Coding Insights: Tips to Enhance Practice Cash Flow

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

Effective coding and billing is a cornerstone of building a profitable practice. Review of Optometric Business Professional Editors Mark Wright, OD, FCOVD, and Carole Burns, OD, FCOVD, share their insights of how to ensure accurate coding that results in swift, high reimbursement.

What is the Most Important Thing You Can Do to Prevent Third-Party Denials?
Third-party claim denials can cost your practice significant revenues, cutting into your profitability. Here is the most important action you can take to stop those denials from happening. >>READ MORE>>

Cloning, Copying & Clinical Plagiarism: Why You Have Probably Done It & What Could Happen As a Result
Have you ever copied and pasted a template into your practice management system when documenting a patient visit? Did you assume it was OK? If you have done this, you may have committed what is known as cloning, copying or clinical plagiarism. Here is why doing this is a bad idea, and what could happen if an insurance company sees you are doing it. >>READ MORE>>

False Claims Act: Avoid a Violation that Could Cost You $1 Million
Your practice may be credentialed by an insurance provider, but that doesn’t mean each doctor in your practice has also been credentialed by that insurance provider. Here is why billing an insurance provider under the name of a credentialed doctor is a big mistake if that doctor was not the one who delivered the care. >>READ MORE>>

Coding & Billing Flow Chart to Help You Maximize Your Reimbursement
Coding and billing can be intimidating and difficult to track to ensure it is being done correctly every time. Here is a flow chart that will help you put in place a complete coding and billing system to make claim denials less likely and maximize reimbursement. >>READ MORE>>

Top Lessons Learned So Far about Using the New E/M Codes
New E/M codes went into effect at the beginning of this year. Now that we are a couple of months into using the new definitions for the E/M codes, here are the lessons we should have learned. >>READ MORE>>

Medicare Physician Fee Schedule: The Annual Exercise that Will Help You Limit Your Accounts Receivables
Every year it is important to go through an exercise with the Medicare Physician Fee Schedule. If you are a Medicare provider, this details what Medicare reimbursement is for each CPT code. From this we can determine what the patient is responsible for today and what Medicare will send to you in a check (if your fees meet or exceed the Medicare reimbursement). Here is how to do this exercise. >>READ MORE>>

The Solution to Billing Successfully Under the New CMS E/M Coding Guidelines
The Centers for Medicare & Medicaid Services (CMS) finalized new E/M requirements, which became effective on January 1, 2021. This new rule reduces the burden on providers imposed by the old coding system and rewards time spent evaluating and managing patient care. Here are the details about this change, and what it means for your coding and billing procedures. >>READ MORE>>

2 Reasons NOT to Agree to Charge a Patient’s Vision Vs. Medical Insurance
Patients may sometimes request that you charge their vision plan, rather than their medical insurance, to allow for cost savings when they have a medical eye problem. Here are two important reasons not to do that, and what you should do instead. >>READ MORE>>

99000 E/M CODING: DETAILS ON THE BIG CHANGES COMING JAN. 1
Jan. 1, 2021, brings big changes to E/M coding. The new changes make coding office encounters easier. Here are the changes in a nutshell. >>READ MORE>>

HOW TO HANDLE THIRD-PARTY CLAIM DENIALS
Every practice is going to experience third-party claim denials. Some denials are fixable, such as claim submission problems (incorrect or incomplete information) or third-party processing errors, and some are not fixable, such as lack of coverage issues. Sometimes fixes are easy to make and other times the fixes take additional work. No matter the reason, every practice should have a process for handling the denials. These three steps will give you a starting place for that process. >>READ MORE>>

MODIFIER 25: WHEN TO USE & WHEN NOT TO USE IT IN CODING & BILLING
Modifiers in coding and billing should be used judiciously. The Office of the Inspector General has specifically cited overuse of Modifier 25. Here is how to use this modifier exactly as it was intended. >>READ MORE>>

CODING & BILLING: BOOSTING PROFITABILITY WITH BETTER REVENUE CYCLE MANAGEMENT
Tracking money coming into the practice, from the first point of contact with the patient, to the last, is essential to profitability. Here is the important role coding and billing play in this process, and how to ensure you are fully reimbursed for all services. >>READ MORE>>

2020 MEDICARE PART B DEDUCTIBLE CHANGE: WHAT YOU NEED TO KNOW
Changes have been enacted for Medicare patients’ Part B deductible. Here are the details on this change, and how your practice will be impacted, including how this changed deductible will affect your coding and billing process. >>READ MORE>>

EXTENDED OPHTHALMOSCOPY: 2 MAJOR CODING CHANGES FOR 2020
Extended ophthalmoscopy is a valuable tool in the diagnosis and treatment of patients, helping you to determine how you can best help them. Two changes take effect this year impacting how you code this procedure for reimbursement. Here are the details. >>READ MORE>>

SETTING YOUR FEES FOR 2020 TO BE MORE PROFITABLE
It’s the time of year to begin thinking about your fees for the next year. One place to start is to look at the Medicare Physician Fee Schedule Final Rule for next year. Here’s what you need to know to set profitable fees for the coming year. >>READ MORE>>

THE GOVERNMENT IS WATCHING: HOW TO PROTECT YOURSELF
Each year the Department of Health and Human Services, as well as the Department of Justice, publish a Health Care Fraud and Abuse Control Program Report for the fiscal year. Here are a couple of statements contained in the 2018 Annual Report that got our attention. >>READ MORE>>

5 THINGS TO DO TO MAKE YOUR PRACTICE AUDIT-READY
In today’s world, audits are not a question of if, but a question of when. It’s always better to stay prepared for an audit than to live a life of regret after the audit. Here’s what you need to do to make your practice audit-ready. >>READ MORE>>

PROOF OF DELIVERY DOCUMENTATION: HOW TO SERVE PATIENTS & BE IN COMPLIANCE
The Centers for Medicare and Medicaid Services has established rules about delivering glasses and contact lenses to patients. Here are the details about these rules, and what your practice should do to stay in compliance. >>READ MORE>>

CODING: REMOVING REDUNDANCY IN EVALUATION & MANAGEMENT DOCUMENTATION
Until 2019, if anyone other than the doctor took part of the history, the doctor had to do it again. The Centers for Medicare and Medicaid Services has removed that requirement. Here is what you should know about the removal of this requirement, including how you can optimize this change in rules to streamline your coding process. >>READ MORE>>

MEDICARE PROVIDER COMPLIANCE: WHAT ODS NEED TO KNOW
Coding and billing for Medicare can present challenges, which could result in violations of the law. Here are the top points to keep in mind to align with regulations and maximize reimbursement. >>READ MORE>>

CODING SELF-ASSESSMENT: A QUIZ TO TEST YOUR CODING ABILITY
Accurate coding impacts the level of reimbursement you receive, and can protect your practice from charges of insurance fraud. Here’s an assessment to alert you to areas of coding that you may need to learn more about, or approach differently. >>READ MORE>>

CODING & BILLING: FEE-FOR-TIME COMPENSATION ARRANGEMENTS
When you are out of the office, and another OD is seeing patients in your place, do you know the proper billing procedure? Here is key information to ensure you’re doing it right. >>READ MORE>>

CODING FOR TELEHEALTH CONSULTATIONS
The final 2019 Medicare Physician Fee Schedule contains four existing CPT codes, and creates two new CPT codes for inter-professional internet consultations. Here are the details. >>READ MORE>>

CODING & BILLING: INCORPORATING LIFESTYLE HISTORY INTO MEDICAL HISTORY
When you care about your patient, you learn about their lifestyle and incorporate these important facts into your medical history. Here’s how to do that in the coding you do. >>READ MORE>>

 

 

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