concierge practice and how it may still be viable in the new environment.
Highlights of the session:
- What requirements do exchanges impose on providers?
- Definition of services that are “covered” in exchange and other plans as per ACA
- Private vs. public exchanges: what providers need to know
- Must you serve exchange patients under existing contracts?
- Terms to look for in new deals to serve exchange patients
- Reducing liability risk for nonpayment
- Due diligence steps recommended before taking on exchange business
If interested, please click the following link to register and get your early bird discount:-
CLICK HERE TO REGISTER
Please apply discount code "SAVE20" at checkout to get an additional $20 discount on registration.
Looking forward to your participation here.
Thanks,
Jennifer Smith
Optometric Billing-What "ObamaCare" Means to Your Pracitce
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.
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.
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