Prevention that Leads to Practice Health
Tips for staying on top of the billing details you’d rather put off until tomorrow.
“Prevention” is all about discipline. Staying ahead of trouble.
We workout. Pay attention to our nutrition. And make sure we get our annual physical. None of it is convenient. It’s just that in the long run, there’s the promise of a healthier, longer life.
The same is true of the health of your optometry practice.
Making your practice more efficient, staying on top of your AR, finding new opportunities for revenue—all of this demands everyday discipline. A commitment to staying on top of the myriad (many of them small) details.
RevCycle Partners’ team of insurance billing experts lay out their best preventative practice health tips – from credentialing to verifying eligibility and benefits to insurance billing.
Start Early with Credentialing
Of course, optometry practices know this. But it’s easy to let the details slip because you don’t have credentialing systems in place.
What if you lose your in-house billing expert, for instance, and all the credentialing reminders go to her account? To avoid this, establish a credentialing-specific email.
When it comes to credentialing, you can never start too early. If you know you are planning to hire a new doctor, don’t wait until his or her first day on the job. And make sure you update your CAQH frequently.
Attesting should happen every 60 days instead of every 90 days. Practices must maintain their re-credentialing dates so that they do not get removed from insurance panels.
Also, many insurances are starting to require offices to use online services for credentialing, demographic updates, and more. Make sure that you are set up electronically for those insurances.
Verify Patient Eligibility and Benefits Prior to the Visit
Is your patient in-network or out-of-network? Has his or her coverage been terminated or changed? Will the service you provide this patient be covered?
Establishing this basic criterion prior to a patient visit (especially a new patient visit) is important because it impacts how much you will be reimbursed by the insurance company and ultimately what the patient will pay.
If your practice is not in-network, often the insurance will cover less than the patient expects. The disparity between what a patient expects and the reality of what insurance will pay can lead to untimely payment by a patient who anticipated paying much less. Or your practice might have to write it off as a loss.
Not to mention, billers will spend unnecessary time making calls explaining the disparity and collecting the payment.
Obtain Prior Authorization and/or a Referral
Many routine vision plans require authorization to bill for services and materials. Similarly, many health insurance plans require a referral from a PCP to be seen by an optometrist.
Not obtaining this information up-front might lead to delayed insurance payments or worse, unhappy patients who are asked to pay for the services on a rejected claim.
Verify and Enter All Patient Information Correctly
This might seem patently obvious but always review your forms. When staff members feel rushed to push a patient through the booking process, he or she may let details slip. A team member might abbreviate a field in the moment with intentions of correcting later; however, they may forget to go back.
Issues with patient details, including the correct spelling of the name (no nicknames!), date of birth, and policy number, will cause claim denials. Mistakes with these small details ultimately can result in delays in processing the claim as your biller corrects and re-files.
Stay Up-to-Date with All Payer Information
Keep office contact information current with payers. It is important that payers can reach the provider via email. As easy as it is to ignore payer newsletters, they are an important source of information on policy changes. Be sure to read them and note any changes. Staying on top of upcoming changes will aid in preventing claim filing errors.
Monitor Trends in Claim Denials
Hold regular staff meetings to talk about what you are seeing while working aging claims. This gives you the opportunity to train staff, and hopefully prevent the problem going forward.
For example, if a particular procedure keeps denying for non-medically necessary diagnoses, have a staff meeting where you go over the LCD or payer rule for that procedure. Make sure everyone knows when it will be covered. This preventative measure will minimize delays in the billing cycle.
Use Your PMS and Clearinghouse for Key Performance Indicators
This includes claim rejections, average turnaround time on claims, and total service write-offs.
Most practice management software platforms will help you analyze total AR over time. You can see if it is growing, shrinking, or staying steady. Most clearinghouses will tell you how many of your claims are rejected each month at the clearinghouse or by the payer for things such as missing data or eligibility issues.
Gather that data and use it! As a staff, you should aim to eliminate as many rejections as possible. Developing a plan for doing so can be another topic for your staff meeting.
Know Your Average Turnaround Time for Your Biggest Payers
As with credentialing, don’t wait until the last minute. Be proactive.
If you know EyeMed pays within two weeks, for instance, begin questioning the status of claims as they near the two-week mark. Don’t wait until 30 or 60 days to look into them. The longer you wait to investigate a claim, the higher the risk of missing timely filing deadlines and being forced to write off balances.
Stay on Top of Your Aging Claims
Have systems in place to make sure adequate resources are in place to get claims created and filed within a short window of the service date—under one week is recommended. Dedicating the resources upfront to get the claims out makes sure you aren’t letting claims slip through the cracks, leaving money on the table for services already rendered.
If you find yourself deep in aging claims, check out this helpful downloadable for a step-by-step guide on how to work them.