5 Billing Issues That Affect Revenue For Your Optometry PPT
                     
5 BILLING ISSUES THAT AFFECT 
REVENUE FOR YOUR 
OPTOMETRY
HEALTHCARE OFFICES AND PRACTICES ARE OFTEN OVERLOADED WITH WORK 
AND MANY COMMON MISTAKES CAN EASILY HAPPEN HERE. TO REDUCE THESE, 
MEDICAL BILLING COMES IN HANDY. THE CODING SHOULD BE DONE BY THE 
OPTOMETRIST AS HE IS THE ONE WHO IS WELL-EDUCATED ABOUT THE ETHICAL 
CODING PROCEDURES. HE IS RESPONSIBLE FOR ENSURING THE USAGE OF 
CORRECT OFFICE VISIT CODES AND THE CLAIMS TO BE CORRECTLY CODED. IN 
OPTOMETRY, THERE ARE AROUND 16 WAYS TO CODE EYE EXAMINATIONS EXCEPT 
FOR CONSULTATION VISITS.
BUT BILLING IS BEST HANDLED BY STAFF OR OUTSOURCED PEOPLE WHO ARE 
TRAINED, BILLING SPECIALISTS IN OPTOMETRY. HOWEVER, THERE STILL CAN 
BE BILLING ISSUES THAT CAN HAMPER YOUR REVENUE AND CAN INVITE 
UNFORTUNATE RESULTS LIKE A DENIED CLAIM OR AN AUDIT. BELOW ARE THE 
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MEDICAL VS. ROUTINE
UNDERSTAND THE DIFFERENCE BETWEEN ROUTINE AND MEDICAL EXAMS WELL 
TO ENSURE YOU GET THE FULL REIMBURSEMENT FOR YOUR SERVICES. THE 
CHIEF COMPLAINT AND DIAGNOSIS CAN HELP YOU IN THAT. IT WILL MOST LIKELY 
BE BILLED AS A MEDICAL EXAM IF THE PRIMARY DIAGNOSIS IS MEDICAL BUT 
ADDRESSES THE CHIEF COMPLAINT. ALSO, REMEMBER TO NEVER ASSUME THAT 
A BLURRY VISION MEANS A REFRACTIVE ISSUE, AS IT CAN BE THE REASON FOR 
AN UNDERLYING MEDICAL CONDITION THAT MAY RESULT IN A MEDICAL EXAM.
INVALID/INCORRECT MODIFIERS USAGE
MODIFIERS HELP IN DESCRIBING A SERVICE ACCURATELY BUT CAN ALSO LEAD 
TO DENIED MEDICAL CLAIMS IF USED INCORRECTLY. THERE ARE AROUND 17 
MODIFIERS IN OPTOMETRY BUT BELOW ARE SOME FREQUENTLY USED FOR EYE 
EXAMS.
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DUPLICATE/INCORRECT BILLING
THIS HAPPENS WHEN A PARTICULAR PATIENT IS BILLED DOUBLE OR MORE FOR 
THE SAME TREATMENT OR TEST. THE OPERATOR SHOULD BE CAREFUL ENOUGH 
ABOUT WHETHER THE PATIENT HAD ALREADY PAID OR NOT. THIS ISSUE WILL 
INCREASE ADMINISTRATIVE WORK AND WILL BE A PAIN FOR THE PAYER TOO. IT 
MAY ALSO LOOK LIKE THE PATIENT HAS AVAILED MULTIPLE SERVICES ON THAT 
DAY.
• UNBUNDLING
A FEW MEDICAL BILLING CODES ARE SPECIFICALLY DESIGNED TO BE USED 
FOR A GROUP OF PROCEDURES THAT ARE FREQUENTLY CARRIED OUT 
TOGETHER. UNBUNDLING IS AN ILLEGAL PRACTICE WHEN THESE SERVICES ARE 
BILLED UNDER SEPARATE CODES. THIS CAN CAUSE HARSH CONSEQUENCES AS 
IT CAN INCREASE THE PROFITS FOR THE CENTER.
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Upcoding and Undercoding
UP CODING CAN HAPPEN WHEN A MODERATE (IN TERMS OF TREATMENT AND MONEY) 
DIAGNOSIS IS UPGRADED TO A MORE SERIOUS AND EXPENSIVE TREATMENT. IT CAN ALSO 
HAPPEN WHEN A PATIENT IS CHARGED FOR A SERVICE THAT WAS COVERED 
UNDER MEDICARE, INSTEAD OF AN ADMINISTERED SERVICE. BOTH THESE SITUATIONS 
CAN DEMAND HIGH PAYMENTS THAN WHAT YOU SHOULD RECEIVE.
UNDER CODING IS WHEN A PROVIDER ENTERS A BILLING CODE FOR A LESS EXPENSIVE 
PROCEDURE TO AVOID AN AUDIT OR TO HELP A CUSTOMER SAVE HIS MONEY.
LAST BUT NOT THE LEAST, REMEMBER TO FOLLOW UP ON YOUR DENIED CLAIMS AND 
NOT CONFUSE THEM WITH REJECTED CLAIMS. ANY OPTOMETRIST MUST LEARN 
ETHICAL BILLING AND CODING PROCEDURES AND ADHERE TO THE OPTOMETRY 
CODING GUIDELINES THAT CHANGE EACH YEAR.
ONE BEST OPTION TO KEEP PROPER TRACK IS TO OUTSOURCE OPTOMETRY BILLING
 TASKS TO SOMEONE.
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About 24/7 Medical Billing Services
24/7 Medical Billing Services is the nation’s 
leading medical billing service provider catering services to more than 43 
specialties across the entire 50 states. You can rely on us for end-to-end 
revenue cycle management. We guarantee up to 10-20% increase in the 
revenue with cost reduction of your practice for up to 50%. 
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CALL US TODAY :
Media Contact – 
24/7 Medical Billing Services,
28405 Osborn Road,
 Cleveland, OH, 44140
Tel: + 1 -888-502-0537
Email: [email protected]
Website: https://www.247medicalbillingservices.com/
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