Claims denial is the failure of an insurance company or carrier to honor a request by a person (or his or her provider) to pay for healthcare services provided by a healthcare professional.
Is your optometry office suffering from poor cash flow and out-of-control accounts receivable (AR)? Have you ever wondered where your revenue is hiding?
Professional fees for patient care account for 55% of optometry office income on average (medical eye care, eye exams, and treatment). With more individuals having medical insurance and managed vision plans, money can easily be misplaced. Keeping track of all the facts so that your claims are submitted and paid accurately and on time is a problem for any eye care business.
How can you increase sales while decreasing accounts receivable? In this section, we will discuss typical difficulties, denial management solutions, and marketing techniques that will assist your practice in reducing the number of days your AR stays unpaid and sits in the aging bucket.
Standard Accounts Receivable Process Issues
We cannot emphasize more how critical it is to review your AR to avoid significant cash flow issues. If you file claims on a regular basis and post remittances as they come in. In general, AR should reflect the actual worth of pending claims that require your attention.
If claims are not filed, are rejected or refused, or payments are not deposited, your AR reports will be inaccurate.
Enrollment, Provider Credentialing, and Incorrect Codes
- Challenge: Group enrollment policies and correctly submitting codes and modifiers are problematic. The practice had $37,000 or more in unpaid bills that were 60 days or older.
- Solution: All insurance payers’ group enrollment and provider credentialing procedures were made simpler. The AR Aging bucket has been reduced by 90% to $3,700.
Denied Medicare Claims
- Challenge: With more than $160,000 in the outstanding 60+ days Aging bucket, cash flow was severely low.
- Solution: Corrected various coding and modifier errors, as well as erroneous information on, refused Medicare nursing facility claims. AR was easily lowered to $112,000 by just resolving the refused Medicare claims.
Rejected and Denied Claims
- Challenge: $10,000 or more in the outstanding 30-120 day Aging bucket.
- Solution: All rejected and refused claims were reviewed and scrubbed, and required adjustments were made to collect the amounts owed. Before submitting new claims, Fast Pay Health ensured that they were clean and error-free. Within 30 days, the outstanding 30+ Aging bucket was reduced to $2,000.
These 10 Optometry Billing Strategies Will Increase Your Cash Flow
How can you reduce our receivables while increasing top-line revenue for a healthier bottom line? That’s where our intelligent billing techniques come in.
1. Submit Claims on a Daily Basis
Many of the largest medical payers processes claims within 5 to 7 business days. Some people pay at the same time every month or even every week, such as on the 15th or final day of the month.
You may maintain a steady flow of claims and get them reimbursed quickly by filing them on the day of the appointment or within one business day. If you only file claims once a week, your AR will grow like a weed, resulting in a greater backlog to clear through, which typically leads to additional billing problems.
2. Collect all co-pays, coinsurance, and deductibles in advance
If the patient’s insurance plan contains a co-pay, coinsurance, or deductible, always collect it before they leave the office either check-in or check-out.
Consider a five-day workweek over four weeks: If you see 20 patients a day and each has a $15 co-pay, you’re missing out on more than $1,150 in upfront revenue that you don’t have to bill the patient.
3. Prioritize patient billing
If a debt is left for the patient to pay, collecting payments gets progressively difficult the longer it has been since the patient’s visit.
Sending invoices before the due date can help decrease AR delays, avoid late payments, and improve your chances of getting paid on time. Open balances may provide a distorted picture of your AR.
4. Assist Patients in Understanding Their Bill
One of the primary reasons patients do not pay a medical bill sent to them by their provider is confusion. And misunderstanding leads to ignoring the bill, which means you do not get paid.
Examine your existing statement or invoice to ensure that it is simple to grasp, and always include a due date. Maintain contact with your patients in between visits to ensure that the bill does not fall between the cracks.
5. Make Electronic Billing Available
Consider providing electronic patient billing with an online bill payment mechanism accessible via your EHR patient portal or website. You may minimize past-due amounts with the assistance of top medical billing services and save staff time hunting down payments, mailing invoices, collecting monies over the phone, and manually processing payments using online bill payments. Text and email reminders might help you get paid faster.
Many eye care patient portals interface with EHR and practice management systems to instantly submit payments, eliminating the need to re-key billing data. When you allow your patients to use a secure patient portal at their leisure—from home or on the move, on any mobile device—your patient connection will be more meaningful.
6. Make use of automated payment reminders
Consider employing an automated patient reminder service that may notify patients through voice, text, or email when a payment is due. If you provide an online payment option, your message might direct people to phone your clinic or check in to their patient site.
7. Post Remits When You Receive Them
Delaying payment posting will keep your AR artificially high, and you may miss rejections. Think again if you believe that receiving electronic funds transfer (EFT) payments means you may postpone your posting. Some payers have tight refiling restrictions that limit the amount of time you have to challenge a claim from the remit date.
By managing remits within one to two days, you may shift the amount to secondary insurance and bill that much faster. Alternatively, you can transfer the patient’s outstanding balance and produce a statement. The longer it has been since the patient’s appointment, the more difficult it is to collect money.
8. Make a Payment Schedule
Not all payers will have a constant payment schedule, but you should be able to get some of the major ones out of the way. Keep track of the dates on the checks that arrive to determine if there is a trend. Knowing when you have a lot of payments to make enables you to plan ahead for the remainder of the week.
9. Scrub Claims in Order to Reduce Claim Denials
Are you concentrating on those annoying claims that fail? Are you validating insurance information and confirming the correctness of the charge entry? Was it a non-covered service, associated with an incorrect diagnosis, omitted a modifier, or packaged with another procedure?
Reimbursements are closely tied to precise information, and clean and accurate claims are paid faster. Before you submit your claims, make sure they are clean and error-free.
10. Look into unpaid or expired claims
Do you go over your aging claims on a regular basis to discover why open balances remain? Pay particular attention to rejections on clearinghouse reports and remittance denials. If your patients have supplementary insurance, you may face timely filing denials. Many payers require you to bill secondary insurance within 180 days of receiving the first payment, whichever comes first.
Examine claims submitted through clearinghouses, check claim status on payer websites, and call payers to find out what happened to those unpaid accounts when no remittance can be identified to assist fix the issue.
Note the name of the payer representative you spoke with throughout your chat, since this information may be useful later on. Either investigate as soon as the problems appear when posting or make a note of any claims on a remit that include errors and study them after publishing the check.
Look into any accusations that are more than 30 days old. In certain circumstances, the payer may still be processing the claim. Also Knowing which payers take longer to process a claim helps you to prioritize those who should pay promptly.
