Denials in Ophthalmology Billing and How to Minimize Denials

Denials in Ophthalmology Billing and How to Minimize Denials

You and your staff work hard to provide the best care to your patients. Nobody wants to see that their claim has been denied, as it leads to valuable time and energy spent reviewing patient files, double-checking entries, contacting patients, finding errors, and refiling claims. Some claim denials can go on for so long that deadlines get missed, which means your practice doesn’t earn what it should, and your potential revenue is lost.

Ophthalmology billing is complex, and simple mistakes can lead to claims denials. So why do claims get denied? Here are some of the most common problems that can cause claims to be denied:

• • Insurance Eligibility:

    This is one of the most common reasons for claim denials. Your staff needs to always verify that patients are eligible for the treatment they would like to receive and what is the maximum benefit.

  • Missing Information:

    Incorrect or missing data is an area that is easily preventable if a practice adopts an automated billing system that prevents patient files from being submitted incomplete, including checking for names, dates, addresses, and insurance provider information.

  • Coding errors:

    Coding is a complex field, and medical codes and modifiers often get updated or changed. Coding needs to be absolutely accurate to be successful, which means also being aware of any updates. It can be challenging for your staff to stay abreast of coding changes.

  • Lack of Authorizations:
    
    Claims can be denied if they are not considered medically necessary or if they require referrals and/or prior authorization. Your staff will need to be trained to always check for referrals or authorizations so that patients receive the correct care and so that their claims will be successful.
• Missed Deadlines:
  
  Again, this is an area that is entirely preventable with the right software systems. Different insurance providers have different deadlines, and late submissions will usually be denied.

No medical practice is perfect. Mistakes will slip through the cracks. However, most practices aim to have a denial rate of 5% or less. If your denial rate is higher than 5%, your medical billing systems may need a review.

How to Minimize Denials

To help your practice reduce rejections, here are some steps you can take:

• Pinpoint where exactly the denials are happening and why
• Review your data collection systems and claim processing systems
• Train staff on medical billing and coding best practices
• Automate your IT systems to avoid easily preventable errors

Eye Care Billing Consultants has one distinct goal: to help practices like yours streamline and automate their medical and coding billing tasks effectively so that claims are successful and your practice maximizes its revenue cycle management.

Our systems were designed to automate the process and facilitate maximum reimbursement. And our dedicated US-based teams work with you from start to finish. If your practice is struggling with claims denials, contact us to find out how Eye Care Billing Consultants can help ophthalmology practices like yours improve their billing systems.