Ophthalmology and Optometry Coding Alert

Hint: Requesting self-pay amounts before surgery makes all the difference.

Chasing down copays, deductibles and coinsurance amounts after insurers pay you for a patient’s surgical procedure can be exhausting. What if you never had to do this again? One ophthalmology practice has found a way to collect almost all of its charges without ever having to reach out to post-surgical patients—and she’s willing to share how she does it.

Ophthalmology Coding Alert sat down with Tracy J. Kenniff, MBA, OCS, practice administrator with Eye and Lasik Center in Greenfield, Mass. to find out exactly what you can do to maximize your collections without alienating patients.

Self-Pay Collections Should Take Place Before Surgery

One policy that could dramatically transform your collections is taking care of patient balances on the front end, rather than waiting until after a surgery takes place, or even waiting until the day of the procedure.

“We found that collections issues came about when patients were responsible, particularly for big ticket items,” Kenniff said. “We ended up with a few who paid on the day of Lasik that bounced checks or had other issues, leaving us without the payment. Plus, keeping in mind that our top priority for our patients is to create the best experience and not wanting them to fret on the day of the procedure, we felt we needed to institute a new policy.”

The overhauled system requires patients to pay in full for their portion of any procedure a full seven days prior to the service. “We pride ourselves in collecting 98 percent of self-pay money up front,” Kenniff says. The other two percent come from situations like emergent care involving patients who don’t have insurance or other unforeseen issues. “But 98 percent of collecting the self-pay portion is all about preparing and understanding why the patient is coming in,” Kenniff says.

Carve Out Self-Pay Procedures

If your practice frequently performs Lasik procedures, you probably already know what most insurers will pay for it (if anything) and you can easily establish the up-front payment that you’ll be collecting from the patient. In other situations, you may have to carve out the patient’s portion of a procedure. This can happen in instances such as cataract surgeries with premium lens implants (PLIs). “The PLI is the out of pocket expense because the cataract surgery itself is covered by Medicare,” says Kenniff. “Those types of combination procedures have the same policy—seven days prior to procedure we require payment in full.”

Although requesting up-front payments has increased collections and dramatically decreased issues after surgeries take place, there may be times when this policy requires you to get tough with patients. “There’s been a hard line that we needed to follow and a few times where we have had to postpone a patient’s surgery by about a week in cases when we didn’t get payment. It is a necessary evil in order for us to be able to keep up with our policy,” Kenniff says.

Even Without Procedures, Handle Issues Up Front

You don’t want to surprise your patients with your collections rule a week before their surgery, so you should let them know about your payment policies as soon as they join your practice. But that’s not the only routine that will help you collect—you should also prevent denials by verifying insurance up-front, and questioning patients about their coverage if you find any glitches.

“We have a team of people in the clinic who work on prior authorizations and confirm insurance,” Kenniff says. “If a new patient is going to be coming to our office, we try to pre-verify their information; if we can’t, our team will call the patient and say ‘We’re planning to bill insurance for your exam and we tried to get a prior authorization; however, it says you don’t have coverage. Is there another insurance we can bill?’”

In addition, your front office staff should know to ask whether a patient has medical insurance versus vision insurance, she says. “We have people who work in billing who have given several key indicators to the call centers, and they say to the patient, ‘Typically, with that insurance, you may have a vision plan as well,’ and that triggers it for the patient to check on other coverage.”

Once the insurance coverage is established and eligibility is confirmed, Kenniff’s practice calls the patient and tells them their copay and deductible on the phone so they’ll be prepared to pay it on the day of the service. “We identify patients for follow-up appointments whether they’re insured or self-pay, so we can remind them a week before the visit what their estimated payment will be.”

Ask Self-Pay Patients to Sign in Writing

At Kenniff’s practice, any self-pay patients, regardless of procedure (with the exception of refraction) have to sign a form saying that they understand they’re fiscally responsible for a specific amount of money, which has been a success for the office. “As we grew we needed to streamline processes to make it easier for the front desk and the billing people, and it ended up working out really well and helped us have more timely charge entry,” she says. “We pride ourselves that every office claim gets in within 48 hours—usually 24—and all surgery claims get filed the day of the surgery.”

If you’d like to institute a similar policy in your practice, you can slowly implement the changes on a one-by-one basis until your collections are solid. “It’s changing the culture of your practice,” Kenniff advises. “It doesn’t happen overnight.”