Is accounts receivable (AR) the most important metric?
I believe that over-30 AR is likely the most powerful metric to follow but only if you are also watching your write-off reports. Excessive write-offs can make anyone’s AR look perfect.
We use the CMS client services and have had no issues with payment.
That is pretty amazing. An accepted medical reimbursement authority did a pilot study on the accuracy of information provided on the CMS client service department. Over 60 days, they found the information provided to be accurate less than 10% of the time. I would not rely on provider help desks…ever.
We use a billing service out of India, and it seems to work great. Are you against them?
In general, most complaints and failed relationships with billing services are those in foreign countries. Poor communication and lack of follow-up on unpaid claims are common issues.
Do you trust blogs?
Information provided by individuals without credentials who are predominantly focused on ways to “get paid” should be ignored. A few folks are providing correct information on these blogs—Steven Gadsby, CPB, CPC, CPPM, and Tom Cheezum, OD, CPA, COPC, come to mind—but they are few and far between.
How do you know who to trust?
Listen to people who tell you how to understand the basic tenets of reimbursement, not the way around the rules. Listen to medical necessity, fraud and abuse laws and experienced contract auditors—not for ways to get around the rules. Make a presenter provide documentation for their beliefs.
Could you review the estimated percentages of EM code use?
Again, these are estimates and vary based on your patient demographics, but you should be pretty close to these.
Evaluation and Management Code Percentages
Level 2 - Less than 10% Level 3 - No more than 30% Level 4 - At least 40% Level 5 - No more than 15% Percentage of medical visits billed using 92004/14 - Less than 30%
There seems to be a great deal of opinion regarding the use of the G2211 add-on code. Should we use it?
I encourage use of the G2211 code when appropriate but only when used with the evaluation and management code set. Remember, it must be a patient with a complex condition (NOT dry eyes or allergies, for example); require ongoing care for more than a year; require more time, counseling and testing; and NOT be a patient you are referring to another provider to manage or coordinate care with on the condition. Experts I trust have stated use of the code could easily fall between 20-40% of medical encounters.
Can we force patients with diabetes to use their medical insurance?
If a patient owns payment assistance (including managed vision plans) and the plan reimburses for a comprehensive examination for diabetic patients, the patient has the right to mandate which payment assistance they want to use. They OWN the coverage. In general, many optometrists make patients really mad to make a few more dollars on the examination. Patient satisfaction still matters if you want to grow your practice. This does not apply to patients with complications related to diabetes, which would not fall to the routine column and therefore be an obvious medical submission.
Eye care professionals are getting paid for submitting fundus photos on diabetic patients with no complications. Do you disagree?
Getting paid means nothing—people get paid all the time for incorrect things, and, in an audit, they will pay the money back. Also, it is stated E11.9 (diabetes without ocular complications) is on the “allowed” list of diagnoses for fundus photos. Understand that the “allowed list” only means it would be allowed if you can demonstrate medical necessity. CMS national policy on fundus photos clearly states that photos of nothing would not be considered medically necessary.
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