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What Is Balance Billing? Is It Ever Legal?

There are numerous types of bills that are applicable in medical practice. The burden of payment can fall on the patient or their medical insurance provider. Some are lawful, while others are not. Therefore, it is important to know about the essential payment concepts and know when they are applicable to avoid facing lawsuits and fines. One of such concepts is balance billing.   What Is Balance Billing? Balance or extra billing is normally the difference between what a patient’s insurance provider is willing to pay based on the cover they offer and what your facility charges the patient for the services they

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5 Billing Tips for Dieticians & Nutritionists

Diet and nutrition providers that are looking to leap into billing with insurance may not know the best place to start. After all, today’s insurance landscape is extremely complicated and can feel daunting if you are not familiar with the process. Many specialists who previously did not accept insurance are beginning to and more and more insurance plans are bringing dietician services under their umbrella of coverage. The realization has been that accepting insurance is a quicker way to get paid for services, it helps make services affordable for patients, and brings in a higher number of patients than without.  Ultimately

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A patient receiving treatment from a chiropractor.

Chiropractic vs Physical Therapy Insurance Billing

When looking at chiropractic vs physical therapy billing, it’s easy to get the two confused. Both disciplines carry some similarities but are ultimately completely different specialties. It is important to distinguish between them, especially when it comes time to bill for services. Utilizing an EDI/clearinghouse partner that is familiar with both categories of claims can be a great resource for providers looking to improve billing/revenue. In the meantime, however, let’s find out what makes these two so different when it comes to billing and claim management.   Likelihood of Coverage  While the two specialties carry great differences, there are a few key elements they share. They both work one-on-one with

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A doctor’s clinical and practice management tools linked together with healthcare interoperability. 

The Importance of Interoperability in Healthcare Billing

With the medical world in the midst of a digital revolution, interoperability is more important than ever. But how do we define this tech buzz word in the context of healthcare in a way that makes sense for practitioners? Simply put, interoperability is as it says, the ability for systems to communicate and operate together.   Today, many practices are onboarding not only electronic health records and clinical tools, but practice management suites that assist with billing and compliance. With all these tools in a healthcare provider’s toolbelt, it’s critical that each software system work together securely. Without seamless communication, the benefits of these tools are greatly hindered. Let’s dive into the details of

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A healthcare provider’s billing staff working with an EHR billing integration to improve their practice management. 

7 Benefits of EHR Billing Integrations

Medical billing is a challenging and demanding process. The nuances that go into filing claims, avoiding denials, tracking bills, coding, and the like can be overwhelming for any clinic.  Delegating the process to a proper billing system can simplify the task tremendously, allowing practitioners to focus on their core tasks. That’s why clinics are generally looking for an EHR system with a ready-to-go medical billing integration like a clearinghouse.   By gaining an opportunity to submit insurance claims quickly and efficiently, practitioners can minimize rejections and denials while getting their money as fast as possible. While they may already have a separate

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close up. man using a keyboard shortcut on a laptop keyboard

Why Use EDI in Healthcare?

As the digital world continues to advance, we are privileged to use various software and technologies that make our jobs easier. One such technology is electronic data interchange (EDI) software. EDI in healthcare allows for improved claims processing with improved security and efficiency for patients and healthcare providers. Medical professionals everywhere are taking the leap and adopting EDI. Keep reading to find out why.  What is EDI?  EDI stands for electronic data interchange, which is a fancy way of saying, EDI serves as the courier of data between two parties, a middleman. When it comes to insurance billing, EDI and EDI clearinghouses are incredibly valuable tools that handle the communication between

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An optometrist performing an eye exam for her patient. 

Why You Should Use Vision Billing Software

Rampant errors in insurance claims and coding may result in delayed revenue cycles for clinics. These errors prevent vision care professionals from realizing the percentage of payments they should from insurance companies. Even when they finally receive these payments, it’s weeks after the claim has been submitted, slowing down cash flow. But billing tools like Apex EDI’s insurance claim clearinghouse remove the headache from the whole process.  About Vision Care Billing Software  An efficient vision care billing software has many benefits for your practice:  Saves time and money  Integrates seamlessly with your current optometry software  Reduces errors in your billing process  Access to web-based claim management and reporting

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Billing employee frustrated on the phone over denied and rejected claims.

What You Need to Know about Denied and Rejected Claims

Denied and rejected medical claims can erode a significant chunk of your practice’s revenue, especially if you’re not set up to manage them efficiently. The good news is that the majority of rejected and denied claims are preventable and caused by common errors. You can make a big difference in your claim rate by identifying problems in your workflow, educating your team, and using the services of a reliable clearinghouse. Here are 5 important things you should know about how claim errors interrupt your revenue cycle.   The Difference Between Rejected and Denied Claims  Denied and rejected claims are not the same and will

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Optician offering glasses to a patient.

Could Retail Optical Benefit Your Practice?

As an ophthalmology or optometry professional, one of the best moves you can make to grow your practice is to incorporate a retail optical outlet as part of your operations. This move makes sense when you consider that one of the key factors that patients consider when choosing eye care is their health insurance.   As a medical professional, a visit to your practice would be billed under their medical plan instead of their vision plan. However, if your patients require a basic examination or to purchase glasses, contacts, or other vision aids that you prescribe to them, the cost would

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Doctors and billing team working together to submit claims more successfully.

4 Keys to Submitting Claims Successfully

Submitting claims requires an A-list clearinghouse. Let’s face it. The claim management process is quite tasking, and without the right intermediary, getting what is due to you can be an uphill task.  A slight delay or an unsuccessful claim could mean poor cash flow for your organization. In today’s post, you’ll discover what it takes to file a successful claim. We’re persuaded you’ll find this helpful and that it’ll positively influence your bottom line. So, let’s get started!  1. Make Payments a Priority  Cash flow is the bloodline of every successful organization. Without adequate funds, it’s more like a blood clot blocking

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An optometrist performing a routine eye exam on her patient. 

Medical vs. Vision Care Claim Processing

Handling claims regarding optometry and ophthalmology can entail a string of tiny details, including differences between billing to a vision plan versus what you should bill through a patient’s medical insurance. Differentiating between the two can often be a little confusing at first, and that’s okay. To make things easy, let’s review what the differences between both types of claims are, why they’re important, and how you can make handling them a seamless process.   Vision Plans vs Medical Insurance  The average medical health insurance policy covers unexpected emergencies, meaning that routine eye exams, contact lenses and glasses are not considered or covered

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How to Audit Medical Claims

A medical claims audit can prove to be the most valuable tool in your clinic’s compliance arsenal. When properly conducted, an audit can boost your claims accuracy and help your medical billing unfold more efficiently. Whether you choose to conduct your review internally or hire an external auditor, it’s important to understand how to audit medical claims.  The key to ensuring that your audit proceeds smoothly is to first streamline your claims process with a proven clearinghouse such as Apex EDI. Below is a look at the claims auditing process and the role that medical claims software can play in

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Guide to Optometry Billing and Coding

According to the US Center for Disease and Control (CDC), approximately 12 million people in the United States have some form of vision impairment. Another 93 million adults are at a high risk of severe vision loss. With such startling revelations, experts estimate the employment gap for Optometrists to increase faster than most regular occupations in the US. As the demand for optometric treatments rises, practicing optometrists must streamline their billing and coding process to ensure they follow proper procedures.   To help you get started, we have put together a definitive guide about optometry billing and coding.  Billing and Coding for Optometry 

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Are Claims Management Companies Worth It?

The world of insurance claims can be challenging, intimidating, and downright frustrating at times. Between changing regulations, delayed payments, and unresponsive financial institutions, you may find yourself wishing a fairy godmother would swoop in to magically take care of all your claims and deliver all your payments in light speed.  Unfortunately, fairy godmothers don’t exist in the insurance claims world. But for many private practitioners, claims management companies are the next best thing. They have the skills and resources to handle your claims processing from start to finish, helping you to secure payments faster while reducing your stress. In short, hiring a claims

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What is EDI Enrollment and What Are the Benefits of an EDI Clearinghouse?

The introduction of the electronic claims process changed healthcare forever. In a system that was riddled with inefficiencies and inaccuracies due to paper claims management, digital billing offered a solution. For providers looking to eliminate these problem areas in their claims process, EDI enrollment is necessary. Electronic Data Interchange (EDI) is an innovative digital communication tool that is used to deliver data from a provider to a payer. In order to be eligible to submit electronic claims to an insurance company, providers must complete EDI enrollment.  What is EDI Enrollment?  Some payers require EDI enrollment in order for providers to submit electronic

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