by Jessica Woodall
Running an optometric practice presents several challenges. Today, we are going to look more closely at some of the obstacles around coding and documentation, billing processes, and compliance. The most common challenges we uncover during a practice review are:
- Difficulty obtaining accurate medical insurance information during appointment scheduling
- Lack of expertise, or time, verifying insurance, understanding benefits, determining copays and deductibles, and identifying approved CPT codes
- Challenge collecting accurate payments at the time of service and minimizing the aging of medical insurance and vision plans that ensure steady cash flow
- Compliant documentation management to mitigate the risk of recoupment, implementing optimal documentation practices, and knowing the CPT code requirements to uphold professional standards and minimize potential liabilities
How Our Practice Review Helps Uncover Your Unique Challenges
The main goal of our practice review is to give owners more transparency into their revenue cycle management (RCM) processes, and to highlight the biggest areas of opportunity and any potential risks to the business.
In our practice review, we work remotely with your practice to evaluate a medical records sample, the RCM process, and Accounts Receivable (AR) workflow. In these three key areas we review and assess operations, credentialing, coding and documentation of the medical records, and reports relevant to daily operations. Included in your final review, you’ll get access to a detailed and comprehensive report of opportunities, risks, and recommendations.
Our chart review compares the chart documentation related to the codes selected and their requirements, as well as best medical record documentation practices. Unlike standard audits, our review provides feedback around compliance issues, coding improvement to enhance revenue, and coaching for best practices in documentation.
Examples of What Our Team of Experts Look For
- Is all medical insurance information and verification, including benefits, documented prior to the appointment?
- What percentage of fees are collected upfront vs. sitting in AR?
- Are all claims reviewed for errors before submission and submitted within 48 hours post-service?
- How quickly are rejected and denied claims corrected?
- Are patient accounts reconciled upon receipt of Explanation of Benefits (EOB)?
- Are EOB payments aligned with bank deposits?
- Are insurance aging reports reviewed at a minimum of bi-weekly? And, is appropriate action taken to correct and resubmit the claim or collect payment?
All of these items necessitate thorough training and accountability among staff members. Optometrists often do not receive adequate education in Evaluation and Management (E&M) code documentation, relying on a learn-as-you-go approach through various educational sources or other optometrists.
Common documentation errors, such as insufficient impressions of primary diagnoses having an error rate of 77% and inadequate interpretation/reporting of special testing having an error rate of 62%. Once you’ve received our practice review, which includes a thorough examination of medical records alongside an analysis of accounts receivable, EOB assessments for optimal reimbursement, and an evaluation of code usage, procedure utilization, and various other statistics, we’ll schedule call or video meeting with you to review our findings and address any questions you may have. We’re committed to collaborating with you to bridge any identified gaps, fostering a healthier and more financially sound practice.