6 Billing and Coding Tips from Our RCM Team

Although there are plenty of resources on the internet to help manage your practice, we find that billing advice specific to optometry insurance claims can be lacking. We always prefer to go straight to the experts when it comes to providing revenue management and claim filing advice for ODs. That's why we started the Ask Shane Anything video series and the Ask an Expert webinar series. 

This time, we interviewed the expert team that helps our revenue cycle management customers submit claims in a timely fashion to speed up their cash flow. With all the recent changes in Medicare and the rise of medical billing in general, we knew that a few inside tips on medical claims would be useful for our readers. See how you can grow the medical side of your practice below:

How Our RCM Team Tackles Medical Claims

If you're currently working on your billing in-house, these tips might clarify a few new rules or help you work any denied or rejected claims. If you're still on the fence about diving into medical claims, we encourage you to reach out to us for any advice.
  1. Does the patient have Medicare part B or do they have a Medicare Advantage plan? When verifying Medicare eligibility, if the patient has an advantage plan, Medicare will provide the plan name. These claims do not get submitted to Medicare at all.
  2. Medicare deductibles restart every January. The part B deductible increased by $30 dollars this year to $233.00
  3. Patients must meet their deductible before the 20% coinsurance begins.
  4. Medicare supplemental insurances (Medigap plans) may not cover the patient’s deductible.
  5. Routine vision exams and refractions are not a covered service by Medicare and should be charged to the patient on the date of service. The patient must have a medical diagnosis to bill the exam to Medicare.
  6. For testing, each Medicare MAC has their own local coverage determination that provides the medically necessary and payable diagnosis codes for services. It’s important to make sure the procedure is considered medically necessary by Medicare based on the diagnosis.

If your practice is growing rapidly and you're finding yourself in need of expert help, consider outsourcing your billing to our team. 

If you're interested in learning more about how RCM fits into your practice, schedule a consultation with our team.

Request Your RCM Consultation

Editor's note: This blog was originally published January 2022 and updated March 2023.


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