Optometry Coding & Billing Alert

Published on Tue Jul 13, 2010 PDF

Know what your options are for non-par patients.

You know that solid collections knowledge is the key to bringing in patient co-pays, deductibles, and balances, as well as payer reimbursement. Are you wondering where you should focus your time and energy? This quiz will help you determine whether you're on the right track, or if you should work on your collections know-how.

Question 1: If your optometrists are seeing patients with insurance you do not participate with, what are your options to ensure that your practice still gets paid?

A. Collect the fee for your services directly from the patient at the time of service.

B. Ask the patient to pay you when he receives reimbursement from the payer.

C. Submit the claims to the payer accepting assignment if the patient agreed to allow you to do so.

D. All of the above.

Question 2: True or false: Even if you can predict what the Medicare EOB will say (which is nearly impossible), the odds of knowing whether the patient will owe you her deductible get worse and worse every day after January 1.

Question 3: Which of the following are not good collections statements?

A. The balance due for the services the doctor rendered today is...

B. How will you be paying your balance today: cash, check, credit card?

C. Did you want to pay for that today?

D. All of the above.

Question 4: How often should you, preferably, review your practices collections efforts?

A. Daily

B. Weekly

C. Yearly

D. Never.

Question 5: Which of the following statements is/are true about patient payment plans?

A. Patients are much more likely to make payment arrangements when in your office.

B. You should make patients pay a down payment on any payment plan you set up.

C. Patients setting up a payment plan with your practice should sign either a payment plan agreement or a promissory note.

D. All of the above.

Answer 1: D. All three of the options given are appropriate ways to ensure your practice gets paid if your physicians are seeing patients with insurance you do not par with. You can bill the patient at the time of service, collect from the patient once he gets reimbursement from the insurance company, or submit the claims to the payer accepting assignment if the patient agreed to allow you to accept assignment, even though you do not participate with that payer.

Answer 2: True. Even if you can predict what the Medicare EOB will say (which is nearly impossible), the odds of knowing  whether the patient will owe you her deductible get worse and worse every day after January 1. For example, say your physician sees a patient on Jan. 15, who tells you that she hasn't seen any other physicians yet during the year, but also mentions during the history portion of the E/M visit that she performs her glucose test daily and that she just received a new box of glucometer strips the day before. Although this patient has not seen a Medicare physician, she probably did pay some money toward her deductible when she ordered the glucometer strips.

Answer 3: C. When conducting collections training, suggest that collectors avoid words and phrases like "can you," "will you," would you like to," and "did you want to." If your policy is that payment for coinsurance is expected at the time of service, then you don't need to ask whether the patient "wants" to pay, says Jay Neal, a coding consultant in Atlanta.

Answer 4: B. Someone in your practice's billing department should review collection efforts, preferably on a weekly basis. The only way you'll know if your collections training is working is to regularly evaluate how successful each collector is. Reviewing individual collection rates can also help you tailor your training so that you're helping your billing staff where they most need help.

Answer 5: D. All three of these statements are correct:

Patients are much more likely to make payment arrangements when in your office. You should make patients pay a down payment on any payment plan you set up. Patients setting up a payment plan with your practice should sign either a payment plan agreement or a promissory note.