Optometry Practice Management: The Benefits of Outsourcing Payroll

Hey everyone! Today, I want to dive into the world of payroll, a crucial yet often challenging aspect of running an optometry practice. Many of us are optometrists first and HR specialists second, so managing payroll isn't always in our comfort zone. Over the past fifteen years, I've tried various approaches, from using different payroll providers to assigning the task to employees or handling it myself. Through this experience, I've come to believe that outsourcing payroll is one of the best decisions you can make for your practice. Let me explain why.

The Benefits of Outsourcing Payroll

Firstly, outsourcing payroll saves you a significant amount of time and effort. As practice owners, our plates are already full with various responsibilities. Dealing with payroll on top of everything else can be overwhelming. By outsourcing to a professional payroll service, you can free up your time to focus on more critical aspects of your practice.

Additionally, outsourcing can help reduce the risk of errors. Payroll involves complex calculations, including wages, deductions, and taxes, along with compliance with regulations. Mistakes are easy to make, especially if you're not well-versed in payroll procedures. Tax regulations can be intricate and subject to frequent changes, and errors can lead to penalties, fines, and legal issues. Outsourcing ensures that your payroll is handled accurately and in accordance with the law, reducing the risk of such consequences.

Outsourcing payroll can also offer cost savings. While there is a cost associated with outsourcing, it is often much less than hiring an in-house payroll specialist or spending your valuable time on payroll tasks. Outsourcing eliminates the need for additional staff, training, software, and other expenses associated with managing payroll internally.

Recommended Payroll Providers

When it comes to choosing a payroll provider, there are several options available. Here are a few of my favorites:

1. Gusto: Known for its ease of use, Gusto offers automated tax filings, direct deposit, and employee self-onboarding. It integrates well with other small business tools and features automatic tax liability withdrawal with each payroll, preventing large sums from accumulating in your accounts.
   

2. Intuit Payroll: Part of the Intuit family, Intuit Payroll provides tax calculations, direct deposit, and employee self-service. It seamlessly integrates with QuickBooks, which is convenient for businesses already using QuickBooks for accounting.
   

3. Wave Accounting: Wave is cost-effective and easy to use, with accurate payroll calculations that take only a few minutes. However, it does not offer automatic tax filing in most states, which may require more manual tax management. Suitable for those seeking more control over tax filings or with inconsistent income.
   

Choosing the Right Provider

When selecting a payroll provider, consider your familiarity with accounting software, the level of automation you prefer, and your ability to manage tax filings. Gusto is recommended for its ease of use and automation, while Intuit Payroll integrates seamlessly with QuickBooks. Wave Accounting offers cost savings but requires more manual tax management. Choose a provider that aligns with your practice's needs and capabilities.

Why Outsourcing Makes Sense

In summary, outsourcing your payroll can save you time, reduce errors, ensure compliance with tax laws, provide peace of mind, and offer cost savings. It allows you to focus on providing excellent optometry care to your patients, which is what you do best.

Subscribe to Gusto here and get up to $200.

I may receive a commission from the above payroll companies for any business they receive on account of this blog posting. That being said, the opinions in this post are my own and are not influenced by any potential earnings.

A Guide for Optometrists: Billing Humana Out-of-Network

Last August, I opened a new optometry office located inside a Walmart Vision Center. Our population is heavily Medicare and Medicaid, and we rely on medical billing for about 90% of our patients. A large number of our Medicare patients have Humana medical benefits and EyeMed vision coverage. With the current EyeMed reimbursement for Medicare Advantage patients at only $55, it is important to us that we bill the Humana medical plan for as many patient exams as possible.

Challenges with Humana Provider Networks

I was surprised when I reached out to Humana for credentialing, only to be informed by Humana Provider Relations that they had closed their networks to optometry and were not issuing any contracts for this specialty, which was not the news I had hoped for. Currently, we are in negotiations with Humana to become In-Network providers. In the meantime, we have been billing Humana using our patients' Out-of-Network benefits, which has proven quite successful. I'd like to share some tips on how to bill Humana Out-of-Network and still achieve better reimbursement than you would with EyeMed.

Key Steps to Effectively Bill Humana Out-of-Network

• Verify Patient's Coverage: Before providing any out-of-network services, it's crucial to verify the patient's insurance coverage. Contact Humana's provider services or use services such as Availity, TriZetto, or Office Ally to confirm the patient's eligibility, benefits, and any out-of-network coverage limitations. This step will help you determine the patient's financial responsibility and set appropriate reimbursement expectations.
  

• Pay Attention to Out-of-Network Benefits: When implementing these strategies, it's crucial to pay attention to the patient's out-of-network deductible. If the deductible is high, you might choose to bill the vision plan instead. Alternatively, for exams that are clearly medical in nature (e.g., for diabetes or cataracts), you can request that the patient pay out of pocket. In this scenario, you would still submit the claim to Humana, and the payment would count towards their deductible.

In the case of this patient, there was no deductible, co-insurance, or co-pay for either in network or out of network providers. This information was found on Availity.

• Obtain Informed Consent: Inform the patient about your out-of-network status and the potential financial implications. Obtain their written consent, acknowledging their understanding of the potential higher costs associated with out-of-network services. This step ensures transparency and helps avoid any disputes later on.
  

• Bill with Accurate Codes: When billing Humana for out-of-network services, it's important to use the correct billing codes. Ensure that you accurately document the services provided, including the diagnosis, procedures, and any relevant modifiers. Adhering to proper coding guidelines will help prevent claim denials or delays.
  

• Submit a Clean Claim: To expedite the reimbursement process, submit a clean claim to Humana. Ensure that all required fields are completed accurately, including patient demographics, provider information, and service details. Double-check for any errors or omissions that could lead to claim rejections.
  

• Consider Coordination of Benefits (COB) with EyeMed: If Humana denies the patient's refraction, you can submit the claim to EyeMed using COB. Some Humana plans are still eligible for EyeMed COB, except Humana Vision Insight and Humana Medicare. Follow the process of filing your claim with Humana first, then transferring the unpaid refraction to EyeMed using a CMS 1500 form.
  

• Billing Patients for Unpaid Copays or Deductibles: Unlike VSP, EyeMed only pays for the refraction code. It's important not to routinely waive copays or deductibles owed by the patient, as this is considered insurance fraud.
  

Billing Instructions for Humana Claims

Submit your out-of-network claims either electronically with Payer ID 61101

or by mail on a CMS 1500 form to: Humana Claims, P.O. Box 14601 Lexington, KY 40512-4601

Communication is Key

Effective communication with patients regarding the billing process is essential. Transparency builds trust and ensures patients understand the financial aspects of their care. Implementing these strategies can increase reimbursement for EyeMed/Humana patients, impacting your practice's bottom line. If you have any questions, feel free to reach out. I'm here to help!