Staying Up to Date in Ophthalmology Billing
Keeping up with the latest ophthalmology billing codes is the best way to make sure your practice reduces denials and is properly compensated.
Ophthalmology billing is a particularly complex field because, unlike other medical fields, ophthalmologists must use two sets of codes: evaluation and management (E&M) and eye codes. It’s important for your staff to know the difference between the two types of ophthalmology codes and how to accurately use them.
Eye Codes: Eye codes cover both general and specialized ophthalmological services, including those for spectacles and constant lenses, as well as more specific codes for prostheses. Eye codes also cover how frequently patients can access certain services, such as eye exams.
Evaluation & Management Codes: These are much more specific compared to eye codes. E&M codes relate to the evaluation and management of a patient and should only be used when a visit to an ophthalmologist has a medical element, like a physical exam or a medical treatment based on an assessment.
Figuring out which treatment should be billed using eye codes or E&M codes often presents a double challenge to your staff, and simple mistakes can lead to the denial of a claim.
What are the common ophthalmology billing errors?
When claims are denied, it’s usually because of one or more of the following problems:
- Lack of patient information, lack of verification, or patient ineligibility
- The procedure performed does not match the diagnosis
- Incorrect codes were used
- Invalid or missing coding modifiers
- The procedure is not approved by the insurer because it’s considered experimental
- The patient has already received maximum benefits and is ineligible for further treatment
It can be difficult to keep up to date on the latest ophthalmology codes, specific payer rules, reimbursement rates, and necessary examinations. All of this can lead to support staff and doctors spending more time than necessary dealing with cumbersome billing-related problems.
Outsourcing your ophthalmology billing for better compliance
Eye Care Billing Consultants know the challenges that ophthalmologists face. We are a medical billing company dedicated exclusively to the specialty of Ophthalmology, and we help ophthalmologists automate their billing practices for better compliance and easier workflow. Our goal is to make billing easier and more efficient, so your practice can reduce its claims denial rate and maximize its revenue cycle management.
We do more than just submit claims – our systems help avoid ophthalmology coding errors, and our experienced billers provide service and support using the latest billing technology. All of this helps our clients achieve the highest collection rate possible.
If your practice is struggling with its billing practices or is facing challenges with denied claims, contact Eye Care Billing Consultants today to find out the myriad ways we can help your practice stay up to date with coding and billing.
