Billing and coding play a major role in revenue cycle management, but practices can easily run into roadblocks that hinder financial success, from medical billing confusion to trouble navigating Medicare and other insurance plans, as well as having an undefined workflow. PECAA Billing and Coding Advisors Teri Thurston, Dianne Boulay, CPOC, and Cathy Uimari, CBP, CPC, leverage their private practice management experience to provide tips to maximize revenue and reduce billing and coding conundrums, which can affect both new and seasoned practices.
Vision vs. Medical Billing Demystified
Thurston, Boulay and Uimari understand that determining the correct division of financial responsibility between vision and medical plans can be complex due to several challenges, including Coordination of Benefits, different billing rules and reimbursement rates. They can help you:
- Determine which plan is primary based on a patient’s specific circumstances.
- Understand each plan type’s specific billing requirements and guidelines.
- Correctly apply billing and coding rules for vision and medical insurance plans to avoid denials and reimbursement delays.
- Avoid billing errors that can result in lower medical reimbursements.
Megan Waters, OD, of Waters Family Eyecare in Livonia, Mi, said, “My biller has been doing a great job however, claims were coming back rejected so we reached out to Teri. She said this is what you do, and we got paid. It was a simple phone call and we got it done.”
It Takes a Doctor-Led Team
Running a successful practice requires a thorough understanding of the billing and coding landscape, including guidelines, insurance, claims, billing and reimbursements. Even if a practice has the luxury of having a billing manager, practice owners should still have a strong awareness of the billing and coding process. “It reduces confusion and frustration when the owner understands the team’s billing activities and any pain points within the process,” says Thurston. “For example, knowing that a team member is having trouble accessing a patient’s plan or that the practice’s overall billing and coding process could benefit from greater automation to reduce errors or processing time, the practice owner can allocate more personnel and resources.”
Just as important as the communication between practice and patients, a well-connected internal team fosters collaboration, growth, and success.
Connect With Us!
- Leverage The Coding Coach Newsletter emailed quarterly to all members and access The Coding Coach Online Library, both available it in the PECAA portal.
- Contact Teri, Dianne and Cathy in the PECAA portal for all your unique billing and coding questions.
Teri is a revenue cycle professional with over 25 years of experience in the eye care industry. She has managed complex billing teams for ophthalmology and optometry practices. She has worked with various physicians to increase profitability, implement RCM efficiencies, and ensure billing compliance. She is passionate about supporting eye care professionals through billing and coding education.
With over 19 years in the optical industry, Dianne specializes in eye care billing and coding. Her background spans management roles in private practice and a leading RCM billing company, offering insight into billing efficiency and profitability. She partners with PECAA members to optimize RCM processes and financial performance. Holding CPOC and OCS certifications, Dianne exemplifies excellence and compliance in coding practices.
Cathy brings over a decade of expertise in medical billing, coding and revenue cycle management. With certifications as a Certified Professional Biller and Certified Professional Coder through AAPC, she has a proven track record of ensuring accuracy, compliance and efficiency in healthcare billing processes. Cathy is dedicated to helping providers navigate the complexities of billing and coding with confidence.