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Like other specialty practices, your ophthalmology or optometry practice needs highly trained and proficient billing professionals. In a perfect world, your team would have the latest financial management certifications and never consider leaving your practice. Unfortunately, that’s usually not the case in a healthcare industry rocked by staffing shortages—repercussions of the great resignation.

With the right practice management technology and revenue cycle management (RCM) services, you can get claims out accurately and bring in more of the money you’ve earned—even if you don’t have billing and coding experts on staff.

The award-winning software, NextGen® Enterprise PM, helps fill financial management expertise gaps by providing technology that automates routine processes and integrates all aspects of running your eye care practice. You’ll save significant time and effort when you put tasks, such as eligibility check, billing and claim generation, reports, and statements on a continuous, automatic cycle.

Friendly RCM experts to the rescue

When you outsource RCM services from NextGen Healthcare, your practice is assigned a client manager with expertise in ophthalmology and optometry billing. This gives you an ally in maintaining profitability. Ophthalmology is one of many medical specialties supported by NextGen® RCM Services.

Your client manager collaborates closely with your team members, who are responsible for handling claims, payments, accounts receivable (A/R), and other duties. Your staff is not alone in figuring out how to resolve the issues that inevitably arise. Insights from a client manager can save your practice time and help maintain steady cash flow. This assistance is essential for eye care practices that experience staff shortages or lack expertise in financial management.

Your eye care practice can choose different levels and types of service depending on specific needs.  For example, if your eye care practice uses its own staff to submit claims yet still needs help with denial resolution—NextGen RCM Services can take that responsibility off your plate.

Suppose your staff is fine with managing claims and payment but needs help with customer service. In that case, NextGen Healthcare offers a call center with live agents who can answer incoming calls regarding patient billing and collect payments, set up payment plans, and update demographics and insurance information.

Staff augmentation

Staff augmentation services may prove invaluable in a variety of situations. For example, if you have an individual on your billing team who needs to go on leave for an extended time, NextGen Healthcare can provide short-term staffing to fill in during their absence. For an office or billing manager, this fills an immediate gap.

Ongoing frustrations involving insurance eligibility checks may pose an even greater challenge.  For example, suppose your practice has just one person staffing the front desk and faces frequent bottlenecks during check-in. To avoid making patients wait to see their ophthalmologist, the front desk staff person skips eligibility checks. This results in increased denials leading to revenue loss and time-consuming resolution efforts.

To avoid any missteps, NextGen Healthcare can help with eligibility, authorizations, and referrals. Credentialing services are available to help eliminate denials or non-par payments that may occur because providers aren’t properly credentialed with insurance payers. All these services can prove helpful for an understaffed office team.

Coding and charge capture

NextGen Healthcare provides a coding and charge entry service that leverages system edits and a rules engine called the NextGen Charge Review Rules Engine.  The engine auto-corrects charge information based on specific criteria. Your practice can also create custom rules that meet your unique needs; for example, automatically appending a modifier to a charge code based on experience with a specific payer.

Keep your business moving forward

The technical solutions and services covered here aim to help your practice maintain profitability on a daily basis while you focus on providing excellent eye care. To get a clear picture of the bigger financial picture for your practice, gaining all the insights you can from key performance indicators (KPIs) is essential.

As one example, you want to closely monitor changes in A/R. Practices commonly track claims in 0–30 day, 30–60 day, and 60–90 day buckets. Anything that remains in A/R for more than 90 days can cause concern—especially if denials are an ongoing issue.

With NextGen® Financial and Operational Analytics, your eye care practice track aging claims based on a specific payer, practice location, or other criteria. If a significant number of denials can be traced to one particular provider, payer, or CPT code, you can drill down and investigate this key KPI. For example, you can use this information to determine why a certain insurance company denies claims more often than other payers.

Bottom line

To run a financially effective eye care practice, you need smart technology to help you stay focused on quality care. The technology and services mentioned will help save time and lower costs, especially in an ever-competitive and changing ophthalmic market.

To experience better RCM efficiency for yourself, click here to schedule a demo today. You can also check out this e-book, 10 Steps to Find a Better Practice Management System, to help you find the right system for your practice.

Kristi Bolinger, Director, Specialty Solutions, Ophthalmology

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Kristi Bolinger

Director, Specialty Solutions