Ophthalmology and Optometry Coding Alert

Question: After checking to be sure we haven't made a coding or billing entry error, our practice automatically appeals payer denials using a standard letter. We don't seem to be very successful in ultimately getting payment. How can we improve our appeals process?Louisiana SubscriberAnswer: Before you begin the appeal process, first check the payer's policies. If, for example, the payer has a policy that bundles A-scans (76519) into any E/M services performed on the same day and will not be reimbursed separately, don't appeal these. Writing appeals is timeconsuming enough, so you don't want to waste time on appeals you cannot win because there is already a specific policy in place.Next, be sure you follow the payer's appeal procedure exactly. Often, the address to submit appeals is different from the claims address, and some payers require you to send a special form with the appeal.Get specific: Rather than sending a [...]