Medical Billing

Tips for Efficient Ophthalmology Medical Billing

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“Lead your practice to profitable revenue cycle management with optimal Ophthalmology medical billing services”

An ophthalmologist, otherwise known as an eye care specialist, spends most of their time treating disorders of the eye. From primary vision care to surgical procedures, these healthcare providers are always surrounded by patients. Even though this medical branch is a subspecialty, this doesn’t limit the scope of their work.

Although treating patients is an ophthalmologist's core responsibility, they must keep their practice profitable. This is certainly possible, but it comes with challenges that become a reason for a care provider’s stress. The goal of submitting clean claims and getting adequate reimbursement is achievable. Making the medical billing process feasible with some tips will not only solve administrative difficulties but also maximize revenue.

In case the complexities persist, healthcare providers can get help from any medical billing specialist or a medical billing company.

This blog is a discussion on ophthalmology medical billing with tips to maintain billing and coding effortlessly. By the end of this blog, you will understand this topic in detail.

Let’s start with defining ophthalmology medical billing and getting to know it’s different features.

Explaining Ophthalmology Medical Billing

Ophthalmology medical billing is the process of getting reimbursement for the treatment and procedures rendered to patients during their visit. This process includes various steps where the end result is compensation for services.

The process begins with patient verification and leads to data recording and claim submission. After that, the insurance company verifies these claims, and healthcare providers get their due revenue. However, sometimes claims get denied and in that situation, there is a chance of rectification and resubmission.

The main component of this process is billing and coding as it is essential for a growing ophthalmology practice. Usually, all the major mistakes in the medical billing process happen in this step. This is because coding is not just complex, it is also vast in number.

The branch of ophthalmology treats a wide range of eye disorders and offers care services for cataract, proptosis, thyroid eye disease, eye tumors, Glaucoma, macular degeneration, retinal detachment, endophthalmitis, refractive errors and many more.

This makes the process of ophthalmology medical billing extensive and hard to handle. Also, the world of medicine is constantly evolving, which amplifies the need to follow regulatory guidelines diligently.

Complex Ophthalmology Coding

There is a multitude of codes under ophthalmology, but a major division is Eye Codes (CPT) and Management Codes (E/M). An understanding of the difference between these codes drastically reduces the probability of errors.

CPT codes are specific to ophthalmological procedures and treatments. However, E/M codes are based on patient data such as their history, and physical examination.

CPT/HCPCS codes are called procedure codes but there is one more category of codes which is ICD-10 codes; ICD-10 are diagnosis codes. Generally, diagnostic codes are coupled with procedure codes during claim submission.

Maximize Revenue with these Tips for Ophthalmology Medical Billing

The process of ophthalmology medical billing is a hassle for healthcare providers, but it is necessary in terms of revenue.

Here are some viable tips to improve ophthalmology billing and enhance the overall performance of the practice:

Recognize the Requirements of the Billing Process

The process of medical billing is a framework of different steps where every step has its significance. Missing the details of even any one step would hamper the overall performance. Understanding the process is essential to recognize the needs at different stages to get a positive outcome.

A better billing practice requires insightful knowledge of subspecialties and the different codes attributed to them. There must be clarity of CPT and E/M codes to bill the claims accurately.

Apart from that, other factors of consideration are insurance guidelines, medical necessity requirements, possibility & reasons for errors, and rate of receiving timely reimbursement.

Taking care of these components will improve the quality of each claim and help in getting complete reimbursement.

Error Free Patient Information

Simple errors in patient information can lead to major losses of the practice. This highlights the need to focus on accurate patient verification and documentation. Failure in this leads to chances of errors and missing details. Usually, such errors occur due to manual recording or improper data entry.

Prevention of minor mistakes like incorrect data or typing errors is the responsibility of the provider. If the provider maintains the accuracy of the information and keeps patient data up to date, the possibility of claim denials will be reduced.

As a healthcare provider, you must be aware of the consequences of making such errors. Therefore, taking measures to correct this drawback is essential to improve revenue cycle management and workflow.

Once managed correctly, the positive impact will be a boosted bottom line.

Ensure Accuracy of Codes

As we discussed earlier, ophthalmology billing codes are unique. A wide array of diagnosis and procedure codes are a major cause of confusion.

To avoid any confusion, you must carefully choose between different codes at the time of filing. Be precise with the nuances of eye codes and E/M codes to eradicate errors in coding.

You can achieve proficiency in coding by ensuring the accuracy of additional aspects of recording and coding. Choose the right codes based on the medical necessity of the patient and check if that aligns with insurance coverage. Along with that, check patient history to determine various edits in codes.

This way you will choose exact codes and get your desired revenue.

Prevent the Risk of Out of Network Billing

Out-of-network billing is highly risky as it leads to denials, rejections, and delays in payments. But if you happen to bill out of network, you must take care of certain factors.

First, you must disclose this fact to your patients that you bill out of network. If the patient is unaware of this, then explain the financial policies to avoid confusion.

Discard the idea of patient co-pays or out-of-pocket payments. This will help you prevent the violation of the anti-kickback statute.

Further, to enhance performance, focus on creating balanced billing and valid charges to get revenue on time.

Keep your Bill Submission Prompt

Claim submission is bound between a stipulated time where every claim must be submitted within the specific time. These due dates are decided by the insurance company and a failure to submit them on time will result in a disrupted revenue cycle.

So, the point of attention is that the submissions can’t be made either before the due dates or after the due dates. If the submission is done before the due date, there are chances of claims getting misplaced or lost.

On the other hand, if you fail to submit claims within the due date, your claims can get denied.

Therefore, be more careful with the time of claim submission and make sure you don’t face the consequences. Make prompt submissions to get reimbursement on time.

Monitor Outstanding Balances

No medical billing process ends with the submission of claims. The same goes for ophthalmology medical billing. The real task is to monitor outstanding balances as a major part of revenue is trapped in them.

If claims get denied, there is a responsibility to carry out a denial management process to recover the lost revenue. In the case of AR, there must be a follow-up procedure to reduce AR days and get valid compensation.

The bucket list of responsibilities includes tracking, analysis, correction, and resubmission of claims to get maximum reimbursement.

Outsource Ophthalmology Billing Services

Handling the whole process of ophthalmology medical billing is tedious and not every healthcare provider’s strength.

That is why outsourcing ophthalmology billing services can get you maximum results in terms of financial stability and receiving reimbursement.

An outsourcing partner will take away the burden of medical billing. As a result, healthcare providers will have more time to offer quality patient care.

Benefits of Ophthalmology Medical Billing Services

  • The experience and specialization of professionals will lead to better coding, claim submission, and revenue cycle management. They will ensure accurate coding, timely submission and proper denial and AR management.
  • A dedicated team will reduce the overall administrative burden. As a result, the stress related to medical billing will be eliminated giving healthcare providers trouble-free environment for patient care.
  • A single billing partner will take care of all the aspects of the process. This will not only save time, but also lead to cost efficiency. It is cost-efficient as healthcare providers no longer need to hire or train or in-house billing.
  • The services of a billing partner will improve the efficiency of revenue cycle management. This streamlining will benefit the practice by reducing payment delays, minimizing claim denials and boosting the cash flow.
  • Maintaining compliance will also become effortless. The billing partner will follow all the regulatory requirements and protect from legal or financial consequences.
  • Overall, ophthalmology medical billing services will result in scalability, flexibility, focus on patient care, and faster reimbursement.

Why Choose Unify Healthcare Services

Unify Healthcare Services is a leading medical billing company with years of experience in ophthalmology medical billing. Our expertise in the specialty makes way for optimum financial stability and gains. Our team takes care of every step in the process to prevent revenue leakage by eliminating errors. Our proficient coders understand the different codes specific to ophthalmology. We take extra care to deliver custom solutions to all the challenges for maximum reimbursement.

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