It’s an easy mistake to think that medical billing is only the responsibility of the person (or people) in the billing department, as they send out insurance claims and make sure they get paid. But the most successful practices realize that everybody in the office plays an important role in the billing cycle.

Does everybody on your staff realize how crucial they are to the process? Read below for the sometimes surprising ways that each team member touches billing.

FRONT OFFICE

Your front office staff gets the billing process off to the right start with patient registration and insurance verification. Make sure your front office is verifying and, if necessary, updating each patient’s insurance coverage.

At each visit, copy both sides of the patient’s insurance card to ensure that you have the correct claims filing address as well as other important information.

Double check that the patient is giving you the correct insurance and not accidentally providing a dental or prescription insurance card. If you take vision insurance, find out if the patient has vision coverage and/or is eligible.

Even if a patient hasn’t changed employers or their employer hasn’t changed insurers, the contract may have changed. Most employers renew insurance benefits annually, and changes are common. A difference in the alpha prefix or suffix of the patient’s ID number might signal a change in coverage. Be sure to check these numbers carefully.

If there are any doubts, call or go online to check coverage!  This may take an extra 5 minutes, but that’s a lot less than the time you’ll lose trying to collect information from a patient who has presented you with invalid insurance information.

And don’t forget! The MBI (Medicare Beneficiary Identifier) transition period ends 12/31/2019. New MBI numbers will be required on all claims beginning 01/01/2020.

PHYSICIANS

The primary focus of the ophthalmologist is always on patient care, but your practice’s doctor(s) also play a crucial role in ensuring the financial health of the practice through accurate billing.

Ensure your doctor is set up for success with processes that will help them:

• Choose the correct diagnosis code and any modifiers
• Identify the correct eye

If an insurance company requests medical records, those records must document and prove medical necessity for the services billed!

CERTIFIED OPHTHALMIC ASSISTANTS (COA) & CERTIFIED OPHTHALMIC TECHNICIANS (COTS)

These “physician extenders” allow ophthalmologists to see more patients in a day. It’s important that they’re not only up to speed on your practice’s billing procedures but are correctly capturing information.

SCRIBES

Scribes offer a valuable extra set of hands and eyes to your practice’s providers. Their ability to accurately capture and document plays a critical role in reimbursement. Make sure your scribe(s):

Document all components of the exam performed. This will help substantiate the level of exam billed.

Capture any other information pertaining to the patient encounter. Whether it’s patient history, lab results, procedures or something else, accurate records will help document and prove medical necessity for services billed!

Is your team operating at its best?
EyeMed Management Solutions has many years of experience identifying optimization gaps in a practice’s billing process. If your team isn’t operating at its best, we can help. Learn more about our results and contact us to discuss how we can help maximize your revenue by improving your billing health.