It is estimated that an astounding $125 billion goes uncollected by doctors due to inefficient or incorrect billing procedures. How much is your ophthalmology practice contributing to that amount? What you don’t know in this case can seriously hurt your practice. It is quite possible that as much as 25% of your income may be lost due to:
- Theft or embezzlement
- Incorrect coding of CPT or ICD-10 codes
- Charges never submitted
- Inaccurate information entered for the practice, patient or insurance provider
- Lack of patient insurance coverage verification
- Duplicate billing
- Inaccurate documentation of services
- Lack of or improper follow-up
Why is Ophthalmology Billing a Challenge?
There are a number of reasons why ophthalmology billing is such a challenge for practices.
Overworked staff. Ophthalmology billing is all about close attention to details. If your practice does not have staff dedicated to this process – if they perform billing as a side job to their main role in your practice – mistakes are going to be made. Any time a billing error results in a denied or rejected claim, that adds more staff time to stay proactive with the status of the claim and correction of the problem. The longer the payment process from insurance companies or Medicaid, the greater the possibility of not getting paid for a service you provided.
Lack of continual staff training. Even if you have a dedicated staff for billing, without continual training on the ever-changing rules of ophthalmology billing, mistakes will still be made. Your staff must know the intricacies of CPT and ICD-10 coding and their updates, how to properly document services provided, etc. Even a seemingly minor error can result in a serious negative impact on your monthly revenue.
“Not my job” mentality. Billing in ophthalmology is, in fact, everyone’s role in your practice. From your front desk to your technicians to your doctors, everyone must gather and input accurate information about the patient’s personal information and treatment in order for success. The sooner your staff realizes their part in the revenue stream (as it relates to billing), the more profitable your practice will be.
Procrastination. It’s always better to get the job done right the first time, rather than putting things off. For example, your staff should collect all co-pays or account balances at the time of service, rather than backtracking to get these payments later. Insurance coverage should be verified at every visit. Denied or rejected claims need to be processed as quickly as you are made aware of them – rather than being dumped into a pile of things to do later.
Lack of quality control. Does your practice have a checklist for billing procedures to ensure the most accurate information is going out? Do you have a second or third set of eyes that reviews every claim submission before it’s submitted? Just as you proofread your marketing materials, it can be helpful to proofread your claim submissions. Internal controls can also deter theft and embezzlement.
Being unaware of your financial status. As stated earlier, what you don’t know can hurt you! Upper management should be fully informed about your billing functions through financial reports, benchmarks and trending analysis. To ensure that your processes are timely and accurate, set up daily, weekly and monthly monitors.
Break the Chain of Inefficient Billing: Hire an Ophthalmology Consultant
Advantage Healthcare Consulting, a division of Advantage Administration, is a Management Services Organization (MSO) that offers practices of any size the opportunity to increase their revenue without performing additional surgeries or other procedures. Our ophthalmology consulting services can help you analyze your current billing structure and identify the areas where you are losing money for the services you have already provided. By bringing problems to the surface – problems such as gaps in eligibility and benefit verification, electronic payment posting, accounts receivable management, incorrect coding and many other medical billing pitfalls – our team of experts can make recommendations for improvements. When you are ready to refocus your staff’s time on patient care as opposed to the details of billing, our team can help you execute new plans for billing success. The resources provided by an outsourced ophthalmology billing service can make your job so much easier and fruitful.
Our expertise encompasses helping more than 300+ ophthalmology practices nationwide – all sizes, academic and private, rural and metropolitan, thriving and struggling. Our background in ophthalmology allows us to jump in immediately to make systems more efficient and profitable without compromising the integrity of your practice. To learn more about how our MSO can improve your revenue, contact Advantage Healthcare Consulting today.