Medical billing rejections and denials are often used interchangeably; however, there is a distinct difference. A rejected medical claim fails to meet specific formatting, billing criteria, and data requirements.
Because a rejected claim has never been processed by a clearinghouse, insurance payer, or the Centers for Medicare & Medicaid Services (CMS), the claim is not considered “received” and it did not make it through the adjudication system.
In an era of declining reimbursements, high-deductible health plans, and constant industry challenges, profit margins are tighter than ever for most optometry and ophthalmology practices. Healthcare professionals should be able to focus on patient care—instead of medical billing paperwork and payments.
Researching unpaid or denied eye care claims is a time-consuming and frustrating process for optometry and ophthalmology practices. On average, more than 25% of lost practice revenue comes from poor medical billing and revenue cycle management practices. According to the Medical Group Management Association (MGMA), the average cost of reworking a claim is $25.
Is your ophthalmology or optometry practice getting your money’s worth with your in-house billers or eye care billing service? Choosing the best medical billing service is more than just finding someone to process claims. If you are considering outsourcing your medical billing, and are still on the fence about making the leap, here are eight reasons to help you decide.