Medical Billing Tips for Ophthalmology

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Medical Billing Tips for Ophthalmology
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 its not that easy. Any small errors
in billing can impact your revenue. Lets 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.  
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Medical Billing Tips for Ophthalmology

• 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 dont 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

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Medical Billing Tips for Ophthalmology

• 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 practices
  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 payers guidelines.

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Medical Billing Tips for Ophthalmology
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_at_medicalbille
rsandcoders.com