Audit-Ready Documentation: What I&R Should Look Like

Practices that stay on top of Medicare billing come out ahead.  In this episode of the OneSpot Insurance Billing podcast, Cindy Braden welcomes back Casey Squicquero, a 17-year veteran of optometry billing, for round two of their Medicare deep dive. Casey walks through the free tools, tricky rules, and practical habits that separate a smooth Medicare claim from a denied one. Here’s what we cover in the episode: Tools to help navigate Medicare billing — a walkthrough of the free CMS resources every biller should bookmark. QMB (Qualified Medicare Beneficiaries) — what QMB status means for your practice, even if you don’t accept Medicaid. Additional tips to help — practical strategies for cutting down denials and getting claims paid right the first time.   Resources Mentioned in the Episode Medicare Coverage Database: https://www.cms.gov/medicare-coverage-database/search.aspx Medically Unlikely Edits (MUE): https://cgsmedicare.com/medicare_dynamic/j15/partb/mue/mue_tool.aspx Physician Fee Schedules: https://www.cms.gov/medicare/physician-fee-schedule/search NCCI Procedure to Procedure look up tool: https://cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx Information on QMB: https://www.cms.gov/medicare/medicaid-coordination/about/qualified-medicare-beneficiary-program   OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/ 

Most practice owners admit they haven’t looked at an aging report in years. Sometimes “money in the bank” is a signal that things are good enough. But what if practices focused on supporting their billing specialist and prioritized revenue cycle management? In this episode of the OneSpot Insurance Billing Podcast, Cindy Braden, OneSpot VP of Sales, sits down with Jackson Pace to dig into why communication between billing specialists and practice leadership is the most underused tool in a healthy revenue cycle.  Jackson is a CPA and founder of Refractional CFO, a firm that works exclusively with optometry and ophthalmology practices across the country. After years in the industry, he’s seen what happens when the relationship between billing specialists and practice leadership works, and when it doesn’t. In this episode, Cindy and Jackson discuss: Why a simple monthly standing meeting between billers and doctors can prevent cash flow surprises and reduce burnout  How billing specialists can prepare for tough conversations with leadership by doing their homework first  What red flags practice owners should watch for that signal billing issues, even when the practice feels like it’s doing well OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/ 

Most practices obsess over a clean AR. But a spotless aging report doesn't mean you're actually collecting money. In this episode, Melissa Allison breaks down the metric that too many practices overlook: collections percentage. Melissa brings over 25 years of managed vision care and revenue cycle expertise to the optometry space. She currently works for AEG Vision, and specializes in the intersection of AR management, payer strategy, and practice acquisition readiness. In this episode, you'll learn: What a healthy collections percentage actually looks like  Why reconciling to your bank account daily is the foundation of accurate AR management  How clean revenue cycle processes directly impact your practice's valuation when it's time to sell or be acquired OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/   

In this episode, Ryan Ames OD, MBA, joins us for a follow-up conversation about diagnostic testing and Interpretation and Report. He explains how to know when I&R is needed, what proper documentation looks like, and how the 99211 code fits into the picture. OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/  Ryan's Resources The OCT shows a normal retina. Now what?: https://www.onespotbilling.com/blog/onespot-podcast-audit-ready-documentation-interpretation-and-report-resource-1 CPT 99211: Understanding the Definition, Its Limits, and Common Billing Errors: https://www.onespotbilling.com/blog/onespot-podcast-audit-ready-documentation-interpretation-and-report-resource-2 A Complete Interpretation & Report is NOT Optional: https://www.onespotbilling.com/blog/onespot-podcast-audit-ready-documentation-interpretation-and-report-resource-3

In this episode, Ryan Ames OD, MBA, discusses medical necessity as more than just billing. It’s about doing the right thing for the patient and documenting accordingly. We also discuss the proper use of the 92000 codes and how to align clinical decision-making with compliant, confident coding. OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/  Ryan's Resource Understanding the Required Elements of a Comprehensive Ophthalmological Service (92004 and 92014): https://www.onespotbilling.com/blog/onespot-podcast-digging-into-medical-necessity-and-the-92000-codes   

If write-offs are creeping up or revenue is slipping through the cracks, it’s time to take a hard look at the front end of your revenue cycle. Strong, consistent time-of-service collections don’t just boost cash flow. They can significantly reduce the burden on your billing specialists and clean up AR problems before they develop. In this episode, I sit down with Jennifer Pankow, who brings more than 30 years of practice management expertise. Working with hundreds of practices nationwide, Jennifer shares practical, proven strategies to streamline workflow, improve cash flow, and better serve patients. Here’s what we cover: How to set up and maintain fee schedules, and why estimates on patient responsibility matter to revenue; Effective strategies for up-front patient collections; and, How to build reliable billing processes, with real-world examples and best practices. OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/ 

Hiring the wrong billing specialist can have a lasting impact on your eyecare practice. A poor fit can bleed revenue, wear down other staff, and even sour patient relationships. Over time, these issues erode trust. And compromise the financial health of your practice. But with the right hire? The opposite is true.  That’s why Melissa Jacobson, Director of Billing Operations at RevCycle Partners, says hiring for this role is less about technical know-how and more about finding someone with the mindset and skills to thrive in a constantly changing landscape. In our latest episode, you’ll learn: Why the billing specialist role is one of the most important in eyecare practices. The traits that matter more than billing experience. Smart strategies for crafting job descriptions and interview questions that reveal the right candidates. And more! OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/ 

Understanding all the various parts of Medicare and ensuring you’re getting paid correctly can be more complicated than expected. Too many practices learn this the hard way. Their claims are denied, their staff grows frustrated, and patient confusion often leads to lost revenue.  On this episode of the OneSpot Insurance Billing Podcast, Cindy Braden sits down with Casey Squicquero, Customer Support Manager at OneSpot. With 16 years of optometric billing experience, Casey has seen the most common Medicare billing mistakes—and she shares  how your practice can avoid them. Tune in to learn: Why credentialing with Medicare isn’t as straightforward as it seems. The key differences between Traditional Medicare, Advantage plans, Railroad Medicare, and DME credentialing. What every practice needs to know about QMB (Qualified Medicare Beneficiary) status and how it impacts patient payments. OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/  Resources from Casey Medigap (Medicare Supplement) Plans: https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits  CMS: Who are the Medicare Contractors for your state: https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs/who-are-macs#M… What’s New with Medicare: https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs/whats-new Qualified Medicare Beneficiary (QMB) Program Group: https://www.cms.gov/medicare/medicaid-coordination/about/qualified-medicare-beneficiary-program https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloa…

If you think aging reports are something to deal with later—think again. Your accounts receivable data tells the story of your practice’s financial health. And according to billing and coding manager at PECAA, Teri Thurston, too many practices are ignoring that story until it’s too late. In this episode, we discuss how aging reports can be used not just to clean up past-due claims, but to make strategic, forward-looking decisions that improve your cash flow, staffing, and even your payer mix. In this episode, you'll learn: Why aging reports should be part of your monthly review process—not an afterthought. What metrics and benchmarks reveal whether your billing cycle is healthy or hurting. How to use KPIs to guide staffing decisions, payer negotiations, and growth plans. How small, consistent billing improvements create big long-term gains. OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/   

To fix your insurance billing accounts receivable problems, sometimes you need to go upstream. That may mean taking a hard look at your eligibility and benefits verification process. In this inaugural edition of the OneSpot Billing Podcast, Cindy Braden interviews Acquios Advisor's Michelle Bogeart. With years of experience in optometric billing and practice management, Michelle offers actionable tips for creating workflows, avoiding common mistakes, and empowering team members to take ownership of the process. In this episode, you’ll learn: Why upstream processes like eligibility checks are important to reducing A/R headaches. How to build team buy-in. What tools and training resources Michelle recommends for ongoing billing success. Resources from Michelle Join Acquios Advisors in-person for the Insurance and Billing Workshop in Omaha, Nebraska, July 25-26, 2026!  Check out other events and workshops that they offer by visiting: www.acquios.com/events-workshops Register for Evolutions today! Summer 2025 Evolutions Workshop - Acquios Advisors Quick Tips – If you haven’t already, provide a quick reference guide for your team letting them know which plans you are in and out-of-network for. When scheduling the exam, collect patient demographic information including health insurance and vision plan information so that you can check Eligibility and Benefits prior to the day of the exam! Revenue Cycle Management Healthcare Solutions | Availity OneSpot Billing Resources Watch a preview of our OneSpot Billing Tool on your own time: https://www.onespotbilling.com/2025-preview-video-onespot-billing-tool  Visit us at our website: https://www.onespotbilling.com/ If you're ready to talk about how OneSpot Billing can optimize your billing process, reach out here: https://outlook.office365.com/book/[email protected]/