The Top 5 Billing Mistakes That Cost New York Ophthalmologists Thousands
For ophthalmologists in New York, accurate medical billing is crucial to have continuous profitability and follow compliance. But billing errors can not be escaped and are surprisingly common. This results in lost revenue, denied claims, and even legal repercussions.
1. Incorrect Use of CPT and ICD-10 Codes
Billing errors are usually the result of incorrect use of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes. In ophthalmology, specificity matters the most because of the intricate nature of its treatments. Using the wrong code or failing to include necessary modifiers can lead to claim denials and lost revenue.
How to Avoid It: Stay updated on coding changes and ensure your billing staff undergoes regular training. Utilize electronic health records (EHR) and billing software with built-in coding validation to reduce errors. Additionally, consider hiring a certified professional coder (CPC) who specializes in ophthalmology billing.
2. Failure to Verify Patient Insurance Coverage
Many practices assume a patient’s insurance details remain the same from visit to visit. This is not true. This confusion leads to denied claims when policies change or coverage lapses.
How to Avoid It: Implement a process to verify insurance eligibility before every appointment. This includes checking deductibles, copayments, prior authorizations, and any plan restrictions. Many clearinghouses and EHR systems offer real-time eligibility verification features.
3. Not Documenting Medical Necessity Properly
Insurance companies require clear documentation to justify procedures. A lack of proper medical necessity documentation can lead to claim rejections or post-payment audits.
How to Avoid It: Ensure that patient records comprehensively reflect the condition being treated, the necessity of the procedure, and the expected outcome. Train providers on documentation best practices and use templates in EHR systems to standardize notes.
4. Upcoding or Undercoding Services
Upcoding—billing for a more complex procedure than was actually performed—can result in audits and penalties, while undercoding—failing to bill for services provided—leads to lost revenue.
How to Avoid It: Conduct regular internal audits to ensure coding accuracy. Utilize coding compliance software and educate your staff about the risks of both upcoding and undercoding. If uncertain about coding accuracy, consider an external coding audit.
5. Missing Timely Filing Deadlines
Each insurance provider has a specific time frame within which claims must be submitted. Missing these deadlines can lead to claim denials with no opportunity for reimbursement.
How to Avoid It: Establish a streamlined billing workflow to track claim deadlines. Many billing software systems have automated reminders for submission deadlines. Additionally, make sure denied claims are promptly addressed and resubmitted if eligible.
Conclusion
Avoiding these common billing mistakes helps significantly improve the financial health of your ophthalmology practice in New York. By investing in an ophthalmology billing service provider that utilizes advanced billing software, and implements proactive billing procedures, providers can prevent revenue loss and stay compliant with insurance regulations. One such billing specialist that helps ophthalmology practices across New York state is Instapay Healthcare Services. Reduced administrative burden, increased revenue and improved cash flow is the result of having Instapay Healthcare Services by your side!
If you’re struggling with billing challenges, consider Instapay Healthcare Services as your professional medical billing service provider to maximize work efficiency and billing accuracy.
