Aiming for Clean claims in Optometry? Know how!

1
(No Transcript)
2
Aiming for Clean claims in Optometry? Know how!

• It is important for practices, including
  Optometry, to ensure the submission of clean
  claims for capturing and increasing timely
  revenues by identifying the causes for
  non-payment. It is essential that the staff is
  well-trained and possesses thorough knowledge of
  the billing and coding procedures of the
  Optometry practice.
•  
• According to hmsa.com, A clean claim is defined
  as a claim that has no defect or impropriety
  (including any lack of any required
  substantiating documentation) or particular
  circumstance requiring special treatment that
  prevents timely payment from being made on the
  claim. 
•  
• Submission of clean claims is crucial for the
  avoidance of denials and rejections. Repeatedly,
  coding errors, omissions or incorrect
  information, and/or lack of verification lead to
  rejected or delayed payments. The entire claim
  settlement process is of submitting the claim,
  sorting data, and finally rendering the payment.
• A few steps to clean claims processing are
• Data
• One of the major steps is filling out the form
  CMS-1500 accurately and completely before
  submitting it to the claims processing system.

3
Aiming for Clean claims in Optometry? Know how!
Provide the correct ID numbers, patient and
policy information, location of services,
diagnosis codes, CPT and ICD codes, apt
modifiers, create Local Coverage Determination
linked to coding congruence, create National
Correct Coding Initiative (NCCI) edits guidelines
for apt modifiers, and send it to the correct
insurer.   2. Technology For higher accuracy,
claims should be filed electronically. This is
also useful for contracting, payment of claims,
and benefit quoting. Avoid paper filing and look
towards receiving reimbursements by signing up
for Electronic Funds Transfer. 3. Avoid
Duplicate claims It is important to be aware of
services that are bundled into a single package
as this can help avoid duplicate claims. Be
patient before filing a secondary claim. 4.
Deadlines
4
Aiming for Clean claims in Optometry? Know how!
To avoid definite rejections, submit the claims
for reimbursements within the stipulated time. If
extra information is required, it too should be
submitted within the given time frame. Also, keep
a buffer between the filing of claims and
deadlines to preserve time for eliminating
errors. In case of denials, try resubmitting the
claims within 3 days or ask for a response time
of a maximum one week. 5. Verification Verify
the patient entitlement and benefits with the
insurance provider at least two days preceding
the date of service. This should include policy
dates, primary/secondary/tertiary insurance,
medical coverage, in/out of network benefits,
copays and deductibles, and procedure
verification with regards to authorization and
insurance coverage. 6. Documentation It is
imperative to maintain a copy of all records
(procedures, services, medication) for processing
claims. 7. Understand the system
5
Aiming for Clean claims in Optometry? Know how!
Another best practice is to entirely understand
CMS and insurance providers rules. Continuously
monitor and analyze the denials and underpayments
of failed claims and comprehend the vulnerable
areas. It is ideal to keep the claim percentage
high for running a profitable optometry practice
which comes from getting paid at the first
submission. Ensure common goals and develop plans
to resolve any fundamental issues.   To know more
about our Optometry billing and coding services,
contact us at info_at_medicalbillersandcoders.com/888
-357-3226.