myoptometrybilling-blog

[myoptometrybilling-blog]

Following would be the Optometry billing and coding mistakes that affect reimbursement

A Duplicate Claim - If a filed claim is an exact duplicate of a preceding claim which was submitted, they will be denied on the grounds of being replicate.  This could happen because the claim could have been formerly processed but it was not compensated for some reason CPT j CODE.  

Billing for Non-Covered Services - Optometrists need to be more careful about billing for the appropriate services.  In a case where an excluded Medicare service like changing and fitting of eyeglasses or contact lenses despite no harm to the eye, it cannot be billed.

Medical Necessity not based - If the payer does not observe the process or diagnosis as a medical condition, and then the claim can be denied.

Incorrect Bundling of Services- This reveals a lack of consciousness of NCCI which modulates the appropriateness of these tests being administered around precisely the same date.

Ineligible Beneficiary - A claim that is filed for the beneficiary who may not have the Medicare eligibility.  The reason for your ineligibility could change from Medicare's number being invalid to the beneficiary not being qualified to receive this benefit.

Submission of Payment to Incorrect Carrier - If the claim is filed to an incorrect lien the claim gets denied.  For instance, one Has to Be cautious about that if medical eye care services have been provided then the medical claim has to be filed to the medical carrier

Medicare turns out to become a Secondary Payer - By the method of co-ordination of advantages; a different payer might provide care for a Medicare patient.  Thus be methodical with your knowledge of those payers.

Incorrect Diagnosis - When a main listed diagnosis is not covered when the professional services can be denied for the processes that have been performed.

Ambiguity at Modifier - The modifier is necessary to finish the claim, at a scenario where the modifier is missing, incomplete or invalid, the claim gets denied.

Coding and Billing are seemingly complex however keeping a tab on present and published policies that are easily available will ensure a high degree of success within the practice.  Preventing these high mistakes can take the optometry revenue cycle management and move towards greater profitability.