Does your practice do in-house billing? Here’s something to know

Weighing the pros and cons of outsourcing versus in-house medical billing for your optometric practice?  

You’re not alone.  

When making the numbers game work, it’s critical for practices to accurately and efficiently navigate an often-complicated billing process that’s constantly changing with each new regulation. But even for practices that opt for outsourced billing or some hybrid option, having competent and knowledgeable practice staff to take on this administrative burden is not just a nicety—it’s a must for revenue. 

A Certified Paraoptometric Coder (CPOC) is a specialty-level certification from the Commission on Paraoptometric Certification (CPC) that attests the staff member’s proficiency and expertise, and validates their superior knowledge, in an optometric coding environment. The AOA caught up with several AOA associate-member CPOCs who perform in-house billing and coding to hear their take on CPOC certification, as well as how it benefits their practice management. 

• Terri Garrison, CPOC, CPOA, of North Carolina. 
• Matthew Baseley, CPOT, CPOC, of Indiana. 

Why did you pursue the CPOC certification? 

“I decided to pursue the CPOC because I have been in the optometry field for 22 years and 12 of those years have been in billing, specifically. I felt it was a better way to understand what the concepts of coding were and it was also a personal goal that I wanted to achieve. I also hold a certificate as a CPOA and keep that up, as well. By obtaining my CPOC, I feel I received an overall better understanding of optometric coding guidelines and rules.” -Terri Garrison 

“I had taken on a new role as a clinic lead at a new practice and already had my CPOT but was wanting to continue growing my knowledge. I had done billing before and was working closely with doctors and scribes and making sure exams were being billed appropriately, so it made sense to go down this path. I was able to achieve a better understanding of the billing process, not only from billing to insurance but from assisting the doctor in deciding what is being billed for the patient. When to use modifiers, how CPT codes work and how to be able to tell what they mean by just looking at the code. My knowledge of diagnosis codes grew as well, and it made it easier for me to understand what they mean and how to use them or find the right one in the exam. Before, I felt I had a good understanding of these topics, but once I had my CPOC certification I felt I understood the fundamentals even more.” -Matthew Baseley 

Who would make a good candidate for pursuing CPOC certification? 

“It really is to the benefit of the practice staff and doctors to identify anyone in their office looking to pursue the CPOC. I feel it covers a broad spectrum and would give those who check in/check out patients a good working knowledge of these processes.” -Terri Garrison 

“The company I work for advocates for certification for all staff and has built guidelines that I think make a lot of sense. I would say check-out staff and staff in a billing department would benefit but even chairside scribes would learn so much from this. It can really elevate a person’s understanding and drive them to that next level of thinking and working with the doctor. I think sometimes people think this certification is not for them because they hear the word “coder,” but it goes much deeper than just billing. Knowing all of the things that come with this certification makes so much of the day-to-day make sense on another level. Knowing that there are parts to diagnosis codes and CPT codes and what they all mean makes life so much easier than just trying to memorize everything.” -Matthew Baseley 

What from the CPOC certification process do you feel you were able to directly add to your optometric practice? 

“I train staff members now, and it has been beneficial in working with scribes in building their confidence on what diagnosis to use and how to find it and what the parts of the diagnosis code mean. Same thing, like before: teaching staff how to bill and when certain modifiers, and making sure everything looks right for insurance.” -Matthew Baseley 

Interested in learning more about how paraoptometric certification can add to your optometric practice or redefine your own skillsets? Find specific information below: 

• Paraoptometric Examination Candidate Handbook 
• 2024 CPC Exam Schedule 
• CPC Examination Study Resources 
• CPC-Approved Continuing Education