Optometry Insurance Claim Filing Game of True or False

When's the last time you brushed up on or evaluated some of the processes in your office? If it's been a while, it's probably time to make sure your electronic claim filing process is running as efficiently as it could be.

Electronic claim filing may be one of the most confusing tasks of running an eyecare practice, and because of that it also might be the most neglected. We've got a quick game of true or false to help you determine if you're getting it right at your office.

True or False? Electronic Claim Filing Edition

True or False? An OD doesn't need to get involved in claim filing, that's the biller's job.iStock-1314752834

False. We know that it's good to delegate tasks to different team members, and everyone has a job to do. But being too removed from the claim filing process can be risky. At the end of the day, it's all about making a profit for your practice and claims equal money. When it's all said and done, providers are responsible for the claims, not the biller.

What would happen in your practice if your biller quit and you couldn't fill the position right away? That may sound a little far-fetched, but would your practice be able to handle operating costs without claim reimbursements coming in? If the answer is no then it's important that you understand the basics behind your claim filing processes.

True or False? A clearinghouse is a waste of money since payers have their own sites.

False. It's not exactly apples to apples to compare payer sites to a clearinghouse. It would be similar to saying that there is no reason to have electricity in your house when you've got candles.

Going to various payer sites to file your claims means that you're taking the time to learn multiple systems and keeping up with the know-how of navigating each of them. With a clearinghouse, you've got a one-stop-shop to manage them all.

A good clearinghouse is affordable and can offer you and your practice a ton of value. These are just some of the benefits you get when you use a clearinghouse:

  • Thousands of payers in one location
  • Patient eligibility verification
  • Claim submission and tracking
  • Secondary claim processing
  • Detailed reporting and analytics
  • Claim uploading from practice management systems
  • Electronic remittance advice (ERA)
  • ERA auto-posting incompatible practice management systems
  • Patient Responsibility Estimates

True or False? The Internet is awesome.

True. The Internet has the ability to make a lot of day-to-day tasks in your office easier. You can access the Internet from a variety of devices, and you can restrict access and customize security settings. And you shouldn't be scared of online claim filing.

Now can you rest at night knowing that your clearinghouse is safe? Clearinghouses have the same compliance responsibilities as the payers. Information that is entered and processed is secure, and you can customize your account settings so that your staff only has access to the info that they need. And the same goes for Internet access in your practice. You can make sure only certain sites are accessible from your office computers.


Are you interested in learning about what happens to outsourced claims? View the infographic below:

See the Lifecycle of a claim 

 

Editor's Note: This post was originally published on Jan. 2, 2014. It has been updated for relevance and richness of content on May 24, 2021.
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