Don't Get Screwed By Optometry Insurance Billing

  • By Andrew Roy
  • 06 Feb, 2016

Rebuttal to Original Article By Vision Web http://blog.visionweb.com/bid/194230/Birds-and-The-Bees-Don-t-Get-Screwed-by-Optometry-Insurance-Billing

Don't Get Screwed By Optometry Insurance Billing
You know there are a lot of ways to look at this subject but only one makes sense for ALL sizes and types of optometric practices. Before reading any further, however, I wish to divulge a few things to you first.

  1. I encourage you to first read Visions Web's original article that this article is rebutting. You can find it here:  http://blog.visionweb.com/bid/194230/Birds-and-The-Bees-Don-t-Get-Screwed-by-Optometry-Insurance-Bil...
  2. Even though opticXpress is an optometric billing firm, we are a wholly owned subsidiary of a company that also owns an optometric practice and I, the person that is writing this article, am the sole proprietor of that company. 
  3. I am writing to you out of years of experience both operating an optometric billing firm and a managing the billing departments of both my own and numerous other optometric practices. Yes, I am patting myself on the back a bit but, considering the niche market I operate in, you won't find too many other people with both the years of knowledge and experience that I have in this field.
  4. What you are about to read is PREJUDICED...that is to say, I am writing to you as a BUSINESS OWNER, not an optometrist that owns a practice...THERE IS A DIFFERENCE. A huge, huge difference.
All those items aside here's the brass tax, simple formula to "not getting screwed by your optometry insurance billing":

DOCTOR SEES PATIENTS+DEDICATED BILLING STAFF (IN HOUSE OR 3RD PARTY)-DOCTOR BEING OVERLY INVOLVED IN THE BILLING PROCESS-DOCTOR'S STAFF BEING OVERLY INVOLVED IN THE BILLING PROCESS=NOT BEING SCREWED BY OPTOMETRY INSURANCE BILLING.

Yes, it's actually that simple. If you follow items laid out in the original vision web article on your own you will IN FACT, get screwed by your optometry insurance billing. Here's why. Both that article, and  the multiple AOA resources that it's based on, specifically the para-optometric certification program (which is a crock of crap if I've ever seen one), call for a "all hands on deck" approach to optometric billing. Staff involvement is hailed as the end all to errors and the golden ticket to better reimbursements patient satisfaction. IT ISN'T! Yes, there are more things that staff member should be actively involved in, like benefit verification but not much else.

Think for a moment, the last time you went to your family doctor for your yearly check up, how many of the staff members at that facility were actively involved in your insurance billing process? How about the last time you went to the emergency room...did that nurse that triaged you or your loved one actually give a hoot about whether or not she was coding your visit properly? What about the last time you got your teeth cleaned at the dentist, did the hygienist tell you that she was also a trained para-dentist who was knowledgeable in all aspects of dental billing? The answer to all of these questions was most likely NO! Every single one of those facilities operates in a manner that understands that EVERYONE there has their own job to do and that if there is a break down in the division of labor things don't operate according to plan. There are front desk personnel to take down your demographics and collect payment, there are triage nurses in the ER to help narrow down your diagnosis for the doctor, the hygienist's job at the dentists' office is to make sure your teeth are cleaned and ready for when the dentist comes in to perform your exam; all the facilities have people in place to perform specific functions and collect certain pieces of information and in ALL these examples, that information goes to some sort of billing department that is staffed with people who have their own , one job to do.....INSURANCE AND PATIENT BILLING. PERIOD. THAT'S IT. SIMPLE. NOT ROCKET SCIENCE.

I will concede to you, in my examples above there are certain pieces of knowledge that each person must know and understand in order to facilitate the flow of information to the billing personnel BUT THERE IS NOT ONE EXAMPLE THERE, EXCEPT FOR OPTOMETRY, WHERE INDUSTRY SPECIALISTS ARE ADVOCATING THAT EVERY MEMBER OF THE STAFF BE TRAINED IN THE ART OF INSURANCE BILLING. Optometrists, you are nuts for even thinking that is a good idea, SHAME ON YOU!!!

73%. SEVENTY THREE PERCENT. Do you know what that number is? That number represents that average collection rate of an optometric practice that has trained their staff to do their own optometric billing. Coincidentally, outsourcing your billing to a 3rd party generally only nets you 75%. Odd, based on what I am advocating in this article, but true. However, do you know what my practice averages each year? 96% collection rate. In fact, all my clients average that as well. We've even found, after sifting through 15 years of data, that it costs both us and our clients more to go after the remaining 4% left on the table than it does to just write it off. Don't believe me? I'll share my practice's collection reports with you so you can see it for yourself. I'm not shy. (Patient data, clearly not included.)

To be clear, you need have a precise definition of collection percentage in your mind first before you read any more of this. 

COLLECTION PERCENT = GROSS AMOUNT BILLED TO INSURANCE-INSURANCE ADJUSTMENTS-PATIENTS PAYMENTS-OUTSTANDING PATIENT BALANCE DIVIDED BY GROSS AMOUNT BILLED MULTIPLIED BY X/100

Ok, I admit, that's probably not a clear definition seeing as I am totally awkward when it comes to trying to draw out math equations on a keyboard but, basically, the expression above is taking your total outstanding balance, dividing it by your original gross billed balance and then turning it into a percentage using the standard math equation to do so. In a nutshell, it's the amount of money left over of everything that  CAN BE COLLECTED. 

Now that we've made that clear hopefully the light bulb has turned on in your head and you've realized that the idea of utilizing staff members, who already have other jobs to do, to do your optometric billing is not getting you very good results. Likewise, outsourcing that billing to just anyone, though less stressful on your staff so therefore somewhat less costly, is not going to get you great results either. So what do you do? 

WARNING! SHAMELESS PLUG FOR MY COMPANY AHEAD!

Let's just go back to the formula I shared with you to begin this article and you will have your answer.
  1. AS AN OPTOMETRIST, YOUR JOB IS TO SEE PATIENTS. DO THAT. 
  2. DEDICATE ONE FRONT DESK STAFF MEMBER, AND POSSIBLY A BACK-UP IN THE EVENT OF ILLNESS OR OTHER EVENT, TO BE A "LIAZON" TO YOUR DEDICATED BILLING DEPARTMENT
  3. HIRE opticXpress (THAT'S ME) TO DO YOUR OPTOMETRIC BILLING AND BE YOUR DEDICATED BILLING STAFF
  4. AS A DOCTOR, GET OUT OF THE WAY! SERIOUSLY, YOU DON'T KNOW HALF AS MUCH AS YOU THINK YOU DO ABOUT OPTOMETRIC BILLING. LIKEWISE, I DON'T KNOW SQUAT ABOUT GIVING AN EYE EXAM. HOWEVER, I TRUST YOU TO LOOK IN MY EYES AND TAKE CARE OF ME. TRUST ME TO LOOK AT YOUR BILLING AND MAKE SURE YOU ARE GETTING PAID PROPERLY AND ACCURATELY . IT'S A BEAUTIFUL, SYMBIOTIC RELATIONSHIP IF YOU ALLOW IT TO BE. 
  5. TRAIN YOUR STAFF, AND ASK opticXpress TO HELP, IF YOU NEED, TO DO THE JOBS THEY WERE HIRED TO DO. NOTHING MORE. WE DON'T NEED 60 MILLION EYES LOOKING AT THE BILLING, AND FRANKLY, NEITHER DO THE PATIENTS.

END RESULT OF THE ABOVE: YOU WON'T BE SCREWED BY YOUR OPTOMETRY INSURANCE BILLING. NO PARAOPTOMETRIC CERTIFICATIONS FOR YOUR STAFF MEMBERS REQUIRED. IT REALLY IS, THAT SIMPLE. I GUARANTEE IT. 

                                                                  CHECK OUT opticXpress FOR YOUR OPTOMETRIC BILLING TODAY.

The Optometric Billing Spot

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By Blog Owner 17 Jul, 2017

Melanie Denton OD, MBA, FAAO recently wrote and article for optometry times relating to the "insurance game". She is 100% right...INSURANCE IS A GAME and unless you learn the rules your practice will never be as successful as it could be, it's just that simple.

One of the biggest things she points out is sometime I've been telling clients for years: when it comes to your insurance billing it's important to STAY INVOLVED! This doesn't mean to hang over your biller's shoulder and check every little thing they do. It means learn and understand the process and the intricacies so that you can have informed and intelligent conversations with your biller and/or the insurance companies. If you know how things work, you'll be that much better prepared to check up on things, make adjustments when things go wrong and make intelligent and informed decisions about the direction your practice is going.

I have included an excerpt of her article below. You can always click the link to read the whole thing.

I know exactly how insurance is billed at my office. Is that the best use of my time?

This is how we get paid, so I think staying involved is a good idea right now when our patient load is smaller.

Staying involved is also effective in making sure that as a practice we set things up correctly. I have watched countless YouTube videos about CMS 1500 forms and how to fill them out, how to read explanation of payment forms, and clearinghouse-specific training.

Related: Defining success: Is more better?

I know how our practice management system interfaces with our clearinghouse, and often I send the claims myself. In the setup period, it is critical to be attuned to the details.

Even if your practice is well-established, it is important to spot check claims and ensure that they are completed correctly not only to ensure your revenue stream is what it should be but also to guard against potential audit concerns.

Related: Behind the scenes of Instagram practice photos

In addition, staying involved helps me to know which commercial carriers are excluding us from specific panels without telling us. (Sometimes PPO or HMO panels require a primary-care referral first or require your participation on that specific sub-panel).

There is no shortcut to setting up your office for the first time on insurance panels. The process is time consuming and at times maddening. Some of the companies we are now regularly taking payments from took six to eight months to credential us.

This is a marathon, not a sprint. Don’t take no for an answer. Fight the good fight.



By Blog Owner 01 May, 2017
Dear Readers, A quick note today:

Whenever you bill a surgical procedure to insurance (any procedure that begins with a '6') you MAY NOT bill an exam to that insurance company for the same day as insurance considers an exam to be PART OF THE SURGICAL PROCESS!

However, if you have a significantly DIFFERENT DIAGNOSIS CODE you may append the exam procedure with a -25 modifier and bill the insurance for both the exam and the surgery so long as the diagnosis code being used for surgery is ONLY POINTED TO THE SURGERY and the diagnosis code for the exam is ONLY POINTED TO THE EXAM!
By Blog Owner 24 Apr, 2017
https://www.linkedin.com/hp/update/6245619520837283841

Primary Eyecare:

"Everyone will come to you and you will be the one who refers them to different specialties". Maybe the eyes are more than just a window to the soul?
By Blog Owner 18 Apr, 2017
It has become a fact, especially since the introduction of "Obama Care", that doing billing in house is more costly than outsourcing. Not necessarily because the cost of salary is higher but because, and this is specifically unique to optometry, most new and small to medium sized practices don't have the man-power or resources to dedicate one person or a group of people specifically to the task of insurance billing. The result is that collection rates rarely exceed 73% of available money from insurance/patients. EVERY ONE of our clients achieve a 93% collection rate within 2 years; typically much faster if that practice owner is willing to let us "run the show" and defer to us when it comes to making decisions and implementing policies regarding insurance billing. This means that your practice will instantaneously be more profitable as a result of your decision to outsource which in turn means that you are spending less money doing so.

https://www.linkedin.com/hp/update/6241990175124185088
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