Major reasons for Denials in Optometry

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Major reasons for Denials in Optometry
A key source of frustration and dwindling
revenues for physicians and healthcare providers
is the denial of claims. It is essential for
practices to identify the reasons, nail them to
avoid future non-payments, and determine
approaches that can work towards improving the
financial functioning of the practice. Below
mentioned are the reasons for denials in
optometry Duplicate claims A very common
error is that claims submitted are the exact
replica of some previously submitted claims. This
happens because sometimes the reimbursement has
not reached the healthcare provider within 30
days. It is important to first check with the
insurance payer before re-filing the claim as the
payments could be in process. Non-covered
service Especially in optometry, there are a
number of omissions. Services such as eye exams
only for the purpose of prescription,
fitting/changing of contact lenses/glasses in
case of no injury/disease, etc. are not covered
under Medicare. It is imperative to be aware of
such billing rules before filing claims.
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Major reasons for Denials in Optometry
Medical necessity In Optometry, some payers
deem various services a non-medical necessity
which needs no further treatment and hence does
not reimburse. A better practice is to check the
LCD (Local Coverage Determination) beforehand on
the carriers' website for a list of covered
diagnosis. Secondary payer The patient could
be having Medicare as the secondary payer due to
the reasons such as working/retirement/aged,
liability and no-fault/auto liability, workers
compensation, and/or veteran's affairs. For
better coordination and compensation, check with
the service provider department. Diagnosis Some
times, a primary diagnosis for an
illness/procedure performed could be treated as a
secondary or a non-covered diagnosis and hence
not covered under the insurance scheme. Check the
insurance payer's LCD policy. Yet again, a
diagnosis cannot be performed only because it is
covered. As a strict policy, it needs to be
proven, documented, and justified in the medical
record. Also, be vigilant of software that could
present details of a covered diagnosis for a
certain procedure which is essentially not
covered.
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Major reasons for Denials in Optometry
Missing information A missing/incomplete or
invalid modifier mentioned against a procedure on
the claim form could be a reason for denial.
Moreover, remember to enter the exact PIN
(Personal Identification Number) or the NPI
(National Provider Identifier) number. As a
medical billing professional, keeping oneself
updated for this complex service is extremely
important. For success, Optometry policies and
guidelines must be followed to ensure greater
profitability. Medical Billers and Coders
(MBC) is a leading medical billing company
providing complete revenue cycle services. To
know more about our Optometry billing and coding
services, contact us at info_at_medicalbillersandcode
rs.com/888-357-3226.