More Related Content More from Medical Billers and Coders More from Medical Billers and Coders (20) Preparing your optometry billing for medicare audits1. End to End Medical Billing Solutions
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Preparing your Optometry Billing for Medicare Audits
The field of Optometry has seen exponential growth in patient traffic and scope of care over the
past decade. With healthcare reforms aiming to bring more and more people under coverage
for primary care, government is inducting many alternative healthcare specializations into
primary care. As Optometry practices are finding expansion of their scope, their liability is also
increasing. 60% of the patients walking into OD clinics today are relying on Medicare coverage
to avail medical services. Therefore, in addition to adhering to required ICD-9 coding
requirements of Optometry, there are a series of activities that ODs have to adopt in order to
prepare for and avoid Medicare audits.
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Incorrect billing is also considered as fraudulent billing at the time of Medicare/Medicaid audits
and Optometric practices are required to reimburse the insurance carriers with the additional
paid amount. Sometimes an amount is penalized as well given the extrapolation of extra
reimbursements. This in turn puts heavy financial pressure on any Optometry practice that has
to suffer through Medicare audit. To avoid such financial burden, therefore, it is important to
prepare your Optometry practice for avoiding and surviving audits.
Patient satisfaction - Medicare audits are usually triggered by customer complaints or
due to questionable utilization. Therefore, it is important to ensure customer
satisfactions with diagnostic, evacuation and minor surgical procedures offered as eye
care by your Optometry practice. Customer satisfaction can in turn be ensured with the
help of transparency in billing procedures and data recording.
Coding practices – Optometry Billing Services relies predominantly on Current
Procedure Terminology (CPT) codes for diagnosis which are legally billable. The codes
generally come under the 92012 or 99202 series and are most prevalent in Optometry
billing. Incorrect application of any other ICD-9 or ICD-10 codes for diagnosis can attract
claim denials and resultantly medical audits. Thus, best way to prepare your Optometry
practice for a Medicare audit is to adopt correct coding and billing practices. Training of
2. End to End Medical Billing Solutions
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staff and updating of EMR or other billing software at a regular interval plays an
important role here.
Billing transparency – Another important procedure performed by OD practitioners is
glandular evacuation. If the Optometrist utilizes LipiFlow Thermal Pulsation System and
administer meibomian gland evacuation, then billing can be done for evacuation
procedure rather than diagnosis. While this is a procedure reimbursed at a higher rate,
incorrect usage can attract unwanted audits.
Having audit reviews – To avoid unwanted surprises, it is better to have regular reviews
of your systems and processes. This simple operational addition can save your
Optometry practice thousands of dollars of audit costs.
Medicalbillersandcoders.com is a coding and billing partner that offers the expertise of a team
of Optometry medical billers to your Optometry practice. With specialized focus on Optometry
billing, you can avoid coding and billing errors thereby improving customer satisfaction as well
as avoid any future audits.