Every practice owner wants to submit clean claims to get paid fast and in a timely manner. But anyone who is involved in ophthalmology billing knows that it’s not that easy. Any small errors in billing can impact your revenue. Let’s talk about ophthalmology billing tips that will help you stay in compliance, and in the money.
Ophthalmology Billing Tips:
Eye Codes and E/M Codes
Ophthalmology is not like other specialties, as it has two sets of codes to choose from for ophthalmology billing. Your medical biller may confuse while choosing any one of these two sets of codes.
To choose the correct code your biller must check payer rules, medical necessity requirements, the exam elements performed by you, and the reimbursement rates for the medical codes you are considering.
As a practice owner, ensure the following to reduce denials and get paid promptly:
- Diagnosis code(s): Eye codes are more limited as to what diagnosis meets medical necessity, and the exact codes can vary by payer. However, E/M codes don’t share those similar limitations.
- If the visit has a medical element then you should use E/M codes. When the exam is strictly visual and contains no medical elements, an eye code is the right choice.
- Patient history is important as eye codes have frequency edits. For example, provide is limited to billing code 92014 once in a year period per patient. E/M codes do not share those similar frequency edits.
- E/M codes require documentation, and its standardized across all payers, the required documentation for eye codes may vary
Out-of-Network Billing
Many providers result in out-of-network at some point. We at Medical Billers and Coders (MBC) can take care of your risk including denials, delayed payments, and violations of fraud and abuse laws.
There are some best practices in out-of-network billing:
- Always stay transparent with patients about practice out-of-network status
- Provide estimation of patient payments upfront to avoid balance billing
- Do not make a routine to waive patient co-pays or other out-of-pocket payments. This may be considered an incentive to refer, violating the anti-kickback statute
- Charge payment on claims must be the same that you use to calculate the patient payment
Patient Billing Statements
Normally patient billing statements are confusing. It is good practice to make your statement clear, simple, and easy to read. In case patient statements are not clear then you are increasing your practice A/R days, and unnecessary frustration from your patient. To keep patients satisfied with your practice’s services then keep patient billing statements clear and precise.
Payers Updates
Commercial, as well as Medicare, have different coverage determinations and ophthalmology billing guidelines. Even in Medicare, the individual MACs will differ as to how they want providers to code a bill and what required documents they want to see. To submit clean medical claims you need to be updated with each payer’s guidelines.
Accurate Billing for Diagnostic Testing
Auditors always keep their eyes open whenever they check for Ophthalmology billing for diagnostic tests. Every provider needs to pay attention to use the right modifiers, meet medical necessity guidelines, and document clearly and complete the services provided by you.
About Medical Billers and Coders
Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions.
We are crucial in supporting physicians with precise and streamlined medical billing services. For more information, call us at: 888-357-3226 or email us at: info@medicalbillersandcoders.com
FAQs
1. Why is it important to submit clean claims in ophthalmology billing?
Submitting clean claims ensures timely payments and minimizes revenue loss from billing errors, which are common in ophthalmology.
2. What are the two sets of codes used in ophthalmology billing?
Ophthalmology billing uses eye codes and E/M codes; choosing the correct one depends on the medical necessity and elements of the exam performed.
3. How can out-of-network billing be managed effectively?
Practice transparency with patients, provide upfront payment estimates, and avoid waiving co-pays to stay compliant and reduce denials.
4. What should patient billing statements look like?
Patient billing statements should be clear, simple, and easy to read to minimize confusion and reduce accounts receivable days.
5. Why is staying updated with payer guidelines essential?
Different payers have varying coverage determinations and billing guidelines, making it crucial to be informed to ensure clean claims and reduce errors.
