Practice Management

Billing best practices for vision and medical insurances

Excellence in medical insurance billing and vision insurance billing in an eye care practice can be a confusing process and continued expertise takes consistent effort.
Published 2.8.2023

Like many things when running a private practice, some simple but necessary pieces of a successful process can be overlooked. On top of that, many major vision plans and medical insurances are equally likely to have their coverage information more opaque than is necessary. Your in-house billing team may be doing a great job overall, but at Anagram, we understand that there’s always room for improvement.

As a healthcare tech platform that works with many private practice eye care professionals we hear fairly regularly that accurate and effective billing is among the biggest challenges that our customers and their colleagues face. Many mistakes made in the billing, collections, and coding process are made because your billing team may not know the best way to approach this particular claim and likely doesn't have easy access to the right resources to find it.

This article was designed in light of the above with an emphasis on the things that are within your control. The goal here is to focus on that which can impact the results your billing team can generate.

When a claim is denied, work to correct and resubmit as soon as possible.

It's tempting to push denied claim resubmissions off to the side and revisit them later, but doing so and delaying resubmission could push this claim out of the timely filing window. If that happens, say goodbye to any of the revenue you expected to see.

Focus on keeping your AR (Accounts Receivables) as current as possible

On the surface this seems like a baseline expectation of any medical billing process, but it is common to see all of the billing focus on filing new claims as soon as possible and never revisiting the 30, 60, or 90 day old claims that hadn’t yet been coded, or filed, or paid.

Work through each patient’s account as you’re posting payments

Think of this as an efficiency move. If your medical billing team is already in the patient's record and posting payments as part of your third party billing process, then it stands to reason that they do a little bit of additional leg work to track this patient's other outstanding claims, other balances that might be due, and in general working to keep the data clean.

Train your entire team on billing at least annually

Training, practice, development, and education are all essential elements of the continued strong performance of your practice every day in every department, but billing training has to be done at least annually because policies and reimbursements can be wildly different from year to year. This is especially important for your intake and billing teams, but the better your entire team understands how this works, the better.

Understand the reporting you have available and take action.

Many practices use their EHR as the crux of their billing process, some use clearinghouses while others use a combination of things to manage and measure their billing processes. A vital and often overlooked element is the ability of your EHR or your clearing house to provide clear and actionable data through reporting. Get on the phone with support, take some time and learn it yourself, but take advantage of the information at your disposal. Those who don’t learn from history are doomed to repeat it, after all.

Keep portal access up to date and secure

This is certainly true for medical and vision plan billing and everything associated with those, but in general data security and good record keeping is another aspect of practice management many practices don’t prioritize and just don't do well as a result.

Verify eligibility before filing claims

A simple and relatively elementary mistake that inexperienced billers make extremely regularly. Filing a claim without having verified eligibility may end up being fine some of the time; when it's not fine, however, it is a costly and frustrating mistake to have made. It never feels good knowing that you could have saved that time by making the right move at the outset, so make that a baseline expectation going forward.

Use as few systems as possible

At Anagram, we spend a fair amount of time talking and thinking about the quality of our data and have come to a massive and Earth shattering revelation: the more disparate systems data has to go through and the more times data has to manually be entered, the more likely it is that whatever process we're talking about ends with mistakes. Work to simplify the process and only use the tools and databases that are strictly necessary, more isn’t always better.

Get copies of insurance cards and IDs

This is another fairly simple solution to prevent what could otherwise be costly and frustrating problems down the road. Upon patient intake make sure to scan a copy of their photo ID and insurance cards, that way if there's ever a doubt about what the patient's actual information is you have documents to which you can refer. This is a great failsafe for entry errors, as it’s incredibly easy to make typos and it’s common for a patient’s name to vary depending on the documents you have on hand.

It's important to remember that even doing all of these things really well will not guarantee a perfect billing process, because there's no way to guarantee a perfect anything for any length of time. If, however, you and your team start to think about your billing as a process that can and should be improved consistently over time, then eventually you will have as perfect a billing system as you need to be successful, and that’s what matters most.

Steve Alexander
Steve Alexander, Head of Growth
Steve Alexander has been in the eye care industry for over 20 years and has worn many hats including optician, ophthalmic tech, lab tech, practice manager, regional manager, operations consultant, CE certified speaker and other in both private and corporate eye care settings. Over the last 8 years, he has been consulting with practices to find ways to better understand their patients, the ecosystems in which they work, and how to create a practice of which they can be proud. For the last two years, Steve has been Head of Marketing and Partnerships at Anagram, an industry leading tech platform driving change in Eye care with the explicit focus of increasing price transparency, private pay business, and improving the lives of patients and the people who serve them.

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