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.
The Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) will be making minor ICD-10-CM code changes to 90 eye-specific codes that become effective October 1, 2017. There are 57 new codes, 25 revised codes and 8 deleted codes for patient encounters occurring from October 1, 2017 forward.
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.