5 Ophthalmology Billing Tips You Can’t Afford to Miss

You already know that getting claims paid is an important part of the financial health of your practice. Unpaid claims are a huge drain on your bottom line.

These easy tips will help ensure that your claims are paid quickly.

#1 Collect the CORRECT Insurance Information

It seems overly simple: incorrect insurance information means claims won’t get paid. But, the most common claim rejection is wrong insurance. It might be because a patient gives an outdated card or because a Medicare patient has signed their benefits to a Medicare Advantage plan (in this case, the billing should go to the selected plan).

So, what can you do?

Get a copy of the card — front and back. Make sure the insurance info is entered correctly into the practice management system. Double check that the doctor is in network with the patient’s insurance plan. And, make sure insurance carriers are set up in your system to send electronic claims

#2 Code Correctly and Document Medical Necessity

Claims must include the correct diagnosis codes and modifiers. Make sure the person preparing and submitting claims is well-versed and up-to-date in ophthalmology billing.

And don’t forget to document medical necessity within the chart. Insurance carriers are requesting medical records more often so it’s important that they are accurate and that the doctor has signed off on it.

#3 Submit Claims in a Timely Manner

Every insurance carrier has a timely filing period (which can vary from 90 days to 1 year). Make sure your practice staff is aware of these deadlines and is submitting well within the range. Claims billed after this period will be denied.

Submitting claims timely improves your cash flow and A/R. Additionally, patients get statements (showing any copays or deductibles owed) in a timely manner. Sending statements for old services to your patients can come as a surprise, even if they know they owe money (because they’ve received an EOB from their insurance). Keeping up with your claims submission process is a big win for your practice.

#4 Collect Patient Balances Up Front

The first and most important step is to inform the patient of your financial policy ahead of time or at the check in for the first appointment. All practices should have a financial policy that the patient signs before their appointment.

A best practice is to collect patient balances while the patient is in the office, if possible. This not only reduces costs in sending (time & supplies/postage) but also increases the likelihood that the statements will be paid. Sending patients statements does not guarantee they’re going to pay. So, you can see how collecting balances while the patient is in the office can really improve cash flow and A/R.

#5 Follow Up on A/R

This should be part of your daily routine. Even if you follow up on a few claims every day, this is a win for your practice.

Common errors for unpaid claims include modifier use and insurance carrier request for records. These are easy fixes, so don’t miss out on money earned by not following up.

And, it’s true, you’ll likely be put on hold when calling insurance companies. Take advantage of the time by multitasking (e.g. respond to emails or tasks from co-workers in your PM software).


Our team has more than 40 years of ophthalmology billing experience. Learn more about our results and contact us to discuss how we can help maximize your revenue.

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