Does anyone bill for Optical Stores? Advice needed.

[Bill the Biller]

Hi,

As mentioned in other topics I'm in the stage of finding my first client. I had a nice chat with a fellow who runs a few optical stores, they do eye exams, glasses, lenses etc.

They have 2000 claims per month.

The software I chose to go with - Kareo - advised me that they do not support vision billing, this means that through the Kareo software/clearinghouse I can only process Medical claims but no vision insurance claims.

My question is, was it a mistake to offer my services to an optical store in the first place? Can I service them in another way? Maybe change software? I need someone to shed some light because I'm lost, and I have to get back to the lad.

Thanks folks,

Bill

[Michele]

We bill optical and it works great for us.  Why can't Kareo support it?  It's basically the same as other billing except you use HCPCS codes for the materials.

I don't think it was a mistake.  We bill for several optical clients.  If you are not invested in the software (have several clients and they are already loaded) then I would consider switching.  It just seems odd to me that they can't support it.  Some of are best accounts are ODs billing for eye exams and materials.

[williamportor]

I agree with Michele, if you're If you are not invested in the KAREO software, please consider switching. There are others such as Office Ally that will accept optical claims. You might also consider investing in a logmein.com account. If your optical client has practice management software that is capable of claims submission, you can simply use theirs.

[Bill the Biller]

Thanks Michelle and wiliamporter.

I wonder why really, but that's just what they said. Now, to switch to a different software is not such a problem on my pocket, but rather how I represent myself. So I have told this optic guy all about the software and how they have an integrated clearinghouse and all other great features that are really the reason why I myself chose to go with Kareo. How can I guarantee him that I'll help him lower his denials and rejections from his current billing specialist if not for my past experience and success with the method I've been billing with?

The second part I would love to know, is their really no different set of rules to learn about when billing optometry other than the fact that there are some HCPCS involved?

Now on a totally different note, I have the following question:

One provider responded to my offer like this.

How about I give you 100 rejected claims to test your expertise in the field. Otherwise maybe you have a 0% success rate?

I told him it's the first time I came across an offer like this, but I can think about it and I'll let him know tomorrow.

Now, is it a possible thing to do without credentialing? Is there a reason why I should or shouldn't accept his offer? Any advice is much appreciated

[PMRNC]

How is he billing now? Is there reason you cannot remote into their system? I don't have software or costs associated with PM systems, instead I use the clients system. If the client needs to move to another system or doesn't have one, I'm happy to help them with choosing one, and  of course setting them up/transitioning but they still maintain the system and support. With this type of business model you don't have to turn clients away due to limiting your services to one system.

[Bill the Biller]

@PMRNC thanks for your reply.

I can't see a company who just have slight issues with their billing, switching to a new billing co, just because they came across a young certified biller. I'm sure their current specialist has been there for a while now, and they know what she can and can't do. So there needs to be something more to me than just that I learned how to bill. My approach to growing this business is posing as a professional company regardless of how many clients I really have so providers who come across have a feeling that this is something legit enough to check out, when they ask me about how we do stuff better than others I point out several great features of the software we are going to use, and that we are a certified team.

Important to point out is that their current In-house billing specialist works a little bit on an outsourced style. She gets paid percentage and not hourly, she pays for the software herself, and they don't even know exactly how she processes the claims, so not that much in-house which I can offer to cut down for them.

[PMRNC]

I wonder why really, but that's just what they said. Now, to switch to a different software is not such a problem on my pocket, but rather how I represent myself. So I have told this optic guy all about the software and how they have an integrated clearinghouse and all other great features that are really the reason why I myself chose to go with Kareo. How can I guarantee him that I'll help him lower his denials and rejections from his current billing specialist if not for my past experience and success with the method I've been billing with?

You can't ever guarantee a client based on a pm system.. IF this is the solution you will use and he will need to convert to for you to do the billing, certainly there needs to be some perks for him.. again, this is one of reasons I don't offer the PM Solution, I'm able to be diversified, offer quick transition, no delay in payments and I can be more competitive in my rates.  The minute you even hint to a provider that they have to switch to use your services, you've downgraded yourself.

I just wouldn't allow myself to go through all these headaches for a potential client to "test" me.   If I were to do something like this, the client would need to agree to let me utilize their current system and I would still charge for my time.

[Michele]

I wonder why really, but that's just what they said. Now, to switch to a different software is not such a problem on my pocket, but rather how I represent myself. So I have told this optic guy all about the software and how they have an integrated clearinghouse and all other great features that are really the reason why I myself chose to go with Kareo. How can I guarantee him that I'll help him lower his denials and rejections from his current billing specialist if not for my past experience and success with the method I've been billing with?

The new system should be the same.  We just switched clearinghouses and we are thrilled.  You just have to pick a system that will allow you to do the same.   There are others out there.

The second part I would love to know, is their really no different set of rules to learn about when billing optometry other than the fact that there are some HCPCS involved?

All specialties have some little idiosyncrasies but for the most part it's the same as any other specialty.

Now on a totally different note, I have the following question:

One provider responded to my offer like this.

How about I give you 100 rejected claims to test your expertise in the field. Otherwise maybe you have a 0% success rate?

I told him it's the first time I came across an offer like this, but I can think about it and I'll let him know tomorrow.

Now, is it a possible thing to do without credentialing? Is there a reason why I should or shouldn't accept his offer? Any advice is much appreciated

Well 100 claims is an awful lot.  That will be giving a lot of free time.  However, if you really think it would be a good account you may want to give it a try.  But I would make sure that you tell them that you don't guarantee that you can get all claims paid, it will totally depend on the denial reasons.

[Michele]

Linda had a good suggestion that I didn't notice when I left my last response.  If you are going to work the 100 denials you would have to do it from their system to make that work.  You need access to everything, and it would be a LOT more time if you had to try to re-enter and/or re-create.

Also, using their system isn't a bad idea going forward if it's a good system.  We do both, work out of the provider's system, or use ours, depending on what would work best for the provider. 

[Bill the Biller]

Thanks all for the replies! Your advice is greatly valued and much appreciated!

Totally off topic, what's the standard procedure for denials as a result of submitting an exact duplicate claim? I got quite a pile of those. I wanted to know if I should ask the provider to get me the original denial remittance advice or if I should call the insurance for each case to find the original reason?

[PMRNC]

Totally off topic, what's the standard procedure for denials as a result of submitting an exact duplicate claim? I got quite a pile of those. I wanted to know if I should ask the provider to get me the original denial remittance advice or if I should call the insurance for each case to find the original reason?

You need the original denials / Remittance.