Billing and Collections: Top 10 Best Practices in Ophthalmology

Billing and Collections:  Top 10 Best Practices in Ophthalmology

Billing and Collections: Top 10 Best Practices

Medical practitioners understand that billing and collection issues can seriously impact the financial viability of their practice. Ever increasing complexity of compliance issues and higher than average patient default rates combine to spell financial instability for medical practices nationwide. In this increasingly volatile climate, how can you protect your practice from financial disaster?

The best defense is a good offense. Following an ordered, comprehensive billing and collections protocol will go far toward mitigating your potential financial risk exposure. Here is a quick discussion of the Top 10 Best Practices for Billing and Collection Procedures.

1)  Eligibility verification.

Ensuring proper verification of insurance eligibility for incoming patients helps to eliminate claim denials, the need to re-submit rejected claims, and failure to collect patient balances and copays at the front desk. By thoroughly verifying insurance eligibility before a patient receives care, you can estimate the patient’s out-of-pocket portion of the total bill, and take efforts to collect it up front. This is an income-guaranteeing practice on three levels. First, you receive patient money right away. Second, it reduces the need for setting up and maintaining a large accounts receivable base. Third, it reduces costs of creating and mailing invoices, thus saving additional money for your practice in supplies, postage, and employee salary.

2)  Comprehension of benefit coverage.

Understanding the nuances of diverse insurance policies enables you to get paid for services rendered as quickly as possible. A staff member knowledgeable in the ophthalmology billing and collections processes is a valuable asset to any practice. An employee who can communicate effectively with insurance company representatives when specific questions arise is worth his/her compensation package many times over.

3)  Proper check-in procedure.

Having comprehensive and up-to-date staff job descriptions is key. Front office staff must understand their job duties and be well-trained in the policies of your practice. They must communicate clearly to patients at check-in their responsibilities regarding outstanding balances, co-pays, and other out-of-pocket patient expenses. Following your written office policies consistently across your entire patient base is essential to good business practice and compliance.  Understanding that your front office is the first line of collection for your accounts and conveying that understanding to your staff will eliminate any doubt as to your serious intention to maintain the financial success of your practice in a proactive manner.


4) Proper medical coding.

Focusing on familiarizing your staff with the codes relevant to your practice will aid this process and help you to meet the challenges the new ICD-10 coding system has brought to the practice. As has always been the case, proper coding ensures a more seamless claims process and greatly decreases the lag-time between filing a claim and receiving payment.

5) File your claims electronically.

The most common reasons for claim rejection are typos and lack of double-checking before filing a claim. Using claim scrubbing software can allow your staff to catch errors before a claim is sent. This is well worth the investment, as claim errors captured before they are sent reduce rejections by a large margin. This same software system can help you submit claims electronically, with considerable savings in money and time for your practice. Claims sent electronically historically also have a quicker payout than do manually processed claims.

6)  Manage your revenue cycle.

This step goes back to maintaining a comprehensive policies and procedures manual for your office, and training office staff in how best to implement those policies as they pertain to collections. For instance, a comprehensive policy will include step-by-step instructions pertaining to invoice generation and billing frequency, monitoring of outstanding insurance claims and denials, appropriate intervals for patient contact regarding past due amounts, and many other considerations. Maintaining a sharp eye on compliance with all your policies in this area will help you to effectively manage your revenue cycle.

7)  Appropriate follow-up.

First and foremost for all follow-up procedures, your staff must be vigilant in keeping tabs on all outstanding insurance claims. Instituting a standard schedule for calling insurance carriers about delays in payment of claims will go far toward helping ease the process along. Persistence on the part of your billing staff is crucial, as insurance companies often tend to hold onto payments as long as possible. Your staff is tasked with the job of communicating in a firm, professional manner with insurance carriers to get the job done. Encourage your staff to be proactive in this regard. Also, patient billing falls within this category as well. Invoices for outstanding account balances must be sent in a timely manner. This will get your patients involved in the process of pressuring insurance companies as necessary for prompt payment of claims. If your patient is solely responsible for outstanding amounts, regular invoicing will prompt regular payment.

8)  Adjustments and secondary claims.

In the event your insurance claims are denied or rejected, it is imperative to repeat the claims process with appropriate claims adjustment coding. Secondary claims should be given the same attention as primary claims by your staff. Use of billing software makes this process immeasurably simpler, as adjustment coding can be automated.

9)  Denials and Appeals Management

Inevitably, a certain number of claims will result in denial. When this occurs, it is essential for you to follow an outlined procedure for appeals as dictated by the insurance carrier and your own internal policy manual. Appeals must be handled in a timely fashion, as many carriers place a limit of just a few weeks for resolution of any appeals process. Designate which employee or employees will be responsible for handing the appeals process, and ensure that the responsible employee is well-versed in insurance appeal processes.

10)  Appropriate handling of collections.

The best scenario for appropriate handling of collections is strict adherence to the first nine best practices listed in this blog. However, in the event that insurance claims are denied and patients still have an outstanding balance, it is key that your staff has adequately explained patient responsibility from the first patient contact forward. Offering to meet with a patient to discuss setting up a payment schedule for large balances can often engender good will in your patient and prompt him/her to make efforts to pay off debt. Caution should be used in offering this as an option, however, as it increases the workload of your staff and lengthens your revenue cycle unfavorably. Your policy manual should clearly outline when and if to send a patient account to a collections agency for payment. If you choose to use a collections agency, you must ensure HIPAA compliance in every circumstance. Educating your staff and the collections agency representatives on exact HIPPA compliance guidelines will protect your practice from issues arising from non-compliance.

Following these ten best practices enables you to maximize your cash flows and work flows to achieve financial stability for your practice.

Advantage Administration, Inc. is pleased to announce it’s subsidiary company, Agnite Health LLC. Agnite Health LLC is an outsourced medical billing company that is specifically designed for ophthalmology practices and is a complete solution for your medical billing needs. Agnite Health LLC is based in Texas with ophthalmology clients nationwide.

If you would like more information about methods of improving your business processes, please contact us. With years of experience in the field of medical billing, we will tailor a solution to the specific needs of your practice and partner with you to achieve your goals.