• By Blog Owner
  • 08 Mar, 2017

Owner of opticXpress begins investigation into merits of suing Vermont Health Connect.

opticXpress Optometric Billing Services
Owner of opticXpress begins investigation into merits of suing Vermont Health Connect.

Due to many problems statewide with Vermont Health Connect, Andrew Roy, owner of Vermont based opticXpress-a medical billing company that deals solely with the speciality of optometry, has begun looking into the possibility of opening a class action lawsuit against them after enduring his own on-going battles with the "Obama Care" organization.

Recently, Mr. Roy was told by the Health Care Advocate, a non-profit organization that specializes in issues with Vermont Health Connect, that there IS grounds for a lawsuit but that it would be extremely difficult due to the fact that it is a state agency.

In 2016, Vermont Health Connect reported to the IRS that Mr. Roy had obtained health insurance through the agency for 10 Months in 2015 when, in fact, he had only obtained 4 months worth of insurance from the despot organization. When the error was discovered in November of 2016, Mr. Roy reported the mistake to the agency who refused to accept documentation from his bank proving their error. Instead, they elected to keep the federal funds for their own use and directed him to take the issue up in a "fair hearing", which is run by an un-regulated third party who has no contact information and who only makes appointments on behalf of Vermont Health Connect at their own convenience. To date, it has been over the requisite 30 days since the fair-hearing team was supposed to reach out to Mr. Roy and no contact has yet been made with him. Consequently, Mr. Roy has been assessed a tax penalty by the IRS which must be paid, per Affordable Care Act regulations, until such a time as the debt is resolved OR Vermont Health Connect is found liable for their error.

Furthermore, Mr. Roy has decided that he will update the public on the issue and possible litigation by issuing timely press releases as well as posting copies of any relevant information in the form of articles on his medical billing blog. The purpose of this is to not only inform the public as to the atrocities that "Obama Care" has wreaked on society, both at large and in Vermont, but also so that it can be used a case study for optometrists everywhere to see exactly what kind of issues face their patients on a daily basis when it comes to both billing and dealing with insurances that are purchased through government run health insurance agencies.

In addition to this possible landmark legal case, Mr. Roy has informed the office of the Governor of Vermont and is awaiting a meeting with the Governor about this matter.

The Optometric Billing Spot

By Andrew Roy 21 Nov, 2017
Up until recently, there have not been any effective patient-derived models in which researchers can test for treatments in regards to macular disease. However, this has possibly changed as researchers have been able to re-program stem cells with three different forms of macular dystrophy. After aging them in a dish these cells mimicked several characteristics of the disease, allowing for scientists to begin working with a human stem cell model. Rebecca Hepp dives into detail in how these research models have paved the way for innovative treatment research. How does this review of optometry affect your optometric billing?
By Andrew Roy 15 Nov, 2017
Ocular surface disease (OSD) management is driving technology to get ahead of the game. This means educating and diagnosing patients in a more timely manner in order to motivate them to start and maintain their treatment. John Rumpakis, OD, MBA, discusses how these new technological advances in imaging, though resourceful, may or may not be billable for insurance companies. How does the coding in these diagnoses affect your optometric billing?
By Andrew Roy 09 Nov, 2017
Optometry is advancing every day in this ever-changing world, and so is the world-wide industry of classic clinics. Brooke Messer, MD, explores the challenge of building a niche practice--that is, building a practice based on that of a certain specialty, such as contact lenses. This type of practice can yield great emotional and financial rewards while making connections between you and your patients. Many resources are made available at your fingertips while bringing a new dimension to the practice when beginning to train staff. Investing in technology can go a long way in building your patients loyalty. How can your optometric billing help build your specialty practice?
By Andrew Roy 24 Oct, 2017
The U.S. prevalence of glaucoma in patients is suspected to rise 6.3 million by 2050. Jarett Mazzarella, OD and Justin Cole, OD write about how integrating newer technologies into optometry practices can help detect signs of early glaucoma and how it is integral for providing data to diagnose and begin early treatments. Clinicians can use many tools such as corneal hysteresis, OCT angiography, visual field testing and electrodiagnostics to help better detect the signs and begin treating patients to prevent them from going completely blind. How does modernizing technologies for detecting disease affect your optometric billing?
By Andrew Roy 20 Oct, 2017
Advances in clinical technology are helping optometrists to sooner detect diseases that may otherwise be undetectable. Last month a patient of Paul M. Karpecki, OD, without symptoms and 20/20 vision, was found to have a significant peripheral malignant melanoma. Upgrading basic tools such as handheld instruments and refractor systems can help in the early diagnoses of most life-threatening diseases; diseases like AMD (age-related macular degeneration) or glaucoma, for instance. Optometry is embracing new innovative technology in order to improve diagnostics. How can upgrading your diagnostic tools transfer into more robust optometric billing?

Click here to read more.
By Andrew Roy 13 Oct, 2017
Optical coherence tomography (OCT) scanning has come a long way in the development of its technology in the last two decades. Through new software updates such as swept source (SS), the OCT can provide higher image acquisition speed and less variation in sensitivity. Instruments now have Anterior and Posterior Segments available for use along with enhanced depth imaging. OCT angiography allows the detection of movement to be seen at higher speeds. Dive into the world of today’s optometric technology knowing how to navigate through these exquisite tools. How will these new advances in OCT affect how you practice optometry and your optometric billing?

Click here to read more.
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

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.
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