Best Ophthalmology Billing Service

FC Billing provides billing and coding services for Ophthalmology in all states in USA. Proper billing and coding is an essential part of a successful Ophthalmology practice.

Ophthalmology and Optometry have a unique set of codes which are not used by any other specialty. These codes are referred to as Eye Codes. Having a thorough understanding of when to bill Eye Codes and when to avoid them is crucial to Ophthalmology billing success. Evaluation and Management (E&M) codes have new criteria since January 1, 2021. E&M codes are now chosen based on medical decision making and time.

Billers need to maintain fee schedules for all insurances with their contracted rates. Then billers and doctors can make informed decision on proper coding. There are also restrictions on which testing and procedures can be performed on same day as well as frequency limits on tests and procedures. Many Ophthalmology practices lose large amount of money each year for not following these guidelines.

FC Billing professionals participate in educational courses with American Academy of Ophthalmology on a regular basis. We attend Ophthalmology professional meetings and maintain Ophthalmology billing certification. We are well versed in Ophthalmology billing and coding and look forward to creating success for Ophthalmology practices.

Common Ophthalmology Billing Issues

1. Coding

CMS has published updated Evaluation and Management (E&M) criteria on January 1, 2021. Many Ophthalmology practices are still struggling with billing correct level of E/M codes; some practices even avoid billing E&M altogether. Billers has an important role of educating everyone involved about billing code requirements and conduct audits for correct use of these codes.

Ophthalmology Medical Billing

2. Frequency Edits

Insurances have frequency limits on services Ophthalmologist can provide to patients. Some limits will depend on insurance plans and others will apply for all plans. Below is a list of frequent CPT codes used by Ophthalmology which have frequency limits:

  • 99202 – 99205
  • 99212 – 99215
  • 92004
  • 92002
  • 92083
  • 92134
  • 76514

3. Payer Requirements

Ophthalmology provides many different types of services for treatment of eye diseases. Services include evaluation, testing, medication management, procedures, and surgeries. Insurances have different policies for each of these services. Some tests cannot be billed bilaterally; some services may have frequency limits and other documentation requirements. Some codes have bilateral payments and some have unilateral payments.

For this reason, billers need to be well informed about modifiers and local coverage determination. They also need to know how to properly link diagnosis codes to individual services in order to get claims paid.

cute girl at eye exam in ophthalmology clinic

4. Diagnosis Requirements

CPT (Current Procedural Terminology) codes on a claim indicates which services were performed and diagnosis codes indicate the reasons for the services. If insurance approved diagnosis codes are not linked with services, claims will not be paid. Billers have to have an in-depth understanding of insurance requirements in their state, referred to as local coverage determination (LCD). They should also know when to use diagnosis codes to indicate pathology for both eyes and when to split them into different diagnosis codes to indicate separate eyes.

Many Ophthalmology practices are regularly underpaid on claims for using incorrect order of diagnosis, CPT, or modifiers.

5. Modifiers

Modifiers are extremely important for claim submission. Incorrect use of modifiers often leads to underpayment on claims. Not using correct modifiers may result in claim denials as well. Ophthalmology practices lose large amount of money each year for not using modifiers correctly. It is also important to keep in mind that improper use of modifiers increase the chance for audits and insurance refunds as well.

FC Billing Ophthalmology Billing Services

FC Billing professional billers and coders manage accounts for all sub-specialties of Ophthalmology.

1. Cornea

We bill for all types of cornea related treatments. Our billers and coders understand the need for MIPS documentation, lifestyle questionnaire for cataract surgery, billing guidelines for premium lenses and catalyst lasers, and co-management.

2. Retina

We bill for Retina Surgeon’s office treatments as well as in-patient and out-patient surgeries. We are well versed in coding for injectables.

3. Glaucoma

We work with Glaucoma specialists for in-office, out-patient, and in-patient services. We work with American Academy of Ophthalmology to stay updated on new laws, regulations, coding change, audits, reimbursement, and all other aspects of Glaucoma billing. 

4. Pediatric Ophthalmology

We help Pediatric specialist with coverage verification, prior-authorization, billing for surgeries and emergency services, claim appeals, peer-to-peer review, and much more.

5. Oculoplastic

There are strict documentation guidelines for Oculoplastic surgery and procedure. We work with insurance companies to get all claims paid and submit and follow-up on all documentation requirements as well.

Steps for Ophthalmology Billing Success

We have been successful in increasing practice earnings for all our providers.

1

Verification of Benefit

We verify patients’ eligibility and benefits. Our verification covers primary, secondary, tertiary, and all other applicable coverage. For any insurance issues such as coordination of benefit, termed policy, suspended policy, we inform the practice prior to the visit. 

2

Prior Authorization

We review all referrals for validity and restriction. We also obtain any needed prior authorization for procedures and surgeries. We put detailed notes in patient file with call reference numbers and insurance company’s instructions.

3

Claim Scrubbing

We review exam notes to ensure documentation includes supporting evidence for services. If there is any missing information, we alert doctors to make needed addendums. We submit claims with service lines in sequence for highest reimbursement. We also review documented information on the claim for accuracy. Our goal is to get claims paid with first submission and as quickly as possible.

4

Follow-Up

We pursue all unpaid claims and get them paid as soon as possible. We also process all insurance refunds, submit appeals, and complete all other needed follow-up. Any claim that goes beyond 60 days becomes our priority. We only take our eyes of a claim once it is fully paid.

Benefits of Working with FC Billing for Ophthalmology Billing

  • Over a decade of Ophthalmology billing experience
  • AAO billing and coding certified
  • Effective work strategy
  • Mastery of insurance requirements
  • We work with physicians in all states in USA
  • Member of American Academy of Ophthalmology (AAO)
  • Senior instructor in AAO meeting
  • We work with local insurance contracts
  • We can increase practice’s profit
  • HIPAA certified
  • HIPAA compliant
  • Expertise in insurance credentialing
  • Payment on all claims

Three Easy Steps – That’s All That It Takes

OPHTHALMOLOGY MEDICAL BILLING-growing financial chart
Sign up for initial meeting
Practice evaluation
Set profitable goals

FAQ

Ophthalmology billing companies may have different contract setups. We work on a percentage basis. Our Ophthalmology billing service comes with a 100% guarantee on insurance claim payment.

Account Receivable represents lost income. The best business policy is to keep AR as low as possible. To do that, payments must be brought in as close to the service date as possible. Any action that can be taken presently to avoid income loss should not be put off till the next day.

We work with provider’s EHR and EMR, so there is not integration or downtime.

We provide, daily, monthly, and on-demand reports.