Five Common Billing Mistakes and How to Avoid Them


No matter how many practices you manage, insurance billing can be complicated for many optometrists. Follow these tested and effective techniques for avoiding the five most common billing mistakes:

1. Understand procedure codes as best as possible.
I've heard it a million times: "I don't want to 'over bill' for an office visit." I understand that if the patient in your chair is not having congestive heart failure, billing for a 99215 can be slightly intimidating. However, you are treating a recognized organ system and you deserve to be paid for your chair time. If your patient is in your chair for 40 minutes, and the severity of the condition, acuity, and number of presenting problems warrant a 99215, would you rather be paid $107 (99214) or $144 (99215)? Why leave money on the table when you have earned every penny?

2. Don't undercharge for services.
Make sure that your fees are high enough that you are reimbursed the maximum amount by every insurance payer. How many of us have let an increase in procedure code reimbursement go unseen? It's important that you or your biller review the reimbursement changes as soon as possible and raise the fees when appropriate. There are many practices under billing by at least $20 on at least one procedure code because they didn't know that reimbursements had increased. Assign one person in your organization to evaluate all your fees. Do the math, and you'll see what this simple mistake could mean to your practice and your bottom line.

3. Understand your modifiers.
How many times have you provided services as a courtesy because:

  1. You have never been able to get paid for both tests on the same day.
  2. Insurance will only pay for one or two punctal plugs a visit.
  3. Insurance will not pay for an office visit on the same day as a procedure.
  4. I cannot bill for an office visit during a post-op period.

Modifiers are your friends, partners even. Understanding them can seriously impact your reimbursements.

4. Stay up to date on diagnosis and PQRS codes.
You might be surprised how many invoices employees write off because of invalid codes. They change yearly. Sometimes a code is expanded or a zero is dropped. Occasionally, a code is completely removed. All of these cause rejections or keep submissions from passing through your clearinghouse. Whether due to untimely filing, lack of follow through, or not knowing where to go from that point, these claims can go unpaid, leaving you providing your services for free.

5. Hire the right billing clerk/company.
Billing clerks' and billing companies' primary responsibility is to maximize reimbursements. It is important that they are well-versed in all of the above and have an interest in collecting every cent possible. Their success could mean the difference between meeting or surpassing that next benchmark.

Follow these techniques and you'll avoid making these five common billing mistakes.

Evan Kestenbaum, MBA

   Heather Mather

Evan Kestenbaum, MBA
, is chief information officer and Heather Mather is billing specialist of GPN, Exclusive Provider of The EDGE. Contact Evan directly at, and contact Heather directly at about any billing questions you may have.