Addressing Common Billing Errors in Ophthalmology and How to Prevent Them
As in any medical field, ophthalmology billing can be complex and challenging. Certain common billing errors come up again and again, leading to insurance claim denials. These billing and coding problems ultimately cause lost revenue, which affects your practice’s ability to operate at its best, meet regulatory requirements, and provide the highest levels of patient eye care. Efficient, detailed and effective billing is therefore a financial and operational necessity.
Most Common Billing Errors in Ophthalmology
Being able to identify the most common billing errors is a key step in preventing and correcting them. Let’s look at some of the most frequent mistakes that many ophthalmologists may accidentally make, and how to avoid them.
- Not Verifying Insurance Coverage: Failure to check and verify a patient’s insurance coverage before providing eye care treatment can lead to claims denials or a lower level of reimbursements. To avoid this, you should have a system in place to check and verify patient eligibility before they even make their first appointment so that your staff have a clear picture of what their policy covers.
- Wrong or Incomplete Patient Information: It may seem like a simple mistake but having incorrect or missing information about your patient can lead to refusals or returns, plus delays in reimbursement. Your billing staff should implement a detailed information capture process from the first patient visit so that all data is accurate.
- Using Incorrect Codes: Medical coding is no doubt a challenging area of your business as it requires extreme precision with little room for error. This can be rectified by ensuring your staff receive regular training on correct coding and that they stay up to date with any changes. You may also want to hire a third party to conduct an audit to identify which coding areas are giving your staff problems, or outsource your coding and billing to a company like Eye Care Billing Consultants.
- Inadequate documentation: Billing is complex and attention to detail is key. If you are missing documentation for an eye code, the claim may be denied. Regardless of which code is used, the documentation must be detailed enough to support the diagnosis and treatment.
Understanding Common Ophthalmology Coding Errors
Proper coding is a huge part of accurate and successful billing; in fact these two areas go hand in hand so it’s also important to know what the most common coding errors are in order to improve your overall billing process.
Here are some of the most common coding mistakes that lead to billing problems and claims denials:
- Unverified medical necessity, where there is no clear documentation about whether or not a procedure was required by a doctor
- Incorrect modifiers, which are not applicable to a service or a procedure
- Unbundled codes, where separate bills for a procedure are created instead of using one comprehensive code
- Generic coding, which does not capture specific components of treatment
- Improper Use of Evaluation and Management (E/M) codes which fail to properly document patient encounters
Ophthalmologists can benefit from undertaking either an internal audit or an audit carried out by an external third party to determine exactly where you are facing problems in your billing process. By identifying which areas are suffering, you can take steps to make improvements, like providing more training to your staff, or by outsourcing your medical billing to a billing consultant that specializes in ophthalmology coding and billing.
If you’re not sure how to identify problems in your billing, reach out to Eye Care Billing Consultants to find out how we can streamline your process and help you improve your revenue cycle management so you get paid for your services provided.
