Of all the fields in medical billing, optometry is generally found to be the most underrated. It’s here in this field, that regulation on who covers what part of vision services becomes fuzzy. Insurance companies apply some of the rules but are also allowed to march to the beat of their own drums in many ways. So optometrists look at this mess of a system from far away and say to themselves, “Nope, it’s not worth it. I’d rather just take $45 on a routine exam, refer them to an ophthalmologist for the medical stuff, and sell them on the glasses”. That’s what the optical business is, right, sale of glasses, contact lenses; “materials” as we refer to them.
Here’s what you figure out, after years of poking around the system and trying to make heads or tails of how to bill medical optometry; once you get the hang of it you come to realize one fundamental thing: Medical Optometry Billing pays more than upselling on glasses. Wait, what? That shouldn’t make sense. The optical industry is mostly sales, right…? Nope!
Let’s look at it a different way. Person came into your office for new glasses. This person already has preexisting glaucoma, and needs to be monitored regularly for cataracts. As an optometrist, you can choose to do one of two things:
Option A: screen the patient, issue a prescription for new lenses, sell him on a frame for a couple hundred dollars at best, and send the patient back to the ophthalmologist for regular screenings. The maximum reimbursement including patient and insurance payments equal approximately $300 annually, as most vision plans pay once a year at best. – this route depends heavily on materials sales and retail merchandizing and has a high patient turnover.
Option B: screen the patient, perform all required testing in-house, schedule 3 month follow-ups for monitoring AND sell the patient on the same frame. This amounts to in excess of $800 annually including patient and insurance payments. That’s at least more than double the amount in Option A, and the patient turnover becomes much less.
Clearly, Option B is the way to go. Only, there are some hidden contingencies and fees associated with this plan. First, and most importantly, you must must must understand the system. This doesn’t happen overnight. Without understanding the system, there is no way to navigate. Differentiating between who is supposed to pay for what is not simple, and needs to be thoroughly understood. Secondly, mistakes in this option cost money. Every deductible not collected, copay waived, denial not followed up on, costs money. It is absolutely necessary to have staff that is trained and competent in differentiating insurance applications and patient responsibilities.
This is the part where optical owners and optometrists get lost or scared off. Honestly, it takes forever to learn the system. Besides the fact that every time you think you have it down they change some rule on you and everything goes down the tubes for a while, there is the fear of staff turnover, retraining, etc. Not to mention the denials. Insurance denies a claim for a reason that sounds stupid (this is 90% of them). Most of the time, optometrists look at the denial, get curious, pick up the phone to call an insurance and hit a 40-minute waiting que. Then they subsequently hang up, forget about it, and by the time they remember the appeals window has closed. Bye-bye revenue. That’s all on top of the numerous clerical denials that are bound to happen in this oh so technical industry which result in losses of massive sums of money. Basically, learning by trial and error is not optimal on any level, and in some cases can lead to business ruin if the cost of maintaining the business is higher than whatever is being billed out.
This is a field that requires professionals. Staff who have been trained in understanding differences between vision plans and medical plans as well as patient responsibilities. Optometrists who are able to understand and differentiate what is covered by which policies. Billers who are dedicated to correctly coding, submitting, and collecting on each and every claim.
It is here that Infinite Medical Billing is able to give optometrists the upper hand. We know the contracting, so we do that for you. Tell you which insurances you accept, as well as what they cover. We remotely merge with your EHR systems so we can work around you without interrupting your office’s system. This is all besides the many manuals, guidebooks, and training information we have available for your use. There is no guesswork when you outsource to Infinite Medical Billing. It’s our goal to apply our proven systems and expertise to assist in the growth and success of our clients. With us by your side, you’ll have no reason to fear the dark unknown that is medical optometry billing.