Staying up to date with optometry billing and coding is a significant challenge for practices nationwide, leading to lost revenue and administrative headaches. Studies show that a significant portion of claim denials stem from coding errors.
This problem is often compounded by a lack of feedback systems, making it difficult for practices to identify and correct these errors in the future. Practices that are able to arm themselves with up-to-date optometry billing and coding knowledge are much more likely to minimize claim denials, and ultimately, boost their bottom line.
10 Powerful Coding Tips for Increased Revenue
Staying on top of coding updates is crucial for optometry practices. It is much like playing a game with ever-changing rules. The Current Procedural Terminology (CPT) code manual is the rulebook for medical procedures, and it’s updated annually.
By familiarizing yourself with the latest revisions, you can make sure you’re using the correct code for your services.
The American Optometric Association (AOA ) is your friend when it comes to staying up to date with coding changes. They regularly provide resources and updates to help optometrists stay compliant with coding standards. By regularly reviewing these resources, you can proactively minimize the risk of claim denials due to outdated or incorrect coding.
Here are 10 coding tips to help you increase your practice’s revenue:
10 Coding Tips
- Utilize Uncommonly Used Codes: Explore lesser-known CPT codes that may apply to specific procedures or conditions your practice frequently encounters but are often overlooked by others.
- Optimize Modifier Usage: Master the use of modifiers (e.g., 22, 25, 59) to accurately reflect the complexity or uniqueness of services provided, potentially increasing reimbursement rates.
- Implement Secondary Insurance Verification: Verify secondary insurance coverage early in the billing process to streamline claims submission and reduce payment delays.
- Focus on Patient Education: Educate patients about insurance coverage, co-pays, and deductible responsibilities upfront to minimize billing errors and improve collections.
- Review Denied Claims Proactively: Develop a proactive approach to identifying and addressing common reasons for claim denials, such as incomplete documentation or incorrect coding, to improve first-pass claim acceptance rates.
- Investigate Underutilized Benefits: Encourage staff to explore patients’ insurance plans for underutilized benefits (e.g., wellness exams, preventive care) that can be billed appropriately to increase practice revenue.
- Utilize Technology for Accuracy: Leverage billing software features like automated coding suggestions and claim scrubbing to minimize errors and enhance billing accuracy.
- Offer Transparent Pricing: Provide clear, transparent pricing information to patients for non-covered services or products to avoid billing disputes and encourage prompt payment.
- Explore Telemedicine Billing Opportunities: Stay informed about telemedicine billing regulations and codes applicable to optometry services, especially post-pandemic, to expand service offerings and revenue streams.
- Engage in Regular Coding Audits: Conduct regular internal or external coding audits to identify coding trends, billing errors, and compliance issues, ensuring consistent revenue optimization and adherence to regulatory standards.
Data Analytics: Turning Information into Revenue Insights
Analyzing revenue not just by service type and insurance provider, but also by CPT code used, provides a wealth of insights for optimizing your billing. This granular data allows you to identify high-performing procedures and potential under-coded services. You can then use this information to develop targeted strategies, such as promoting under-utilized services or ensuring accurate coding practices to capture maximum reimbursable value for each patient encounter.
Additional Revenue-Boosting Strategies
Be proactive with the verification of patient insurance coverage and benefits before the visit. This helps avoid surprises and ensures accurate claim submission. Doing this minimizes the risk of denials due to coverage issues and unexpected out-of-pocket costs for patients, leading to a smoother experience.
Collect co-pays, deductibles, and co-insurance at the time of service. This reduces outstanding accounts receivable and improves cash flow for your practice. Additionally, it ensures a healthier financial bottom line.
Invest in a Robust Revenue Cycle Management Solution
By implementing these tips and leveraging a robust EHR solution like Eye Cloud Pro, you can significantly improve your optometry billing and coding efficiency. An integrated EHR streamlines claim submission, reduces errors, provides valuable data analytics, and simplifies revenue cycle management.
Schedule a free demo of Eye Cloud Pro today and see how our comprehensive EHR system can help your practice thrive.