Billing and coding play a major role in revenue cycle management, but practices can easily run into roadblocks that hinder financial success, from medical billing confusion to trouble navigating Medicare and other insurance plans, as well as having an undefined workflow. PECAA Billing and Coding Advisors Teri Thurston and Dianne Boulay, CPOC, leverage their private practice management experience to provide tips to maximize revenue and reduce billing and coding conundrums, which can affect both new and seasoned practices.
Vision vs. Medical Billing Demystified
Thurston and Boulay understand that determining the correct division of financial responsibility between vision and medical plans can be complex due to several challenges, including Coordination of Benefits, different billing rules and reimbursement rates. They can help you:
- Determine which plan is primary based on a patient’s specific circumstances
- Understand each plan type’s specific billing requirements and guidelines
- Correctly apply billing and coding rules for vision and medical insurance plans to avoid denials and reimbursement delays
- Avoid billing errors that can result in lower medical reimbursements
Megan Waters, OD, of Waters Family Eyecare in Livonia, Michigan said, “My biller has been doing a great job however, claims were coming back rejected so we reached out to Teri. She said this is what you do, and we got paid. It was a simple phone call and we got it done.”
It Takes a Doctor-Led Team
Running a successful practice requires a thorough understanding of the billing and coding landscape, including guidelines, insurance, claims, billing and reimbursements. Even if a practice has the luxury of having a billing manager, practice owners should still have a strong awareness of the billing and coding process. “It reduces confusion and frustration when the owner understands the team’s billing activities and any pain points within the process,” says Thurston. “For example, knowing that a team member is having trouble accessing a patient’s plan or that the practice’s overall billing and coding process could benefit from greater automation to reduce errors or processing time, the practice owner can allocate more personnel and resources.”
Just as important as the communication between practice and patients, a well-connected internal team fosters collaboration, growth, and success.
Dive deep into billing and coding topics with these additional resources open to PECAA Max and HEA Advantage members!
- Leverage The Coding Coach Newsletter emailed quarterly to all members.
- Access The Coding Coach Online Library (For PECAA Max members, find in the member portal on the Billing and Coding resource page; for HEA Advantage members, find in member portal under Coding Coach tab along the top of the page)
- PECAA Max members can also call Teri and Dianne directly with their unique billing and coding questions at 800.959.2020, Option 5 or email codingcoach@pecaa.com.
Connect With Us
PECAA Max members are encouraged to engage with the PECAA Business Advisory team for comprehensive practice insights and to invest as little or as much time as your schedule allows. Included in your PECAA Max membership:
- Business Operations
- Finance & Strategy
- Marketing
- Billing & Coding
- Optical Management
PECAA’s Business Advisory Team can help – schedule a call today!
