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Thread: Medical Optometry - Credentialing, Billing and Coding

  1. #1
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    Medical Optometry - Credentialing, Billing and Coding

    I'm a Therapeutic Optometrist in Texas and have no idea as to the best way to implement medical optometry in my practice.

    Can anyone recommend a book, website, or anything else to point me in a direction to get started?

    I notice there are some companies who provide these services but am wondering what I can find out on my own.

    Thanks for being patient with a noob who has a noobie question! :o

  2. #2
    Master OptiBoarder
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    Are you a member of your State Association? That would be the first place I look. I'm sure many of your colleagues had the same question when thay started therapeutics.

  3. #3
    OptiWizard
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    Check out odwire. There are some others in the same boat you are...

    Make sure to get on medical panels of the providers in the area. Review your exam forms to ensure that you have all areas covered for level of billing/coding...

  4. #4
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    Great Help!!!

    Dr. Nate,

    While on ODWire.org, locate Dr. Tom Miller. He wrote a great condensed book called "The Unoffical Guide to Medical Billing & Coding" that simplifies the subject very nicely.

    Also, if your not already an ODWire member, I highly recommend becoming one. It would be a good complement to this great Optiboard site.

  5. #5
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    Thanks everyone!

    I really appreciate the feedback.

    Thanks again.

  6. #6
    OptiBoard Apprentice
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    Nate start with the book mentioned above from Tom Miller, "The Unoffical Guide to Medical Billing & Coding", it is very practical.

    Feel free to ask any questions, or PM me if you want. I went through the same thing 4-5 years ago and would be more than willing to help.

  7. #7
    OptiBoardaholic
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    Primary Eyecare Network out of California ( primaryeye.net )has some excellent resources for you as far as billing and coding. Learn it, Live it and Love it. We use their forms for Exam, Supplemental tests, and superbill.

    Medical Optometry is an awesome thing, and will help you survive times like these when patients aren't buying spectacles as readily as they used to.

    Folks will always come in for Their Glaucoma, AMD and Diabetes checks. YOU will need to know a pretty good background of the billing side instead of relying on someone else to do it, like an office manager. If that manager leaves for some reason, then you will still have your knowledge.

    Good Luck!:)

  8. #8
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    Question Bump up / Folluw up

    OK, I'm bringing this one back and have a related question.

    I am attempting to hire an office manager who is skilled in medical coding and billing.

    Is it legal / ethical to offer commissions or bonuses based on medical services billed

    and collected?

    What type of bonus or commissions are other O.D's finding useful for capturing a very

    desirable employee?

  9. #9
    Banned
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    I have known OMD's who had an outside service for this that translated all thier billing to insuranceese, stayed on the back of third parties until bill collected and were charged 10% of whatever was collected. As to in-house employee you can probably do whatever you want or can get them to agree to. Besides what has ethics got to do with the optical trade anymore? In this particular case I can't see where ethics is involved (assuming all the billing is for services actually preformed and of some benefit to the patient) who cares what or how you pay your employees except you and the employee. Now if you have a person that would include services not preformed or of no benefit to the patient to increase thier commissions, this would be another matter entirely, but of legal not ethical concern.

    Chip

  10. #10
    OptiBoard Apprentice
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    Thanks Chip! :bbg:

  11. #11
    OptiBoardaholic
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    Nate,

    I would say a bonus/comm. based on performance would be no problem. I would think this would take into consideration the write off from the insurance carriers as well. Billing is a PIA, but it is essentially easy for us, because we only use a small percentage of the actual codes out there. Compare that to an ENT or even a Primary Care Doc, and you can see we have it much easier. Diligence after we see the patient is the biggest challenge.

    Lots of luck!

  12. #12
    OptiBoardaholic
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    Vision West the buying group has a supplier who actually does this for you!
    http://www.vweye.com/
    Products: Medical Credentialing
    (Insurance Paneling)
    What makes them special: Credentialing Specialists of America (CSOA) has over 15 years in the health care industry. CSOA's goal is to increase your medical practice productivity and profitability.
    They offer:
    Complete Medical/Optometric Credentialing (Insurance Paneling)
    Provider Enrollment and Re-Credentialing
    Medicare, Medicaid and NPI Enrollment and much more!
    CSOA has access to all insurance panels/carriers in the USA and most credentialing completed within a 30-90 day period!
    Vision West Members receive 50% discount on credentialing services!
    For More Information contact our dedicated CSOA/Vision West representative Veronica at 1.832.428.2963 and visit www.csoamerica.com to learn more about CSOA, or download the eStuffer, including (FAQ) Frequently Asked Questions INFORMATION PDF HERE.

  13. #13
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    Thnak you Opticalcathy. Credentialing Services of America has been an incredible resource for our members. Even though you can do it yourself, if you don't have the time they are the way to go. You can even renegotiate your rates through them and as Cathy says they have been doing this for over 15 years in all areas of the medical community, including optometry, and have access to any panel you want to be a part of. The cost to members is $150 per insurance panel.

  14. #14
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    Thumbs up Thanks everyone!

    I appreciate all the great feedback.

  15. #15
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    Nate,

    Bonusing your insurance person is legit, but instead of giving a percentage of collections (which may end up being a bit of a calculation nightmare), I would consider giving her a monthly bonus of a certain set amount instead ($100 maybe?).

    But I see a potential problem here. There's no incentive to collect it all...just a percentage of what is collected.

    Instead, I would consider paying her a bonus if she keeps the accounts receivables below a certain minimum.

    You may have heard of an optometric benchmark stating that your accounts receivables should be equal to one-months gross sales.

    That’s insane!!!

    My benchmark is to never, ever allow anything to roll into the 90-120 day category.

    Most insurance companies pay within 30 days, and if not, she needs to contact the insurance company right away to find out why it wasn't paid. Chances are she forgot to 'dot an I or cross a T', but that claim needs to be resubmitted right away.

    If it rolls into the 60-90 day category, action should already be in place and the claim should be paid within that time period. Point blank!

    Here's the value of each dollar that rolls into your aged accounts receivables;

    0-30 days = $1.00
    30-60 days = $.80
    60-90 days = $.50
    90-120 days = $.30
    120 days > = $.10

    I feel it's important to set up a monthly meeting with your insurance person to go over your aged accounts receivables report to help keep her 'at task'. This will also keep her motivated to collect as much as she can up-front.

    Now that $100 monthly bonus sounds pretty good, doesn't it?

    In the spirit of improvement,

    Tom

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