Common claims denials and its solutions for your optometry practice

Common claims denials and its solutions for your optometry practice

If your in-house billing team isn’t fulfilling the duties related to claims management or re unable to suffice the billing management you can’t rely on them. However, today with options to outsource and partnering billing agencies, the income cycle of your practice can steadily move and grow.

Due to inefficiency and lack of knowledge towards optometry billing codes and modifiers, practices are closing down in many parts of the country. And before it reaches you, be ready with denial management solutions for your billing and prevent these types of denials in the future.

Duplicate Claim

Duplicates claims are probably the most common reason for denials in many optometry practices. They happen commonly when a biller finds unpaid claims in their system and assumes it’s not been processed. This causes the billers file the claim again, and the rising need of denial management in billing service.

How can you handle it – When you get an unpaid claim, investigate the claim first, rather than rushing to process a new claim. Check the reasons of rejections. Was it rejected from the clearinghouse? If you’re using clearinghouse use the resubmission future so that you can correct the claim electronically which most clearinghouses provide.

Bundled Payment Solutions

Sometimes, reimbursements can get bundled into another optometry procedure causing non-payment for the services you performed. A common denial happens when you file a claim for cataract surgery. If not documented properly by the surgery department both payments could get bundled into one for the ophthalmologist.

How can you handle it – Firstly, you could correct the denied claim the correct coding initiative. The procedure modifier will display that there was a separate procedure to bypass the rule and ensure that you are reimbursed for your services.

Submission deadline

One of the most common claim denial observed in optometry practice is late submission. Each payer will have a submission firm deadline for accepting and processing claims. This deadline varies according to payers anywhere between 90 days to one year from the day of providing the service. If you miss the deadline the claims get denied.

How can you handle it – Keep a very good eye rejected claims on a regular basis and follow up and fix them before any deadlines. As a business you should be on a consistent schedule of submitting claims and that too on a timely manner. Knowing claims filing deadlines will help you prioritize your reimbursements.

Billing errors can prove costly

Common billing errors can happen with everyone. A claim can also be denied because the service you billed is a service not deemed necessity by the insurance payer. Other reason could be not checking the eligibility and coverage limit.

How can you handle it – Billing errors though common but can be tricky. The best advice is to use your experience and expertise to do the right thing. Don’t let payers regulate what’s vital for each patient. Tem up with a professional optometry medical billing company and resolve the issue at first go. This will not only fasten the cash flow, but would significantly decrease the number of denied claims.

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