How to Reduce Vision Insurance Claims Processing Time

Erroneous, late, and never-submitted claims are a significant factor behind lost revenue in ophthalmology and optometry.

In ophthalmology, consistent timely claims submission gives you more time to correct or appeal rejected or denied claims before they age out.

And in optometry, corrective eyewear claims that are overlooked or submitted late can quickly result in a lost client and a negative review.

In this guide, you'll learn about:

• Common inefficiencies in the claims submission process and revenue cycle that result in lost revenue
• How to identify the weak points in your staff's billing workflow
• Best practices to reduce your insurance and vision benefits claims processing times
• Suggestions for process and staff training improvements
• Key performance indicators for claims submission

And more.

Why Most Vision Offices' Insurance and Benefit Claims Submission Processes are Inefficient

There are four primary reasons that vision practices (including ophthalmologists, optometrists, and "two-door operations" that offer medical procedures and also prescribe and sell corrective eyewear) struggle to submit claims on time and error-free:

• Vision benefits claims often require manual export and data entry from your practice management system (PMS) to the payer site because Electronic Data Interchange (EDI) files for claims generally don't contain the specific predetermined data fields needed for eyeglass prescriptions.
• Practices that primarily focus on ophthalmic medical procedures (which bill through health insurance) tend to have knowledge gaps in submitting particular claims (such as eye exams or corrective eyewear) through vision benefits plans.
• Offices that generate a majority of revenue providing optometry services and selling prescription eyewear (which usually bill through vision benefits plans) may lack experience in billing certain procedures (like preventive screenings and services) to medical insurance.
• Ophthalmic practice management and electronic health record (EHR) systems typically don't integrate with optometric insurance platforms and payer websites, and vice versa.

The billing process for optometry, which usually involves a queue or stack of printed invoices that office staff enter into payer websites manually to obtain authorization as time allows, has multiple potential points of failure:

• Incorrect initial data entry into the PMS or EHR system
• Invoices that are lost or never printed in the first place
• Busy or distracted staff members overlooking or postponing data entry
• Data entry mistakes when submitting to the payer's website.

Coding and billing for vision care is unique among medical specialties. As a result, even though most ophthalmology practices use practice management software (PMS) and electronic health records (EHR) systems that allow for specialty coding, the unique requirements for vision coding create additional opportunities for data entry errors.

All of these issues are compounded by staffing shortages and hiring difficulties in the vision care field.

Medical offices in every sector of healthcare are facing unprecedented challenges in retaining, hiring, and training support staff for a variety of reasons including retiring baby boomers, declining job satisfaction, and COVID-19-related problems, and vision practices are no exception.

Automating repetitive tasks like data entry and claims submissions can reduce errors, free up your best staff members, and make your claims submission process more efficient. revBot by Revival Health is a virtual worker that can perform these tasks three to five times faster than a human, doesn't make mistakes, and comes with an ROI guarantee.

How to Reduce Your Vision Insurance Claims Processing Times

Reduce your claims processing times and improve your revenue by identifying weak points, making a plan, and benchmarking your results. Here's how.

Identify the Weak Points in Your Revenue Cycle

First, perform an informal audit of your revenue cycle to find areas for improvement.

Make a thorough list of problems and reasons for those problems. Set aside time to observe what's actually occurring and ask billing staff in-depth questions about the process.

Investigate these areas and any others that come up in your audit:

• Are your staff obtaining up-to-date insurance information during the scheduling process?
• Do they review benefits and obtain authorization at least two days before the appointment?
• Are patients ever rescheduled due to ineligibility? How often and under what circumstances?
• Is patient responsibility for payment calculated during the appointment? Are payments collected immediately after service is rendered?
• How often do patient bills go into collections? Take detailed notes on the reasons in each circumstance.
• Is your practice management system set up correctly with fee schedules in the system organized by payer to determine allowed amounts?
• What are your rejection and denial rates? Are they trending up or down, and under what circumstances?
• Does your office work the aging file regularly? Are any claims aging out, and if so, what happened in each case?
• How often are vision prescriptions late for any reason or incorrect? Why does this happen?
• If vision claims are being misplaced or overlooked due to the manual entry process, take notes on how, why, and how often this is happening.

This is your opportunity to gather information before you make a plan.

Instead of problem-solving or offering detailed feedback or corrections at this stage, focus on obtaining as much information as possible. Ask your team follow-up questions that lead to helpful insights, but without "grilling" them.

Make a List of Process Improvements and Training Ideas

When you finish gathering information on revenue cycle issues, you should have a detailed list of problems and their apparent causes. Now it's time to consider changes to your process, ideas for training improvements, and other ways to tighten up your revenue cycle.

Consider these three categories to guide your solutions:

• Automating the first and last steps of the revenue cycle (automatically transferring data from the PMS and submitting the claim to the payer using revBot)
• Devising training exercises or other methods to ensure staff members apply critical thinking and problem-solving skills to the steps that require human oversight (such as managing rejections and denials, resubmissions, and identifying trends)
• Creating standardized daily and weekly "to-do" checklists for employees so they don't overlook or skip revenue-generating tasks (like claims submissions!) during busy times.

Once you make an initial list of ideas, hold a staff meeting to discuss problems and their causes, share your suggestions, and solicit input and feedback from team members.

After you implement the changes, it's wise to meet quarterly to discuss new changes, results, and key performance indicators. Plan on 1-2 days of staff training per quarter to refresh, problem-solve, and cover any updates to standard operating procedures (SOPs).

If your staff is struggling to keep up with changes or you notice that everyone's not on the same page, consider creating a cloud-based central repository for SOPs using services with a Business Associate Agreement (BAA) for HIPAA compliance like:

• Google Drive
• Microsoft Office 360
• SharePoint
• Citrix Sharefile

You can create folders for each area of business that contains several short, simple documents with descriptive titles and a table of contents. This is easier to keep updated and more effective in general compared to email updates, word-of-mouth, or a printed SOP binder.

Benchmark Your Claims Processing Turnaround Times

Measuring your claims submission times and other important outcomes allows you to obtain objective, ongoing data rather than rely on guesswork.

It's probably not necessary to do this at a baseline prior to addressing your practice's known weak areas and problems. Unless your claims process and revenue cycle are already running reasonably smoothly, you can simply wait for the initial improvements to take effect, then get your baseline stats at that time.

You can benchmark two different ways:

• Pulling automatically-generated reports from your practice management software (systems like OfficeMate, Crystal, and Revolution can provide statistics on average case processing time, rejection and denial rates, and aging reports  — contact the product support team if you're not sure how)
• Manually filling out a spreadsheet or written list for areas that you can't capture directly from the PMS (such as patients rescheduled due to ineligibility, and late or incorrect prescriptions)

The most direct metric for turnaround time is the average successful submission time, which represents the amount of time elapsed on average between the patient visit (day of service) and successfully submitting the claim to the payer.

Important: it's vital to include rejected and resubmitted claims in the average to get the full picture. Be sure to "run the clock" from the day of service until any rejected claim is successfully resubmitted, then factor that into your average.

‍On average, successful submission time should be between 2-4 days,

counting rejected and resubmitted claims in the overall average.

Of course, if your practice is waiting several weeks or longer to work rejections, your true average successful submission time is going to be much higher. Some practices believe they have a one-day average successful submission time, which is usually a red flag: they're neglecting to work rejections and aren't averaging them in at all!

Review KPIs

Make a master list of key performance indicators (KPIs) to track, then delegate to a senior staff member to keep the KPIs updated and accessible.

Review them weekly so you have a grasp on current trends and can detect problems early, then go over the three-month report during the quarterly training update to review progress and set goals with your front office team.

Key Performance Indicators and Checklists for Vision Claims Processing Turnaround

Use these key performance indicators (KPIs) and checklists to shorten your claims turnaround times and optimize your revenue cycle.

You can also receive a free printable PDF version in your inbox.

Key Performance Indicators for Vision Claims Processing Time

• Average claims processing time from patient visit to successful claim submission, including resubmitted claims (Goal: 2-4 days)
• Individual claims that exceed four-day turnaround (Goal: Zero)
• Claims that are denied for timely filing (Goal: Zero)

Key Performance Indicators for Revenue Cycle Optimization

• Patients rescheduled due to insurance ineligibility (Goal: Zero)
• Bills submitted to collections because patients weren't billed immediately at the time of service, or were billed incorrectly at the time of service (Goal: Zero)
• Delayed or incorrect fulfillment of material orders  (Goal: Zero)
• Rejection and denial rates (Rather than establish a specific goal, look at trends and root causes)

Process Improvement Checklist

• Practice management system is set up correctly with fee schedules in the system organized by payer to determine allowed amounts
• Automate the beginning and end of the claims submission process (the transfer of insurance and billing information from PMS and the claim submission to payer)

Staff Training Checklist

• The officer manager identifies billing issues and mistakes when they occur, then uses them for constructive learning opportunities or to improve staff training or update the billing workflow.
• The office staff meets quarterly for 1-2 days for a training refresher, KPI review, problem-solving, goal-setting, and to review any changes to standard operating procedures (SOPs).
• Maintain an up-to-date central repository of billing and office SOPs with simple, well-organized folders and files in a HIPAA-compliant cloud service.

Daily Staff Task Reminder Checklist

• Staff obtains up-to-date insurance information during scheduling for every patient.
• Biller reviews benefits and authorization at least two days before appointment for every patient.
• Calculate patient responsibility during the appointment every time.
• Always collect patient responsibility at time of service.

Weekly Staff Task Reminder Checklist

• Cross-reference appointments and claims submissions to find any overlooked or unsubmitted claims.
• Review and work the claims aging file.

Frequently Asked Questions About Vision Claims Processing Times

What are the most common causes of slow vision claims processing?

Many offices have inefficient claims submission processes because of the need for manual export and data entry, lack of familiarity with vision benefits (in ophthalmology) or medical insurance (in optometry), and a lack of practice management and EHR integration with certain insurance platforms and payer websites.

Other factors including staffing shortages, training challenges, and failure to track important metrics like rejection rates and average successful submission times for claims can also contribute to inefficiency.

What kind of revenue improvements are expected from reducing claims turnaround times and optimizing the revenue cycle?

Vision practices can expect up to a 15-25% increase in revenue from improving their claims processing workflow, though it varies depending on how efficiently your office is currently running. Gains come from a higher rate of successful payments, fewer timely filing denials, better patient retention, and reduced need for collections.

What are the best methods to improve processing times for health insurance or vision benefit claims?

A comprehensive approach to improving claims processing times includes automating the first and last steps of the revenue cycle, training your staff in best practices to manage rejections and denials and perform resubmissions, and creating checklists of SOPs so claims submission and other revenue-generating tasks are never overlooked.

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