Part 1
Start with your practice's website.

Your website is possibly the first part of your practice that many patients experience. We highly encourage that you remove any barriers to entry if you're looking to expand your patient base to the seniors of your community, and that begins with an accessible website that patients can use to schedule appointments.

The following video from EyeCarePro shows several steps you can take to make your website ADA compliant like adding image descriptions, alt text, high contrast imagery, and responsive modules. There are plenty of simple apps you can use to test color contrast for accessibility. The one mentioned in this video is Color Contrast Checker.

1. Not pulling benefits early

Unfortunately, one of the downsides of running a busy optometric practice is that the task of pulling patient benefits usually doesn’t happen until the patient is already in the practice for their appointment. Starting the process earlier and pulling patient benefits a few days before the appointment will give you enough time to contact the patient to confirm information and provide the OD with a full scope of coverage. Pulling patient benefits earlier can help you reduce rejections from inaccurate information, coverage termination, or the payer not supporting the frequency of service.

2. Understanding primary insurance with Medicare

For starters, it's not a cut and dry process to determine which insurance is primary, especially when Medicare is involved. Half the time patients don't recognize Medicare as insurance, or understand that it is applicable to their optometrist visits. There are four choices: Medicare, Replacement, Supplement, and Secondary. If a patient has a Non-Medicare insurance card but has "Medicare" printed on it, that card is likely going to be a replacement or supplemental policy. Supplements typically pay what Medicare approves but doesn't actually pay, such as deductibles and co-insurance. A tell-tale sign that it's a supplement is that the card will usually list a "plan" on the card, most common being Plan F. The plan is the supplement, which makes Medicare the primary.

Someone that presents you with a card that mentions names like Medicare Advantage, Secure Horizons, or Medicare Gold is providing you with a replacement. It's replacing Medicare and that makes it primary. Your tipoff that you're working with a replacement plan is the mention of co-pays or deductibles. Lastly, if the card looks like any other insurance cards, meaning there's no mention of Medicare anywhere on it and it doesn't have a cryptic name that insinuates the patient is older (like Secure Horizons), then it's probably secondary to Medicare. That means it has its own set of benefits that aren't developed in relation to Medicare. Often those cards don't pay for copay and co-insurance.

3. Letting claim denials get you down

Experiencing denied claims requires you to examine your claim performance through metrics and reports to see why you're being denied and how you can better optimize your management efforts. Especially if you are seeing the same mistake multiple times, it's good to figure out if it's an error with your claim submissions, the biller, or a case-by-case situation. The most common reasons that claims get denied are lack of insurance, late filing, duplication submissions, the payer doesn't cover the service, bundled payment, termination of coverage, or the payer doesn't support the frequency of service. If you're experiencing these reasons for denial, you can learn why, fix them, and your practice will become more resilient.

4. Utilizing Advance Beneficiary Notice of non-coverage 

Practices should attempt to bill the patient three times before writing off a bill. Leaving an Advance Beneficiary Notice (ABN) of non-coverage as part of the front desk paperwork will ensure that patients know they are responsible for any remaining charges. You also want to collect full payment when the patients are still in your practice. Once they leave, your chances of collecting payment drastically decreases. But, if some patients do walk out of your office without making full payment, paying attention to your reporting can help you keep track of balances that are still outstanding. A few reports that are important for keeping track of outstanding claims are your accepted claims report, ERA report, aging report, and accounts receivable.

Healthy Eyes Advantage is the next-generation marketplace for independent ECPs, delivering the most competitive vendor pricing and unique benefits to more than 10,000 independent eye care professionals nationwide. Williams Group Consulting is the eye care industry’s premier consulting firm, delivering innovative, relationship-based consulting, practice transition consulting, and accounting/payroll processing, to thousands of clients across the U.S. and Canada.