The obstacles to reimbursements, stringent rules and regulations, and the behind-the-scenes schemes of optometry billing systems suggest that the revenue cycle in the optometry industry is much more complicated than before. Medicare billing is a quite complex, time-consuming and arduous process. So much so that it has become common for claims to take not just a few days but months to process. Moreover, medicare billing errors and inefficient coding practices may lead to denials, thereby affecting the revenue stream of your practice.
Here are 5 important tips to improve medicare billing and receive timely and accurate reimbursements for your optometry practice.
1. Collect Correct Information and Verify Patient’s Insurance Benefits
Missing or inaccurate patients’ information along with the failure to verify their insurance plans often cause claim denials and rejections. Therefore, before the intake process, billers or staff in the reception area should make sure to communicate with both old and new patients about their Medicare plan, and subsequently, verify their eligibility and benefits.
2. Be Aware of CMS Rules for Billing Medicare Advantage Plans
In medicare billing, it is imperative to note that Medicare Advantage Plan is different from original medicare. Apart from covering all medically important services the latter covers, it covers fitness programs along with vision, hearing, and dental services. But ensuring a seamless process with no errors while billing Medicare Advantage Plan can be difficult. The optometry billing staff needs to follow rules set by the Centers for Medicare and Medicaid Services (CMS) relative to coding, billing, claim submission, and reimbursement.
3. Apt Use of Advance Beneficiary Notice of Noncoverage
Medicare may not cover certain items and services that may not be termed ‘medically essential’ in some situations. Taking such situations into consideration, a optometry provider or optometry billing staff should obtain an Advance Beneficiary Notice (ABN) of Noncoverage prior to offering a specific service to the patient. Failure to collect a signed ABN form from the patient before providing optometry services can be risky as the optometry provider may not receive reimbursements for this. A signed ABN form ensures that the patient agrees to to pay for services that may not be covered by Medicare.
4. Stay Abreast of Varying Billing Regulations
For efficient medicare billing, providers need to have significant understanding of the changing codes, guidelines, and coverage regulations. Inability to keep up with the constantly varying rules and regulations can lead to costly errors and have a negative impact on your optometry revenue cycle management efforts. Additionally, providers should have access to appropriate documentation and follow correct coding guidelines to reduce claim denials and ensure accurate and timely reimbursements.
5. Track and Review Medicare Billing Denials
Many factors such as administrative errors and lack of experienced optometry billing staff can lead to claim denials. One of the best solutions is to track and review common medicare billing errors and train the staff to avoid all such mistakes. Furthermore, maintaining a checklist of prerequisities can also help create a list of things to review before submitting any claims.
Medicare billing can be challenging, considering its complexities, and can confuse even the most experienced billers. Therefore, eye care providers should improve their medicare billing processes for accelerated submission times, smooth practice workflow, and better claim outcomes. Get in touch with CS Eye today to know how we can help you in effective Medicare billing.