What we handle for ophthalmology practices
Billers are assigned by specialty, so the person working your claims already knows your codes and your payers.
Cataract and anterior segment surgery
Billed with correct laterality, global tracking and staged-procedure modifiers.
Intravitreal injections
Anti-VEGF injections billed with correct J-code units, eye modifier and documented waste.
Diagnostic imaging
OCT, visual fields and fundus photography billed within payer frequency limits.
Eye exams and refractions
Routed to the vision plan or the medical plan based on the reason for the visit.
Where ophthalmology claims usually go wrong
These are the four issues we see most often when we take over a ophthalmology practice.
Vision plan versus medical plan
A routine refraction is a vision benefit. A diabetic eye exam is medical. Sending either to the wrong plan denies.
Frequency limits on imaging
OCT and visual fields have payer frequency caps. Repeating them too soon is an automatic denial.
Eye modifiers
RT, LT and E1 through E4 must match the documented eye. Mismatches deny or pay the wrong amount.
Drug waste on injections
Single-dose vial waste is billable with documentation. Practices routinely leave it unbilled.
How we work
Eligibility, every day
Every next-day scheduled patient is verified for active coverage before the visit.
Charges validated
Codes and documentation are checked after the note is signed, before the claim is submitted.
Denials appealed
Every denial is reviewed, corrected and resubmitted. Nothing is written off by default.
Monthly reporting
Paid claims and AR aging reports so you can see exactly where your money is.
Ophthalmology billing questions
Something not covered here? Call (833) 305-5528.
Do you handle both vision and medical plans?
Yes. We determine which plan is responsible during eligibility verification, before the visit.
Can you bill for an ASC?
Yes, including facility claims for cataract surgery.
Do you track injection authorisations?
Yes, including remaining approved doses.