Every office differs when it comes to the staff and the optometrist roles in coding, but rest assured it is a team effort to efficiently and accurately bill and code. Covered below are the typical key responsibilities of staff involved in billing and coding, and how to optimize their contributions to the practice.
Patient Intake
The patient care coordinator, or the employee responsible for checking in the patient must acquire correct patient information, including name, birthdate, address, and insurance information, to ensure the claim will go through to the payor. This is a common area of mistakes in billing and coding.
Coding Correctly
Understanding as well as applying the correct codes for exams, procedures, and treatments are essential to making sure claims are processed smoothly. The codes the billing staff should know:
- Current Procedural Terminology (CPT) codes for services rendered.
- International Classification of Diseases (ICD) codes for diagnoses.
- Healthcare Common Procedure Coding System (HCPCS) codes for supplies and products, such as contact lenses or eyeglasses.
Claim Submission and Follow-Up
Billing staff are responsible for submitting claims in a timely manner (usually within the business week), monitoring the status of submitted claims, addressing denials, and resolving payment discrepancies. Additionally, they are expected to follow up on claims and run an aging report monthly to look at claims on a 30, 90, 120+ daytime frame.
Patient Communication
Explaining charges, verifying insurance coverage, and setting up payment plans also fall under the responsibilities of billing staff. Clear communication builds trust and ensures patients understand their financial responsibilities.
Compliance With Regulations
Billing staff must keep up-to-date with Medicare, Medicaid, and private insurance requirements to ensure compliance.
Documentation and Record Keeping
Keeping detailed and accurate records to provide an audit defense is paramount for billing staff. This includes verifying that the optometrist’s documentation matches the codes billed.
Optimizing Their Role
Regular training on coding updates and insurance policy changes are essential for a billing staff to remain successful. The ways to accomplish this are to invest in their training, foster a positive work environment, and provide them with the right tools (eg, EHR). Regarding training, billing staff can receive certification through the American Academy of Professional Coders (aapc.com) or the American Health Information Management Association (ahima.org).
A Personal Anecdote
Errors in patient insurance information, coding, or delayed claim submission can lead to revenue loss or fines. One example that personally happened to me was my staff did not follow up on filing secondary insurances. This went on for 9 months, so you can only imagine the revenue lost. It is crucial the optometrist also be knowledgeable in the discussed areas, as they are ultimately the responsible party. OM
