A successful and profitable optometry practice is not possible without accurate and competent medical billing and collection processes.

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Improve Optometry Medical Billing Collections
An optometry practice has also the same agenda as other small businesses – you want to succeed. To achieve
success in business is one that focuses on growing revenue while providing excellent experiences to their
customers. Here, customers are patients. Improving optometry medical billing collections is a vital strategy to
achieve financial stability.
Suggestions to Improve Optometry Medical Billing Collection:
Verification with the Insurance Payer
One of the initial steps in optometric medical billing is to ensure that the provider has been credentialed by
the insurance company.
You need to make sure to submit and track credentialing applications based on the insurance plan
requirement. Take your application one step further and follow up with insurance payers regularly to ensure
that the providers are enrolled in the network whenever enrolment is open.
Read more: The time has come to get credentialed first!

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Improve Optometry Medical Billing Collections
Correct use of Modifiers
Many optometrists use to bill a CPT® code 92133/92134 and fundus photography – CPT® code 92250 on the
same visit. If you do not code this correctly then Medicare may deny both codes or only allow payment on
the code with the lowest reimbursement.
92133 and 92134 are subject to Medicare’s Multiple Procedure Payment Reduction (MPPR). This reduces the
allowable for the technical component of the lesser-valued test when more than one test is performed on the
same day.
CPT Code 92133: SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT,
WITH. INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL; OPTIC NERVE. 92134. SCANNING
COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, WITH.
CPT® codes are published by the American Medical Association® and consist of three types or categories of
five-character codes and two-character modifiers to describe any changes to the procedure.

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NCCI edits prevent bundling/unbundling due to incorrectly using CPT® procedure codes and HCPCS billing
codes, including combining inappropriate code combinations. A revised annual version of the National
Correct Coding Initiative Policy Manual for Medicare effective January 1, 2021, was posted December 18,
2020.
While the NCCI edits do permit the use of a modifier for OCT/GDX and fundus photography, be cautious and
use a modifier properly, or it may result in a denial or rejection. It depends on local policies, if tests are
necessary due to 2 separately recognizable conditions, you may be able to link the suitable diagnosis code to
each CPT® and addition of modifier 59 to the second procedure.
Stay Updated
To make sure you are coding your eye care claims properly and error-free, you must remain careful with Local
Coverage Determinations (LCD) and Medicare Administrative Contractors (MAC) in your area and sign up to
receive payer listserv updates.

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Doctors of optometry and their staff need to be prepared for substantial changes in 2021 to optometry
coding and documentation for evaluation and management (E/M) services. Starting Jan. 1, 2021, E/M codes
will need to be selected based on what is more appropriate: medical decision-making or total time, not a
patient’s history and physical.
Use an ABN for Non-Covered Services
If you are unsure that the procedure or service you will provide to the patient may not be covered by
commercial non-Medicare plans or original Medicare and the patient may be responsible for out-of-pocket
costs, get an Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. In this case, the patient
must sign the ABN before you provide the procedure or service to the patient.
Do you have a lot of paperwork burden? Keeping up to date with confusing and never-ending optometry and
ophthalmology billing rules and regulations, payer requirements and complicated EDI processes, and
managing denials and rejections is time-consuming.
Ready to outsource to a leading medical billing company?

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Improve Optometry Medical Billing Collections
You will see increased ROI when you outsource eye care billing to Medical Billers and Coders (MBC). We will
help you to get started. Reach out to us today, we are just one form submission away.