The Optical Vision Site

Billing And Coding

Optometrist Options for Billing and Coding

Medical Billing

While optometry is not a new profession, the industry may not be enjoying the same benefits as larger medical outlets when it comes to receiving their proper dues (in the form of financial reimbursement). This could be attributed in large part to the fact that optometrists are either not aware of the benefits of medical billing and coding, or because they are not utilizing it properly. In either case, there is a lot to be gained from an understanding of the processes and options involved in medical billing a coding and how doctors of any stripe can take advantage of it to make their business run more smoothly and ensure that they are operating at maximum capacity.

1. AOA Coding Today . If the problem is that you are simply not informed about how medical billing and coding can help your business, then you should look to the American Optometric Association for a little help or American Academy of Ophthalmology CodeQuest, their annual lecture tour, will provide optometrists with both the basics of billing and coding as well as up-to-date advances in the field. Or you can simply visit their online forum with any questions you may have.

2. Insurance. Every medical office must deal with a variety of insurance companies, but the main one (and probably the most complex) is Medicare. While it may take some time to learn the ins and outs of what different companies are willing to pay, it would behoove you to find out what they offer as reimbursement for your standard services so that you are getting the most for your time. For example, standard fees are a thing of the past. If a certain insurance company pays more than your regular fee, you may want to ask yourself if you’re charging enough for your services (since payouts are based on what the carrier deems to be fair). There are certainly situations in which you will not be able to recover all costs through insurance, so perhaps you should consider an offset when it comes to items that the coverage exceeds.

3. RBRVS. The Resource-Based Relative Value Scale is a system designed by Medicare to calculate the value of a medical procedure in order to assign it numerical cost (based on the amount of work, overhead, and risk involved). It pays to know what these values are so that you can bill accordingly. You may be able to receive a listing (from Medicare at the very least), but you can also learn to calculate them for other insurance providers who are reticent to release the information.

4. Code correctly. There is no quicker way to lose money than through incorrect coding. If you’re lucky, you will receive a reduced reimbursement, but it’s much more likely that your claim will be rejected altogether. So take the time to incorporate knowledge of coding with your clinical expertise in order to ensure that you get paid correctly. You can do this by attending seminars or getting advice and training from an experienced medical biller and coder (or simply hiring one).

5. Invest in software. It might be next to impossible to do medical billing and coding on your own, especially with the health care industry in flux and changes on the horizon. So consider investing in software that will help you make the right selections, calculate values, and ensure that you are reimbursed fully for your work.

Submitted by guest blogger; Kyle Simpson writes for Medical Coding where you can find information on a career in medical billing and coding industry.

The Vision Council Update on Health Care Reform

The Vision Council has provided some helpful updates on Health Care Reform that we would like to share with you regarding On March 30, 2010, the President signed into law the heavily debated health care reform legislation – so what happens next? There are some immediate changes that will take effect as well as a steady time line for implementation. Here is how the optical industry will be affected by the new health care reform law.

What happened to vision care?

• Eyeglasses have been exempt from the medical device tax included in the most recent version of the bill. While this includes most of The Vision Council membership, The Vision Council Public Affairs and Advocacy Department will work with the Secretary to prevent any tax burden on all medical devices manufactured by our members.
• There will be more Americans receiving vision care because of health care reform.
  o Pediatric vision care will include individuals up to the age of 22 as a result of the extension of the WellBaby Program which includes vision care. Care and product will be covered for those with diagnosed vision problems.
• Optometrists and ophthalmologists will have increased and equal reimbursement rates for their services.
• The amount of pretax dollars available for an individual to place into a Health Flexible Spending Accounts (HSA) will be reduced from $5,000 to $2,500 and could cause people to pay out of pocket or rely on government assistance when receiving optical services or purchasing medical devices. This will be effective December 31, 2012.

What happens to business in this new law?

This legislation mandates individual businesses to offer insurance. Its goal is to help get as many Americans as possible into the system by providing businesses incentives for offering health insurance and imposing penalties on those that don’t.

Large Businesses

Most large businesses already offer health care of some sort to their employees. In the future, those businesses could have premiums reduced because the cost for overall insurance will go down with the addition of 31 million Americans in the system. However, this is not guaranteed because an unknown number of them may have preexisting conditions, come from high risk pools or could reach their annual/lifetime caps. Because of this, premiums could also potentially stay at current levels. If you currently are offering a “Cadillac” health care plan, taxes will be levied on such plans in 2014. Also, if you are a company with over 50 employees and do not offer health care benefits or if you don’t cover 60 percent of overall employee health costs, there will be penalties beginning in 2014.

Small Businesses

The definition of small business varies by state (i.e. less than 10, 50 or 100), but a majority of the programs described in the new health care law are for businesses with 50 employees or under. Starting in the next six months (by 2011) if you currently do not offer all or any of your employees health care benefits and you have a company of 10-25 employees earning $25,000-$50,000 annually, you may be eligible for a 35 percent tax credit back on the premium paid to extend benefits to those employees. Starting in 2014, small businesses will be eligible to buy health care benefits through state health insurance pools called SHOP exchanges (Small Business Health Options Programs). These allow small businesses to group together to buy health insurance at the same rates as larger businesses. Companies with 10 or less employees may also receive a 50 percent tax credit.

National Healthcare – A British Experience Part 1

I am in the U.K. right now and have had two very positive experiences with the British Health Care system from a patient’s point of view. I cannot speak about how it is as a provider but I thought it would be interesting to blog about it from the patient side.

Britain has had the National Health Service (NHS) program for sixty plus years and basically provides health care for everybody funded through the government i.e.taxes. Individuals can have access to both the National Health system and private health care. Private medical insurance is readily available and often provided as a perk by some employers to executive level staff. BUPA being the most well known insurance provider.

I have elderly parents  in the U.K. and a 93 year old mother-in-law in California. My Californian mother-in-law has numerous doctor appointments that usually require planning for at least 2-3 hours per appointment.  Most of that time is spent just waiting for the doctor who is always running late. She has to see a different doctor for each condition which often means 2-3 different doctor appointments a week!

My father here in the U.K. had an appointment with a specialist at the local hospital for a suspected aneurysm. I went with him. His appointment was at 3:10 so I expected to be there with him until at least 5 PM. We saw the nurse practitioner at 3:15. We were able to discuss all of his issues and current medications which took about 15 minutes. The specialist came in the exam room soon after the nurse signaled we were ready.  He did an exam including sonogram which happily showed that the suspected aneurysm was just scar tissue. We were out of the hospital by 4 PM and a letter recommending pain management amongst some other comments was already in the system so that his other health conditions would be addressed immediately. He will be able to see his G.P. next week for the follow-up on these.

The paperwork was minimal and my father’s health and comfort were the prime concern – not who was his insurance carrier, what was the co-pay, what was covered, what was not covered etc. etc. It was a lot more efficient and pleasant experience than any of my mother in law’s appointments I have been to in the U.S.

For more information on the subject of Health Care Reform in the U.S. and how the optical industry will be affected by the new health care reform law our best resource is  The Vision Council. Here are some highlights  from The Vision Council Update on Health Care Reform:

On Tuesday, March 30, 2010, the President signed into law the heavily debated health care reform legislation –  What happened to vision care?

• Eyeglasses have been exempt from the medical device tax included in the most recent version of the bill.
• There will be more Americans receiving vision care because of health care reform.
• Pediatric vision care will include individuals up to the age of 22 as a result of the extension of the WellBaby Program which includes vision care.
• Care and product will be covered for those with diagnosed vision problems
• Optometrists and ophthalmologists will have increased and equal reimbursement rates for their services
• The amount of pretax dollars available for an individual to place into a Health Flexible Spending Accounts (HSA) will be reduced from $5,000 to $2,500 and could cause people to pay out of pocket or rely on government assistance when receiving optical services or purchasing medical devices. This will be effective December 31, 2012.

Making the Most of Optical Managed Care

This post on Making the Most of Optical Managed Care was submitted by ClearVision Optical:

Independent optical dispensers are often reluctant to embrace the world of managed care, but the reality is: managed care is here to stay. Fortunately, there are a number of ways to make managed care work for you and your optical practice.

Junction City Frames by ClearVision Optical

For starters, you need to choose which plans to partner with. This should be a case of choosing the RIGHT plans, not the MOST. That’s because for each insurance provider you partner with, your office will have an equal number of provider policies to manage. Ultimately, this could result in you and your staff spending more time on paperwork – and less time with patients.

Instead, be selective in choosing managed care partners. Study what each partnership will mean to your practice. If a plan won’t provide you with an increase in sales that is in proportion to the amount of work entailed in partnering with it, cross it off your list. It’s also important to consider which plans local companies or unions in your area offer.

Once you’ve selected your managed care partners (and your staff has mastered the practices and policies of each), it’s time to work with your customers. Be sure to position yourself as an expert on eyecare with your customers. Sell what looks good on your customer and what is medically necessary – not what is the cheapest frame. To this end, you can encourage your customer to use their managed care funds as a discount toward better frames. Stress the benefits of quality products in medical terms and the importance of a well-warranted frame.

Despite your effort to up-sell, many managed care customers may simply want inexpensive frames that are 100% covered by their plans. While this audience wants a veritable bargain, they do not want to look cheap. Fortunately, house brands such as ClearVision Collection, Junction City and Koodles from ClearVision Optical offer current styles at managed care-friendly prices.

You also can use managed care to help freshen up your frame board. Take your slower-moving frames off your main board and replace them with new product. Move the old product to a separate area and label it as a specially-priced “Managed Care Collection.” This way, you can offer your managed-care customers name brands at lower prices, while reaping the rewards of having fresh, new product on display.

If you select the right plan partners, educate your staff and offer good value to your customers, you will ultimately reap the many rewards of managed care.

House Passes Health Care Bill – What about Vision Care?

The House health care bill passed Saturday 11/7/09  would:

• Require most Americans to buy health insurance or pay a fine.
• Expand health care coverage to 36 million more people over the next decade.
• Require employers with payrolls above $500,000 to provide insurance to their employees or pay a fine.
• Prohibit insurance companies from denying coverage because of pre-existing medical conditions.
• End premium disparities between men and women.
• Impose a 5.4% income tax surcharge on income above $500,000 annually for individuals and above $1 million annually for households.
• Establish a government-run insurance plan to compete with private insurers beginning in 2013.
• Cost $1.2 billion over 10 years.
• Cut Medicare spending by more than $400 billion over 10 years.

How this will the fact that the House Passes Health Care Bill effect the Vision Care industry? Much more to come on that question but this is a big step towards change that we will all need to embrace whether you support the bill or not!

Source: NCTimes.com

Health Care Reform Package and Vision Care

We are receiving  a lot of correspondence from our readers about Health Care Reform and Vision Care. For example, Eric White, OD has some major concerns about what is happening with the Health Care Reform Package and Vision Care. We are sharing Eric’s concerns with you in case you want to take some action, get involved:

“AOA‘s executive board last week was granted the removal of eyecare from the Health Reform to the Finance Committee. Their thoughts were if VSP did not exist that the medical insurance companies would be forced to pay higher reimbursements. This is a scary thought since my practice is 50% VSP and most doctors in California is much higher. What would stop medical insurance companies to just eliminate private practice and go directly to the Costco’s of the world?

We had our VSP meeting last weekend and almost all if not all of us signed a letter asking the Finance Committee to put eyecare back in the bill. It was voted on a few days ago but I do not know if this was added. We need to let all of our colleagues know what is going on and find out what AOA executive board is trying to do. Many people at the meeting last weekend are on different AOA boards and not one of us knew this was happening.

I wanted everybody to hear about this to become involved in saving private practice. Please consider sending a email blast to all PEN members.

Thank you,

Eric White, OD”

Health Care Reform Updates for the Optical Industry

How will Health Care Reform affect all of us in the optical industry? This will be an ongoing question for some time to come. The Vision Council has developed a memorandum to update their optical vision company members on the process and how the legislation may affect us as individuals and as optical business participants. We will be making sure that we review the updates and pass on as much information as possible.

Today, October 13, the Senate voted on health care reform legislation. The Senate Finance Committee approved comprehensive health reform legislation by a 14 to 9 vote, bringing to a close an extended, multi-day markup of the bill. The Finance Committee bill must now be melded with health reform legislation approved by the Senate Health, Education, Labor and Pensions Committee in July. This process will be driven primarily by the Senate Democratic Leadership. Floor action is expected within the next two weeks and debate could require at least three weeks.

Thank you to The Vision Council for providing us access to these timely Health Care Reform Updates for the Optical Vision Industry.

Know Your Billing Codes by Eye Doc News Blog

One of the Blogs we subscribe to is EyeDocNewsBlog: Here is their update about billing codes:

Modifiers Your New Friend-

By Dr. Ari Weitzner

If you are in private practice, you MUST be familiar with the following three modifiers- otherwise, you are losing lots of money:

-24: This is added to the EXAM code (ie, 92012) during the post-op period (often 90 days after the procedure), when you are examining someone for a different diagnosis (i.e., conjunctivitis 1 month after cataract surgery). Without this modifier, the exam will be denied, as it will be assumed it’s a post-op visit.

-25: Add this to the EXAM code when you do a procedure on the same day- otherwise, you’ll be paid for the procedure only and the exam will be denied (ie, 92014-25  for cataract when you bill for insertion of collagen plugs for dry eye, too, on same day).

-79: Add this to any PROCEDURE CODE you do during the post-op period when it’s unrelated to the original procedure. Otherwise, it will be denied as part of the global fee for the original procedure (ie, removal of chalazion 1 month after cataract surgery).

There are other modifiers, but these three are the most important and come up very often. Make sure your biller understands what you are doing, and that each exam and procedure MUST be attached to a different diagnosis on separate lines.