Insights From Our Editors

How Many Consumers Used Insurance for Both Eye Exam and Eyewear Purchase?

Your staff has an incentive to help patients figure out how best to take advantage of their insurance as it seems most consumers want to use their insurance for both their exam and eyewear purchase. Sixty-nine percent of consumers used insurance for both their eye exam and eyewear purchase, according to Jobson Optical Research’s 2013 Eyewear & Eye Care Consumer Patterns Insight Survey. Seventeen percent just used their insurance for the exam; seven percent did not use insurance for either; 6 percent just used insurance for their eyeglasses/sunglasses purchase; and 2 percent didn’t know if they used their insurance.

Coding and billing correctly is essential for receiving the correct reimbursement for the work you are doing. Coding and billing correctly is also essential to keep out of trouble when the auditor comes knocking. Here are 10 common third-party coding and billing mistakes that you need to avoid.

1. Bundling a refraction with a medical eye examination (i.e.: not charging for the refraction)
2. Billing a medical office visit with a refractive diagnosis
3. The doctor did not document all that is included in the definition of the code billed
4. Procedures were billed without required modifiers
5. Mutually exclusive procedures were billed on the same day with a single diagnosis
6. The doctor charged self-pay patients less than third-party patients
7. The doctor waived co-pays and/or deductibles
8. The doctor is not doing Interpretation and Report when required
9. The doctor is not reporting PQRS
10. The diagnosis and procedure codes do not match (i.e.: anterior seg diagnosis with posterior seg procedure)

Here is how you can tell if you are making any of these coding and billing mistakes. Pull five to 10 patient records that have already been billed to a third party and check them for these mistakes. Did you find any mistakes? If so, then take these three actions:

1) Document the mistakes. This action shows you are examining your records and trying to do your best.
2) Put in place systems to prevent those mistakes from ever happening again in your practice. This action draws a line in the sand and says from now forward, we will not make this mistake again.
3) In three to six months, pull five to 10 records and check them again for mistakes. You want to be able to document the problems found previously have been resolved and are not still occurring.

You do not want to leave money on the table because you billed inaccurately. You also never want to fear an auditor’s review of your work because you billed inappropriately. Make sure you are not making these 10 coding and billing mistakes.

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