Opthalmology/Optometry Billing
(Research Report)
Some Facts:
- 3rd Largest Independent Professional in US Healthcare.
- Different from Normal Billing Services.
- Separate billing staff required which should not be involved in normal billing.
- Coding & Billing guidelines change.
- Insurance guidelines change.
- Medicare has different guidelines.
- Easy practice than normal billing.
- Mostly done In-House, small amount of billing services are doing in India.
- Claims easy to process.
- Limited use of modifiers.
- Tough Insurance guidelines.
- Different service plans. (VSP – Vision Service Plan etc.)
Questions:
- Total Number of Providers?
- Total collected amount per year?
- What are the main insurances covered under the practice?
- Is there any given fee structures or we should follow medicare fee structure?
- Do you use Local Codes (National Codes: eg 0187T) or only standard codes i.e. CPT Codes?
- What are the Eye Services provided in the Practice? (eg: Laser Procedures, Keratoplasty, iridotomy, intraocular Lenses etc)
Services:
1. Virtual Front Desk
a. Appointment Scheduling
b. Online Eligibility Verification
2. Medical Billing Services
a. Medical Coding
b. Medical Billing
c. Charge Capturing
d. Claims Submission
3. Payment Posting
a. Payment Posting
b. Review payments
c. Follow-ups
d. A/R Receivables
4. Denial Management Services (If needed seperately can charge minimum 20% and maximum 30% depends on volume)
a. Insurance Follow-ups
b. Patient Follow-ups (If instructed by the provider)
c. Appeals
d. Aging billing
5. Provider Credentialing/Re-Credentialing
Competitive Pricing Structures:
There are many companies providing the services in different way.
· %age on total collectable amount.
o In-house billing charge minimum 10%, in India rates are vary but these services mostly be done in In-house billing.
Per Transaction Models
· Model 1
o Less start-up fees.
o Low price per month per provider.
o $2-/+ per claim
o Service include only filing of claims to the insurances.
§ Medical Coding
§ Medical Billing
§ Claims Submission
· Model 2
o Less start-up fees.
o $175 per month per provider.
o $2.50 per primary claim submission
o $1.50 per secondary claim submission
o Services Include
§ Providing Fee schedules updates insurance to insurance.
§ Medical Billing
§ Collections
§ Denial Management Services
§ Appealing Problem Claims
§ A/R Services
§ Monthly reporting system
Leave your comments for more information with your email or directly email at help@healthinformatrix.com
Thank you for your time.
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