Are You Running a Modern Billing Department? If Not, Here’s How

Use the latest technology and third-party services to make insurance processing more efficient for your practice.

There are many aspects to utilizing technology, software and people to modernize billing and tracking of both vision and medical insurance. Your practice can make the most of such technology to make billing more efficient and profitable. Here is how you can do it.

Recognize 5 Keys to Optimizing Billing Technology

SOFTWARE THAT GENERATES REPORTS: Utilize practice management software that is capable of generating reports on billing status.

EDUCATE STAFF: Educate staff to be dedicated to efficient use of insurance. Education of a key staff person to coordinate vision benefits and medical benefits is imperative. It is also necessary to train front desk employees to capture insurance information prior to the patient being seen by the practice.
PREVIEW INSURANCE INFO:  Provide insurance information to the doctor prior to seeing the patient. The doctor needs to be aware of medical as well as vision benefits for both professional fees as well as ophthalmic materials.

DELEGATE: Assign a single individual the final responsibility of making sure claims are filed and accounts receivable reports are up to date.
USE A CLEARING HOUSE:  Utilize a clearing house (a third-party company that you send your paper claims to for transference into electronic claims) to achieve maximum efficiency.

The modern practice and its billing department can benefit from the innate efficiencies of a clearing house. VisionWeb could be your clearing house of choice, however there are several to choose from such as Gateway, and Eyefinity. Having implemented VisionWeb/Emdeon many years ago in our practice, you may enjoy the following benefits:

Centralized Claim Filing
It is possible to file claims online without using a clearing house, but this method is far from ideal. Filing claims electronically without a clearing house means going to multiple sites on the Internet, with varying user interfaces, to get the job done. Advanced billing departments realize there is a better way. Clearing houses are a go-to solution for practices because the clearing house software allows employees to do all of the following in one location:

  •    Check patient eligibility
  •    Submit and track claims
  •    Process secondary claims
  •    View detailed reporting information
  •    Manage Electronic Remittance Advice (ERA)

Efficient Management of Reporting and Analytics
Even the most efficient office will have denied claims. The way we keep a close eye on our claims is through detailed reporting and analytics that cover every aspect of claims, such as:
-The number of claims that have been rejected vs. accepted
-Top payers that are rejecting claims, by amount
-Timeline of claim submission for tracking
-Top rejection reasons
Optimized Practice Management Systems
Good practice management software is the brain center of a practice. Practice management software is a significant investment, and yet, practice owners are putting them to work, especially for claim filing. Technologically advanced practices utilize their practice management system claim filing functions to:

-Create batch claim files directly within the system
-Upload the batch claims and submit directly to payers
-Reduce redundancies associated with re-keying claims
-Generate reports quickly and easily on demand

Utilize Electronic Remittance Advice (ERA)
Billing departments become more efficient when they avoid paper claims. EOBs, especially, since payers have migrated to electronic payment methods, are processed more quickly via the internet.  Electronic Remittance Advice is common among progressive practices. Filing via your computer simplifies the reconciliation and secondary claim filing processes by:

-Providing remittance information in a searchable, electronic format
-Making it easy to search remits by payer,  date or provider  
-Giving users the ability to print only the information they need for secondary filing

Utilizing the most efficient electronic format increases the productivity of your personnel and your practice. Change is often disruptive initially, and yet, we adapt and change or we continue to fall behind. Make the insurance processing technology changes your practice deserves!


PALs: What Percentage are Sold to Patients with $60,000+ Household Incomes?

Some 64.4% of no-line bifocal/progressive lenses were purchased by individuals with household incomes of $60,000 and over, according to The Vision Council’s VisionWatch March 2012 Member Benefit Report. Those with incomes of at least $60,000 purchased 46.6% of bifocal/trifocal lenses sold and 57.5% of single vision lenses.

Do you know the demographics for your practice?  Obviously, it would be inappropriate to ask patients to identify their incomes on a pre-exam history questionnaire, however, this information is available from the government at

The broader question is have you used your practice management software to drill down into your own practice data to know the specific demographics of your practice?  Here are five questions for which you should know the answers.

1.       What is the distribution of your patients across different age ranges?
2.       What is the ratio of contact lens patients to total patients?
3.       What is the ratio of new patients to total patients?
4.       What is the distribution of your patient population from various zip codes?
5.       What is the percentage of total patients with the diagnosis of glaucoma?
Once you know what your patient population is, is the moment you know what your patient population is not.  You’ve now identified your marketing opportunity.  Take advantage of this opportunity and move your practice forward.

Top Reasons Patients Leave Your Practice—and What to do About It

JD Powers and Associates has found 4 reasons why patients leave a business, and optometric practice is no exception!

1.    8% of the people leave our practices because they found a better deal somewhere else.
2.    9% leave because something has occurred to make it unreasonable for them to come back.
3.    14% don’t come back because of some unresolved issue. They are mad or disappointed. Maybe a billing problem, trouble with their glasses…something.
4.    But 67% of the people who don’t come back to our practices, don’t come back because of a feeling of indifference. In other words, 2 out of 3 patients that you lose are lost simply because they don’t think you care whether or not they come back.

Consider the following as a basic guide for building better relationships in our business:

1.    Design all protocols and procedures with the patient in mind.

2.    Show respect throughout the visit by using proper names, unless the patient is considerably younger or if the patient requests to be called by his/her first name.

3.    Anticipate the patient’s needs. Walk through the experience, see it through their eyes, think about what they may say or need at each station, and prepare your staff to deliver a wow experience.

4.    Tie a ribbon around the experience by showing you care after the transaction is complete. Give them a handwritten thank you card, call to see how your patients are enjoying their eyewear or contact lenses, check on your injured or post-operative patients with a quick call…