Coding and Billing

Are You Running a Modern Billing Department? If Not, Here’s How

By John W. McCormick, OD, and Shane Shepherd

John W. McCormack, OD, of McCormack Vision Source in Austin, Texas.

Use the latest technology and third-party services to make insurance processing more efficient for your practice.

There are many aspects to utilizing technology, software and people to modernize billing and tracking of both vision and medical insurance. Our practice makes the most of such technology to make billing more efficient and profitable. Here is how we do it.

Recognize Five Keys to Optimizing Billing Technology

SOFTWARE THAT GENERATES REPORTS: Utilize practice management software that is capable of generating reports on billing status.

EDUCATE STAFF: Educate staff to be dedicated to efficient use of insurance. Education of a key staff person to coordinate vision benefits and medical benefits is imperative. It is also necessary to train front desk employees to capture insurance information prior to the patient being seen by the practice.

PREVIEW INSURANCE INFO. Provide insurance information to the doctor prior to seeing the patient. The doctor needs to be aware of medical as well as vision benefits for both professional fees as well as ophthalmic materials.

DELEGATE: Assign a single individual the final responsibility of making sure claims are filed and accounts receivable reports are up to date.

USE A CLEARING HOUSE: Utilize a clearing house (a third-party company that you send your paper claims to for transference into electronic claims) to achieve maximum efficiency.

Shane Shepherd, office manager of McCormack Vision Source

The modern practice and its billing department can benefit from the innate efficiencies of a clearing house. VisionWeb is our clearing house of choice, however there are several to choose from such as Gateway, and Eyefinity. Having implemented VisionWeb/Emdeon many years ago in our practice, we have realized the following benefits:

Centralized Claim Filing
It is possible to file claims online without using a clearing house, but this method is far from ideal. Filing claims electronically without a clearing house means going to multiple sites on the Internet, with varying user interfaces, to get the job done. Advanced billing departments realize there is a better way. Clearing houses are a go-to solution for practices because the clearing house software allows employees to do all of the following in one location:

  • –Check patient eligibility
  • –Submit and track claims
  • –Process secondary claims
  • –View detailed reporting information
  • –Manage Electronic Remittance Advice (ERA)

Efficient Management of Reporting and Analytics
Even the most efficient office will have denied claims. The way we keep a close eye on our claims is through detailed reporting and analytics that cover every aspect of claims, such as:

–The number of claims that have been rejected vs. accepted
–Top payers that are rejecting claims, by amount
–Timeline of claim submission for tracking
–Top rejection reasons

Optimized Practice Management Systems
Good practice management software is the brain center of a practice. Practice management software is a significant investment, and yet, practice owners are putting them to work, especially for claim filing. Technologically advanced practices utilize their practice management system claim filing functions to:

–Create batch claim files directly within the system
–Upload the batch claims and submit directly to payers
–Reduce redundancies associated with re-keying claims
–Generate reports quickly and easily on demand

Utilize Electronic Remittance Advice (ERA)
Billing departments become more efficient when they avoid paper claims. EOBs, especially, since payers have migrated to electronic payment methods, are processed more quickly via the internet. Electronic Remittance Advice is common among progressive practices. Filing via your computer simplifies the reconciliation and secondary claim filing processes by:

–Providing remittance information in a searchable, electronic format
–Making it easy to search remits by payer, date or provider
–Giving users the ability to print only the information they need for secondary filing

Utilizing the most efficient electronic format increases the productivity of your personnel and your practice. Change is often disruptive initially, and yet, we adapt and change or we continue to fall behind. Make the insurance processing technology changes your practice deserves!

Related ROB Articles

Six Steps to Separate Claim Filing Fact from Misconception

Outsource HR and Billing to Improve Practice Quality and Efficiency

How to Coordinate Medical and Vision Plan Billing

John W. McCormack, OD, is a partner of McCormack Vision Source in Austin, Texas. To contact him:

Shane Shepherd is McCormack Vision Source’s office manager. To contact him:

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