Cutting-Edge Billing Services Tailored for Ophthalmology
Experience Increased Profitability with Hassle-Free Ophthalmology Medical Billing.
End-to-End Revenue Cycle Management for Ophthalmology Clinics
Ophthalmology treatments cover a wide range of eye care services, from routine vision exams to complex surgical procedures for conditions like cataracts, glaucoma, and retinal disorders. Owing to the diversity of treatments and frequent regulatory updates, ophthalmology billing is complex, requiring precise coding and stringent compliance to avoid claim denials.
Outsourcing ophthalmology billing services ensures accurate coding, timely reimbursements, and reduced administrative burden, allowing ophthalmologists to focus on patient care instead of navigating intricate billing processes. With expert medical billers handling claims, practices can loosen administrative burden, minimize errors, maximize revenue, and stay fully compliant with evolving healthcare regulations, improving both financial health and workflow efficiency.
Unbeatable Service, Quality & Price
ACCURACY
0
%
TURNAROUND TIME
<
0
Hours
COLLECTION
0
%
PRICE
Starting from $
1100
/Month
CHALLENGES
Challenges in Ophthalmology Medical Billing
Misuse of E/M vs. Eye Visit Codes: Selecting Evaluation and Management (E/M) codes instead of eye-specific visit codes—or vice versa—can result in billing inaccuracies and reimbursement issues. To address that, it’s important to work with ophthalmology coding experts who align documentation with the chosen code and, when both options apply, choose the code that offers higher reimbursement while maintaining compliance.
Incorrect Use of Modifiers: Wrong or missing modifiers like -LT, -RT, -25, -50, -78, -79 can lead to claim denials and revenue loss. Common errors include coding bilateral procedures as unilateral and failing to unbundle services that should be billed separately. Outdated CPT or ICD-10 codes also cause automatic rejections. An ophthalmology billing company like us apply the correct modifiers to ensure accurate billing, prevent denials, and maximize reimbursements.
Ophthalmology RCM Issues: Declining Medicare payments, rising practice costs, and the proposed 2025 fee schedule cuts threaten ophthalmology practice sustainability, making underpayments a critical concern. Our ophthalmology revenue cycle management team tracks reimbursements against contracted rates, ensuring every owed payment is recovered. Effective contract management secures financial stability, regulatory compliance, and quality patient care.
OUR PROCESS
Our Ophthalmology Medical Billing Process Workflow
At RCM Workshop, we follow a methodical workflow to offer specialized ophthalmology billing services. It involves a series of steps to ensure accurate claim submission and timely reimbursements. We start with patient registration and insurance verification, followed by pre-authorization for procedures when required. Medical records are then documented and coded using precise CPT, HCPCS, and ICD-10 codes before claims are submitted to payers for processing. After submission, we track claims for approval and address any denials promptly through resubmission or appeals.
Once practices get payments, we post them and reconcile them against expected reimbursements. Patient billing follows, ensuring outstanding balances are collected efficiently. Our solutions pass all compliance monitoring to optimize revenue cycle performance while staying within regulatory guidelines. Outsourcing ophthalmology billing to professionals like RCM Workshop streamlines this process, reducing errors, minimizing denials, and maximizing revenue flow for ophthalmology practices.
Scheduling & Registration
Carry out well-coordinated appointment scheduling, update insurance details, and handle inbound and outbound calls from/to patients.
Eligibility & Benefits Verification
Confirm primary and secondary insurance and benefits coverage of patients and verify their coverage, co-pays, co-insurance, and deductibles.
Prior Authorization
Initiate request for prior authorization with the payer, follow up to check its status till closure and finally update the system with Auth approval reference number.
Medical Coding
Check the accuracy of codes and modifiers according to specialty and assign corresponding and appropriate charges to the codes.
Charge Posting
Enter the charges for the services provided into the billing system including the cost of the medication and the administration fee.
Claims Edits & Submission
Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.
Payment Posting
Carry out both auto as well as manual posting for payments received and conduct reconciliation against claims.
Denial Management
Analyze and categorize denial claim according to denial codes, $ amount and payers, and resubmit claims after correction.
AR Management
Follow-up with payers to gather status for unpaid claims, and their resolution.
Patient Collection
Sending patient statements and follow-up with patients for final and outstanding payment.
You can confidently rely on us to manage your entire billing process, or you have the flexibility to select specific DME billing services that suit your needs, ensuring a seamless operation without any interruptions.
BENEFITS
Outcomes Guaranteed
We leverage cutting-edge industry practices and data-driven methods to streamline RCM for ophthalmology practices while maintaining top-tier quality standards. Our focus goes beyond revenue management—we aim to boost financial performance. With customized ophthalmology billing solutions tailored to your workflow, we ensure smoother operations and significantly enhanced financial outcomes.
WHY US?
Why partner with us
Outsourcing ophthalmology medical billing services to RCM Workshop helps practices reduce administrative burdens, minimize claim denials, and ensure compliance with constantly changing regulations. With our experts handling all coding, reimbursement tracking, and insurance verification, ophthalmologists can focus on patient care instead of navigating complex billing processes. Our professional billing services maximize revenue by ensuring claim accuracy, preventing underpayments, and accelerating reimbursements. Experience improved cash flow and streamlined operations to grow without being held back by billing challenges.