Coding and Billing

Six Steps to Separate Claim Filing Fact from Misconception

By Sandra J. Durant Certified Para-Optometric Coder (CPOC)

Many ODs think they know insurance claim filing inside out, but VisionWeb has found otherwise. Here are six steps to ensure that you file correctly.

Take a Proactive Role as CEO of Practice

Misconception: An OD doesn’t need to get involved in claim filing because that’s the biller’s job.

Fact: It’s good to delegate, but being too removed is risky. After all, claims equal money. In the end, providers are responsible for the claims, not the biller. It’s worth it to stay in the loop. What would happen to your practice if you lost your biller, and couldn’t fill the position for a month or two? That may sound dramatic and unlikely, but could the practice sustain operating costs without claim reimbursements coming in? If the answer is no, then you have good reason to know the basics. Plus, if the practice gets audited, guess who’s under the microscope? Not the biller! It’s the provider who has to answer the tough questions. Could you answer them? Claim filing is a crucial part of a practice’s success, so providers need to know what’s going on. Not only will it help in instances of claim filing drama when there are disputes or other issues, but it will also help to make sure that the biller’s needs are understood and that the staff has the tools they need to get the job done.


What Is a Certified ParaOptometric Coder?

According to the American Optometric Association, a Certified ParaOptometric Coder (CPOC) is “a person who has attained national recognition via certification by demonstrating proficiency, and expertise, and validating superior knowledge in an optometric coding environment.”

ParaOptometric coders are responsible for ensuring that all of the information about diagnoses and procedures for patients is accurate and complete.

To attain certification, an individual must pass the CPOC examination, an open-book, 150-question multiple choice exam. Questions relate to anatomy and physiology, medical terminology, CPT and ICD-9-CM codes, medical records, claim filing and compliance matters. Test-takers have three hours in which to complete the examination.

For more information and related resources like study manuals:

File Claims In-House

Misconception: We don’t have time to deal with claims, so it’s better to pay a billing service to do it.

Fact: With all the tools and technology available to make claim filing efficient, there’s no reason billing can’t be handled in-house. A lot of practices are intimidated by the complexities of claim filing, or they think that it would be too time consuming to do themselves. Because of this, they outsource their billing when it isn’t necessary. If claim filing on paper through the mail were still the norm, we could understand outsourcing. But the days of labor-intensive paper claim filing are gone. Technology has replaced those manual processes to make claim filing easier and more manageable than ever. Billing services are using this technology, not sitting somewhere stuffing envelopes and mailing claims, so what’s the point in having them do it?

Consider a Clearinghouse

Misconception: A clearinghouse, or third-party company that you send your paper claims to for transference into electronic claims, is a waste of money since payers have their own sites.

Fact: Comparing payer sites to a clearinghouse isn’t apples to apples. That would be like saying there’s no reason to have electricity in your house when you’ve got candles. Clearinghouses generally charge a per-claim fee. Most will also “scrub” your claims–that is, check them for mistakes before submitting them, saving you a lot of time, and, therefore, money. Going to multiple sites means learning multiple systems, and keeping up with the complexities of each. Clearinghouses give you one place to manage everything; it doesn’t get any easier. Accessing all of the payer sites you may file to means creating accounts on each one, for each employee in your practice using it. Your staff will also have to remember how to use each site’s varying functionality, and know how to train others to use them. A good clearinghouse is affordable and offers great value. They aren’t free, but they are worth the money because of all they have to offer. You get the following from a clearinghouse:
• Thousands of payers in one location
• Patient eligibility verification
• Claim submission and tracking
• Secondary claim processing
• Detailed reporting and analytics
• Claim uploading from practice management systems
• Electronic remittance advice (ERA)
• ERA Auto-Posting in compatible practice management systems

File Online

Misconception: It’s too risky to file claims online.

Fact: You can restrict access and customize security settings. The insurance industry has a lot of skin in the game in terms of making sure that online claim filing is secure. Do you think that they would allow claims to be filed online if the risks were too high? That’s a big no. So what about a clearinghouse? How can you be sure that they are “safe”? Well, clearinghouses have the same compliance responsibilities as the payers. The information that is entered and processed is secure. And, you can customize your account settings within a clearinghouse so that your staff only has access to the information they need. It doesn’t have to be a free-for-all.  Same goes for the internet access in your practice. You can set your browsers so that only certain sites are accessible. You don’t have to deny yourself and your practice the benefits of electronic claim filing because you want to control internet use in your practice.

Check Claims Status Online

Misconception: Once you file the claim, just wait until they pay you.

Fact: The average telephone call to check claim status takes nine minutes. A practice that handles 500 claims a year will spend 4,500 minutes if they check status for each. That’s 75 hours! Why would you spend nine minutes on the phone getting claim status when you can get it in seconds using a clearinghouse? Maybe it doesn’t seem like a lot of time when looking at one call. But, how many hours do you think your practice wastes checking on reimbursements? Do the math and you may be surprised. In addition to the tremendous time savings you get from a clearinghouse, the reports you have access to are updated constantly throughout the submission process. You will know within hours if your claims have been accepted for processing, sent from the clearinghouse to the payer, or if there is an error in the claim. That means you can react quickly if a claim needs attention. You can’t get that from the robot manning the phones at your insurance payer.

Use New Electronic Tools

Misconception: Compiling reports on every detail of every claim takes too long and isn’t worth the hassle.

Fact: You can generate comprehensive reports in a matter of seconds when you have the right tools. You can even do it yourself. Efficient practices are on top of their claims, following them in detail. VisionWeb offers a solution equipped with detailed reporting and analytics features that let you stay on top of your claims through every step of the process. For example, it enables you to know how many claims have been paid, how many rejected and how many delayed.

Related ROB Articles

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Effective Billing and Coding Can Generate Otherwise Lost Dollars

Four Key Steps toward Accurate Coding & Billing

Sandra J. Durant, CPOC, is an A/R specialist for Advanced Optometry, PLLC, in Cadillac, Mich., where she uses VisionWeb’s comprehensive suite of electronic claim filing services to manage insurance billing for the practice. To contact her:

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