Optometry Staff to Check Patients’ Benefit Plans Before Documentation

It is quite usual for a patient to visit an optometrist’s office with a thorough understanding of the insurance coverage he or she possesses. The optometrist’s staff should also understand and be good at reading the patient’s illnesses while comparing them with the various diagnosis codes. This helps them decide on whether to bill under vision insurance or medical insurance. However, in reality most of the staff employed at an optometrist’s do not realize the importance of checking the patient’s benefits plans before documentation.

This is primarily because most of them do not fully understand which plan is meant for what. Hence, more often than not they are at a loss as to advising the patient on what benefit plan he or she should be using. In such situations not only are the staff frustrated, they leave the poor patients frustrated as well. The staff need to understand:

To ensure errorless billing and coding, there needs to be at least one staff member in an optometrist’s office who thoroughly understands the various insurance plans that are acceptable, and how the documentation needs to be done.

In order to check this, the primary step will be to check for the eligibility verification of the patient.

It is better to call up the insurance company or access their website on the Internet to get to understand the particular plan better before documenting it.

Better still if the optometrist were to instruct the staff to have a binder handy, containing all the various insurance plans.

Before documenting a plan in the medical insurance verification of chief complaint and the diagnosis plan are essential.

It is also a good idea for the staff to inform the patient about his or her copay for the particular exam.

Similarly, when a problem is listed without the relevant plan, the healthcare staff may be able to understand the case and decide upon its severity. However, the auditors may give it a cursory glance and may not be able to understand it fully. Unless there is proper and complete documentation, the complexity of the case cannot be inferred at the time of review. Hence it is important to document an accurate and detailed description of the condition the patient suffers from and an appropriate plan for it. Any plan has to be clearly documented as it indicates the problems that were managed by the optometrist.

Some more points to remember:

Staff should realize that patients walking in with eye injuries, infections in the eye, cataract or any other eye ailment related to diabetes, these are covered by medical insurance

Vision Service Plan (VSP) offers full coverage for eye care or eye exam. If there is copay, the payment has to be done at the time of service.

Medicare also covers eye examination, though refraction is not covered.

Medicare also offers coverage for eyeglasses only for the first time after cataract surgery.

However, purchase of other eye care aids like contact lenses, eyeglass frames, coatings etc are not covered under Medicare.

Hence, it is important to have an understanding of the benefit plans of every patient that walks in, which will play an important role in ensuring a smooth revenue cycle management for Optometry billing.

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Salient Steps to Ensure Best Practices in Urgent Care Medical Coding

The ever-changing dynamics in the healthcare industry is surely having its impact on healthcare providers. One of the key things that the federal government is trying to ensure is complete secrecy of patient information & abolition of abuse & malpractices. It is true that key ingredients introduced by in the healthcare domain for identification of its billing system have its own merits during insurance claims submission.

Also, major changes induced in 1996, has been done primarily for the protection of patient information that is sensitive. Every practice in the American healthcare industry is skeptical about the new changes that are happening on a periodic basis.

The advent of ICD-10 in October 1st, 2015 has raised a lot of questions among the healthcare providers. They are now looking to revamp their processes in Urgent Care Medical Coding as well as other specialties that are more specific & comply with the standards set by WHO & CDC. Medical Coders of an Urgent Care center has to employ right methodology & eradicate any inconclusive efforts that will be detrimental to their billing priorities.

Also, it’s been observed that a facility in Urgent Care deals with a lot of diverse mode of treatment that needs to be incorporated in the right context during coding. Keeping a well-knit process in procedure & diagnosis codes is the need of the hour!

Hence, any provider who is looking to optimize their Urgent Care Medical Billing services needs to implement certain practices that are transparent & gives them an edge during their claims submission process. Modern healthcare is constantly evolving & insurance companies have set some fundamental guidelines that need to be minutely observed by every provider.

Urgent Care Centers also have to enable a transparent vision for their procedural strategy. Especially new changes are going to determine the coding patterns for procedures & will be an integral part of a provider’s reimbursement strategy. Also, having a comprehensive coding process for CPT dealing primarily with physician services has to be adhered in accordance with the changing dimensions in the AMA.

It is precisely for this reason today we find a lot of players in the outsourcing segment offering timely solutions to Urgent care centers as well as other practices in their revenue cycle management. They realize that medical coding is an integral part of billing & are offering their services that appears to be quite competitive. They look to apply certain aspects that essentially make the entire process of coding consistent.

Quality compliant coding: The key factor in coding is the management of sensitive information yet delivers the right form of treatment to help in the billing process. RCM companies look to employ a comprehensive ambiance where coders implement quality directives in the right perspective.

Stay well-informed: One of the key aspects to be a successful medical coder is self-learning & staying well updated about the changes that are happening in the coding world. CPC & CCS coders help these RCM companies with their skill-set eliminating loopholes in the provider’s process.

Eliminating down-coding & up-coding: Securing investments by both these methods can be catastrophic for a provider especially in the context of today’s robust processes that are automated. An insurance company in a short span of time will understand the fraud that will put an end to a practice’s functional activities. Prominent RCM companies have stringent processes in place that undermines such functions. At the end, a provider has to understand its core competencies & look to have a visionary mindset with coding that will help earn feasible return in the long run.

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Are You Aware of CMS Updates on Ambulance Services?

Several notable changes have been initiated under the Final 2016 Physician Fee Schedule Rule for ambulance services on November 16, 2016

Change in Bonus Payment Extensions

The Medicare ambulance fee schedule amounts for ground ambulance services, which was increased last in July 2008, has now been extended further until December 31 2017. Section 203 extends the provision increasing Ambulance Fee Schedule amounts by

2% for ground transports originating in urban areas
3% for ground transports originating in rural areas
22.6% for ground transports originating in an area that is within the lowest 25th percentile of all rural areas arrayed by population density, known as super-rural areas

All these three provisions will expire on December 31, 2017, unless Congress chooses to extend them beyond that date.

Change in Zip code affecting reimbursements

For ambulance fee schedule purpose, CMS brought in the ZIP code changes that went into effect on January 1, 2015. Geographic designations for approximately 95.22 percent of ZIP codes are however left unchanged

Why is this significant?

ZIP codes changes from urban to rural and rural to urban will have their impact on billing reimbursements especially for rural pickups

CMS increases the mileage rate by 50 percent for each of the first 17 miles and the rural bonus is 3%

More ZIP codes have changed from rural to urban (1,600 or 3.73 percent) than from urban to rural (451 or 1.05 percent)
The state of Ohio has the most ZIP codes that changed from urban to rural with a total of 54, or 3.63 percent of all ZIP codes in the state.
The state of West Virginia has the most ZIP codes that changed from rural to urban (149 or 15.92 percent of all ZIP codes in the state).

And for air ambulance services

Where the point of pick-up is in a rural area, the total payment (base rate and mileage rate) is increased by 50 percent.So, if a point of pickup (POP) ZIP code changed from rural to urban, an ambulance service receives less Medicare reimbursement (and vice-versa if a POP ZIP code changed from urban to rural).

Changes in Ambulance staffing regulations

All ambulance transports must be staffed by at least two people who must meet the requirements of applicable state and local laws where the services are being furnished, and the current Medicare requirements.

For Basic Life Support (BLS) vehicles, at least one of the staff members must be certified at a minimum as an emergency medical technician-basic (EMT-Basic).

Revision of the definition of BLS: Basic life support (BLS) means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffed by an individual who is qualified in accordance with State and local laws as an emergency medical technician-basic (EMT-Basic). These laws may vary from State to State. For example, only in some States is an EMT-Basic permitted to operate limited equipment on board the vehicle, assist more qualified personnel in performing assessments and interventions, and establish a peripheral intravenous (IV) line. This has now been deleted as CMS states that may not accurately reflect the status of the relevant state laws over time

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