SPONSORED CONTENT Optimizing Reimbursements in the Revenue Cycle Management Process By Brett Paepke, OD While service delivery remains at the heart of every healthcare practice, clinicians play a pivotal role in another crucial aspect of the business: revenue cycle management (RCM). Savvy clinicians understand how decisions they make elsewhere can influence both the amount of money available for a billing team to collect and its security. Coding is one of those decision areas. THE COST OF UNDER-CODING Under-coding, or selecting a CPT code below what the medical record supports, can present challenges to a practice’s bottom line. Consider this: Nearly one-third of all optometric encounters reviewed in a friendly medical record audit service over a five-year period were coded below a level supported by the doctor’s documentation. This under-coding means doctors ask payors for less than they deserve. And the impact of that can be significant. For example: Assume an optometrist provides 1,500 encounters over the course of the year. Further assume a $30 difference between coding levels. If one-third of those 1,500 encounters are under-coded, that’s $15,000 left on the table. To restate, most clinicians can be paid more for the services they are already delivering through proper coding decisions. THE BOTTOM LINE While code selection on “routine” visits might be defined by vision care plans, no such restriction exists on the medical side. As an action plan, ECPs should: Revisit the requirements of the 13 office visit/exam codes and their relative reimbursements Four general ophthalmological services (92xxx) Nine evaluation and management services (99xxx) Use this knowledge to make fact-based coding decisions at the end of an exam. By taking ownership of coding decisions, clinicians can ensure they are being compensated optimally for their time and expertise, thereby enhancing their RCM processes and, ultimately, the financial health of their practices. Don’t let under-coding hold your business back. Schedule a consultation with our expert optometric billing team to ensure your practice is capturing every dollar it deserves. About the Author: A graduate of the Pennsylvania College of Optometry, Brett Paepke spent 15 years in clinical practice transitioning to a leadership position in the health IT industry. Through roles such as Chief Compliance Officer, Director of Product Development, and Director of ECP Services, he has led EHR product strategy and compliance teams, created support services for clinicians, and interfaced directly with government agencies, associated Heath IT test labs, and certification bodies. Dr. Paepke currently serves as Senior Director, Medical Advocacy at HELIX. Don’t let under-coding hold your business back. Schedule a consultation with our expert optometric billing team to ensure your practice is capturing every dollar it deserves. P (800) 874-6601 | E marketing@helixsolution.com | W info.helixsolution.com/rcm
