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.

Coordination of Benefits: What It Is & How It Impacts Your Reimbursement
A patient presents at your office for a procedure for which you charge $150 and they have two different insurance policies. Which one do you bill? A better question would be: Which reimbursement would you rather have, $135 or $65? Utilizing coordination of benefits may allow you to receive the higher number. Here is how to do that. >>READ MORE>>

What You Need to Know About Modifier 25 to Maximize Your Reimbursement
Modifier 25 enables you to bill for two separate procedures conducted during the same exam. To ensure you are getting fully reimbursed, however, you must understand the correct way to use this modifier, including the codes it can and cannot be used with. Here are the details on the right way to use this modifier. >>READ MORE>>

Bundling in Billing: What to Do to Avoid Violations
Insurance benefits can sometimes be bundled, and often cannot. Here is when to bundle benefits, and when not to, so patients are helped and the practice is protected. >>READ MORE>>

Why It’s Never OK to Charge a Patient More to Make Up for What Insurance Didn’t Pay
Some practices charge a patient the balance of what their insurance did not pay. Known as balance billing, this violates contracts with third-party payors. Here is why you should never do this, and what you should do instead. >>READ MORE>>

Claim Denials Vs. Rejections: How to Approach Each to Improve Cash Flow
Claim denials and rejections are not the same thing, and must be handled differently to ensure your practice receives reimbursement. Here is how you should manage claim denials and rejections, so you can enhance your practice’s cash flow. >>READ MORE>>

Why You Need to Use MBIs If You Want to Get Paid
In April 2018, Medicare removed Social Security Numbers from Medicare cards and replaced them with Medicare Beneficiary Identifiers (MBIs). Here is what you need to know about using MBIs in your practice.>>READ MORE>>

2022 Medicare Physician Fee Schedule: What to Expect & Plan For
The Centers for Medicare & Medicaid Services (CMS) issued the final rule that includes updates on policy changes for Medicare payments occurring on or after January 1, 2022. Here are important changes to keep in mind. >>READ MORE>>

Ready for 2022? 4 CPT Code Changes You Will Need to Implement
The recent release of the CPT 2022 isn’t as earth-shaking as last year’s release, which included major changes made to the 99000 E/M coding. However, there are important changes to be aware of. Here is what you should know, and the changes to coding you will have to make. >>READ MORE>>

The Coding Protocol Mistake with Huge Repercussions
It’s easy to let coding software or a staff member code patient visits on your behalf. However, it’s essential that the doctor closely review all coding that is submitted. Here’s why, and what can happen when the doctor does not double-check coding. >>READ MORE>>

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>>

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