Once the optometry practice is set, the next mandatory requirement is the establishment of the optometry billing and coding process for reimbursement from insurance. This process is not only essential, but complex and time-consuming, along with the need for perfection. Optometrists diagnose eye-related medical illnesses which include not only glaucoma and macular degeneration, but simple eye examinations too; and for each examination and diagnosis, there is separate billing, coding, documentation and added procedures. Here comes into play the role of an outsourcing company/optometry billing vendors that can take care of all the billing needs, save time and remove the unnecessary pressure on the optometrist and the team, leading to lesser denials thereby faster payments. However, before outsourcing, the right questions need to be asked to make the billing process effective for the practitioner and the outsourcing agency.

A few considerations:

Before outsourcing, consider a few benchmarks. Make a note of your optical practice’s current costs, revenues, payroll, cost of goods and net profit percentages. Compare these to project future revenues with the outsourcing company’s projection reports (including refraction volume, capture rates, average sales). Also, evaluate your other benchmarks such as gross revenues, optician productivity, inventory turns, capture rates and net profits.

Questions to ask before outsourcing:

1. Credentials: Enquire about the number of years the outsourcing company has been in the optometry billing business (credentials and experience). This will validate the unique challenges that can be met which are required in optometry billing, along with the requirements that must be met for medical and routine billing.

2. Training: Request to know the training and certification of the employees of the outsourcing company. For efficient and timely billing and coding, it is vital that all personnel are trained in the latest codes, rules and regulations for optometry billing.

3. Privacy of information: Many a times, e-mails can be compromised; hence it is essential to know how the information is kept confidential (HIPPA trained, signing of confidentiality agreements). In many cases, the outsourcing company uses the healthcare organization’s own system to file and post patient’s claims, hence the information remains protected and cannot be shared or released to unauthorized persons.

4. Technical capabilities: Find out the outsourcing company’s technical capabilities i.e. the optometric software being used and the clearing houses through which claims are submitted.

5. Handling of claims: Ask about the process by which the outsourcing company handles claims. The outsourcing company must never change the CPT or diagnosis code without the physician’s approval. If there is an error, it must be verified prior to sending for reimbursement. If it is a demographic error, or a simple error such as missing ID or incorrect insurance, the outsourcing company must change it at their end during the optometry coding process.

6. Reporting: A very important aspect, find out the ways in which the outsourcing company provides financial reporting. If the outsourcing company is using the practitioner’s own systems, the practice can view the insurance data at any given time. Ask if the outsourcing company also compiles AR trends and provides a report on the errors.

7. Follow-up practices: Ask about the incorrect claims’ appeals’ procedure of the outsourcing company, and their procedure on the processes of unpaid claims (reported in AR).

8. Costs: Note that a la carte billing can be expensive. Hence, ensure that the outsourcing company’s  fees is not the billed fees, but a percentage on the basis of the insurance amounts captured. Be careful of paying for full billing services (auditing, posting, AR, filing, appeals, follow ups) or claim submission services only.

Ask colleagues for some referrals. Ensure that you meet the companies before taking a decision for complete optometry revenue management needs.

Optometry specialists of Medical Billers and Coders provide comprehensive services (optometry billing and coding) that can be restructured as per the client’s requirements. The optometric specialists are experienced and possess the required credentials, and can work with private and government insurance agencies. They are further familiar with medical billing software systems such as Lytec, Medic, Misys, Medisoft, and NextGen; and coding software such as EncoderPro, FLashcode, CodeLink etc. They are also trained in specialised codes such as CPT, ICD-10 etc. The optometric billing specialists can provide services for optometry related features such as diagnosis and treatment of eye diseases, fitting lenses, medical therapy (oral medications), injections and laser surgeries. Medical Billers and Coders specialists’ take care of the entire revenue management cycle: following of compliances, handling denials and appeals, billing and filing claims aptly thus creating a higher influx of referrals and patients, and leading to an increase in revenues.

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