Five Must-Have Billing Policies

By Mary Hollis Stuck February 25, 2020

In this day and age, with everything technology based, most practices are focusing on becoming as streamlined as possible. Patients check in using iPads, pretesting is done with machines that sync to EHR, lenses are probably digitized. In order to keep up with this fast paced practice environment, it is becoming more and more important to also streamline you billing policies. Following this short guide can help you set policies in your practice, increase your receivables, and grow your bottom line.

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1. Start with the front desk. Looking at the GatewayEDI rejection pattern for the past twelve months, there was an enormous spike in claim rejections as of the month of January, 2020. Common rejections included incorrect ID numbers (remember, at this point no Medicare claim will be accepted without the alpha-numeric ID) and incorrect patient demographics. Basic errors, such as inputting the wrong zipcode, or mistyping a patient’s date of birth, could cost you. Payments can get delayed for days, simply due to small typos made at check in. Be sure that your staff is fully trained on the process of collecting information. Let them know the “Whys” when you discuss these details; if someone knows the reason a process is so important, they are more likely to make less mistakes.

2. Have a clear financial policy that patients must sign. Sure, nobody likes more paperwork. However, consider merging your financial and HIPAA documents onto one, if possible. Things like no-show policies, refund or remake policies, and insurance billing policies should be clearly stated on this form. Make sure the patient realizes (or, at least, signs a page that states) that they are solely responsible for providing your practice with their up to date and accurate insurance. If a patient doesn’t have their benefit information with them at the time of appointment, request that they pay out of pocket before being taken back. Should they bring the information back days later, it is usually possible to backdate billing and give them a credit for the amount paid out of pocket. Think about what you want your remake or refund policy to be, and outline that in the statement. While many labs provide at least one remake at no cost, advertising that to the patient may up your risk for things like buyers remorse remakes, which will always end up costing time and money. Be clear if you have no refunds on your eyewear, so that there is not a dispute later.

Image result for analytics3. Run monthly reports on insurance and patient aging. While it may seem obvious that you need to pay attention to claims you submit, and how quickly they are processed, it is important to run monthly reports to ensure that payment is being received in a timely fashion. This can be done with both insurance aging and patient aging. For patients, it may show any outstanding balances, ie materials they haven’t picked up, and still owe for, or a copay that was transferred back to them after submitting a medical claim. With insurance, it can show if a claim has been outstanding for longer than sixty days, which is rare in this field. Should a claim be unpaid after sixty days, it is likely that follow up or resubmission is necessary. Have a plan in place to check these reports regularly, depending on your financial policy and the insurances you accept, and have an action plan in place for following up on unpaid claims or outstanding patient balances.

4. Invest in training for billing and coding. Whether for the doctor or the billing staff, annual (or more frequent) training is a necessity in this field. ICD10 codes are ever changing, and must be done with exact specification. Many optometrists are guilty of severely under-coding, and this allows thousands of dollars to go uncollected per year. Along the same line, if a claim is not properly coded, it can cause lots of headaches for both doctors and staff. Improper diagnosis codes or lack of modifiers can end up in delayed reimbursement, claim denial, or even audits. Consider online courses, conferences or annual meetings, or books to stay on top of the appropriate material.

5. Make sure you aren’t letting money slip out the door in optical. No, this is not referring to loss prevention, although some practices do address that with cameras and security systems. This is referring to the lost charges, such as inventory that isn’t returned properly, discounts not taken at labs, and rebates that are left on the table. Have in depth conversations with your lab reps, buying groups, and frame groups. Many companies give discounts for large orders, waive shipping fees, or offer spiffs for materials purchased. Most major labs or lens manufacturers offer rebates or rewards programs, but you aren’t automatically signed up for them simply by having an account. And don’t forget about multiple pair discounts - codes must be entered, and sometimes registrations are required, to get huge discounts on lenses.

Take time to do an assessment of how your practice handles billing. Again, ensuring that every staff member fully understands the practices, policies, and repercussions of errors, can help keep them attentive to every detail, and make processing much quicker and more accurate. Making sure claims are processed correctly is something that each department must have a hand in, from check in, to the exam lane, to claim filing. Use these tips to develop and implement a plan of operation to help make 2020 your most profitable year ever.

Mary Hollis Stuck

Mary Hollis has been in the optical field since 2005. She has filled many roles within optometric practices and is a billing guru. She is passionate about providing excellent customer service for patients, which she helps to achieve while finding ways to increase practice productivity. Currently, Mary Hollis manages the billing department at Eye Associates of Cayce, a multi-doctor private practice in Cayce, South Carolina.

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