The maximum achievements in ophthalmology billing derive from the collections and their efficiency. In other words, they are achieving maximum productivity with minimum wasted effort or expense. To have an efficient patient and revenue flow in the ophthalmology practice, it’s important to increase the overall patient experience. When the time doesn’t get extended, patients will definitely appreciate it. Their appointments will be on time. They will not be left in exam rooms unattended, and will not have to repeat information to technicians, doctors, and other staff.

But, the more important point is the efficiency in the ophthalmology billing and collections practice.

  • Patients will become frustrated when their claims are returned or denied due to reporting errors
  • Irritated patients can lead to negative online reviews about your practice and the potential for a slowing in lead generation
  • The longer it takes to have claims approved, the longer your practice will wait to get paid
  • Unrecoverable claims due to missed filing deadlines result in lost revenue for your practice.

Let’s see how to improve ophthalmology billing and collections efficiency.

  • The first and foremost thing is to thoroughly understand that the role of billing and collection is not limited to the billing department.
  • The entire team plays a crucial role in the process. In addition to it greeting patients as they enter the practice, the front desk staff should be gathering and verifying the following information as accurately as possible:
  1. Insurance verification
  2. Demographic data
  3. Address or insurance changes
  4. Co-payment collection
  5. Deductible collection
  6. Account review
  • Healthcare professionals and technicians are responsible for ensuring that all of the services provided are appropriately identified and coded so that the billing staff can submit the proper codes for reimbursement.
  • In case the charges are not filed correctly, healthcare professionals cannot submit them for reimbursements.
  • The more efficiently billing staff can collect accurate information, the more professionals can encounter collections.
  • If not, they will have to undergo a specific process where they will have to indulge in arguments with insurance companies.
  • Claims that are denied due to missing information or incorrect coding should be the exception rather than the rule in the healthcare practice.
  • Rather than investing in staff training, it would be worth it to invest in outsourcing medical billing companies that take care of the complete revenue cycle system.

While helping the staff learn the intricacies of ophthalmology billing and coding, keep those skills up-to-date with the constant changes in the field that will go a long way to help the practice get paid faster.

Even a tiny mistake in the data entry can, in fact, result in denials and unnecessary processes to correct the issue.

Reporting for Success:

  • One can monitor the success of your efforts by requiring your billing and collection department to provide monthly reports with the following information:
  1. Insurance Accounts Receivable % Current Aging Bucket
  2. Insurance Accounts Receivable % Older than 90 Days
  3. Patient Accounts Receivable % Older than 90 Days
  4. Days in Accounts Receivable
  • It’s also vital to review these reports regularly so that professionals can identify areas where the processes are struggling so they can implement changes.
  • The reason might also be that the billing and collection staff is overwhelmed.
  • The other reason is that they would need more training to submit cleaner claims or they aren’t getting clean information up-front and constantly having to chase knowledge.

The process becomes too overwhelming in ophthalmology billing:

  • Keeping all the billing and collection processes in-house doesn’t make sense. In that case, outsourcing will save your day!
  • When healthcare professionals choose to outsource, they must ensure to select a billing partner with extensive experience specifically in ophthalmology billing.
  • The complexities of ophthalmology billing may prove to be just as overwhelming for an external billing company if they do not fully understand the process that applies to your specific patient care.
  • It could result in more denied and rejected claims and loss of revenue of the healthcare practice.
  • Outsourcing companies understand the necessity of efficiency in billing practice for ophthalmology billing to grow.
  • Partnering with efficient billing companies with specific ophthalmology billing and collection knowledge, to access their exceptional services at a reduced rate can boost the revenue capacity of the practice.

Eye Codes: When to use 92004 instead of E/M? 

  • Ophthalmology billing and coding get a little tricky because ophthalmology professionals and optometrists get to use E/M codes or CPT codes 92002-92014.
  • Even though CPT codes are non-specific for office visits in most cases, ophthalmology brings its own code range for these services.
  • So, how do you choose them? Generally, while reporting CPT codes, pick the code that most clearly describes the service the eye professional provided.
  • For cases when the ophthalmology professional evaluates eye function or performs a routine eye exam, report an eye code.
  • In case the healthcare professional estimates a disease process of a more systemic nature, write an appropriate E/M code.
  • For example, when a new patient attends a chief complaint of difficulty in reading road signs, the professional is supposed to do a comprehensive examination checking visual acuity and visual fields, retinas, ocular movements, and intraocular pressure.
  • This is an exam of eye function, so report CPT code 92004. On the other hand, when a patient is with chronic blepharitis whose chief complaint is a recent sensation of a foreign body, the patient mentions a recurring headache as well during the history.
  • Slit-lamp reveals a lash is rubbing the cornea on the painful eye, and refraction shows increased hyperopia, which could explain the headache.
  • It’s recommended to consider an E/M code for this particular scenario, as long as the documentation of history, exam, and medical decision-making meets the level of E/M service.
  • Getting the best coding options entirely depends on the quality of the clinical documentation. Sometimes clinicians also feel frustrated by the amount of time and energy it takes for them to document.
  • Many practices, therefore, go for outsourcing their billing and coding services, especially when it comes to specialty billing and coding practices.

To spot a quick way to find out ophthalmology billing codes, choose to get your services from an outsourcing medical billing company to boost your compliance. Have a quick search to find out better medical billing companies to make your practice much more straightforward.

2022 Ophthalmology Billing and Payment Updates

According to the latest changes of the CMS, effective from January 1, 2022, ophthalmology is looking towards some critical changes in the billing and coding system. With the new physician pay schedule in place, it is also important for the revenue cycle teams to look into the changing trends of code usage and maximizing revenue. Here are some points that should help you stay on top of the 2022 ophthalmology billing and payments.

Changes in Combination Codes

Ophthalmology billing and coding experts feel that combination codes are one of the biggest changes applicable in the 2022 calendar. The combination codes mean taking two separate codes for the treatment and making a new code to represent them both. However, only one gets paid and not the second, thereby increasing the sophistication of the code usage. The new combination codes in play are 66989 and 66991.

Deletion and Addition of Codes

Codes 0191T and 0376T, used for iStent or Hydrus respectively, stand deleted as per the new notification. 0671T will be used for using an iStent or Hydrus without the involvement of a cataract sugery. The point to note for revenue cycle managers is that according to FDA, these devices can be billed only in case of the involvement of a cataract surgery. Therefore this service is unlikely to be covered by the insurance company and you would need to focus on patient collection in this case.

68841 is a new Category I code in use currently. Category III codes added as per the new notification are:

  • 0660T
  • 0661T
  • 0687T
  • 0688T
  • 0699T
  • 0704T
  • 0705T
  • 0706T

Changes in Code Descriptions

Codes 67141, 67145, 92065, and 99211 have undergone changes in their code descriptions. Vital point to note here is that codes 67141 and 67145 are now described as minor surgeries with 10 days of post-operative care. Earlier they used to be major surgeries with 90 days of post operative care.

Payment Trends

Some vision codes have had changing trends with respect to their use and payment rates. Though it is not an exhaustive list, data gathered from ophthalmologists support the following trends:

  • Codes 67141 and 67145 will bring lesser reimbursement for the surgeon due to their recent switch over to minor surgeries.
  • Glaucoma surgeries are down by 9% in reimbursement rates. This however does not include trabeculectomy and aqueous shunts to an external reservoir.
  • The cataract surgery code has been going down in the last few years. Keeping up with that trend, code 66984 has reduced by 4%.
  • Strabismus surgery code 67312 has decreased by 10%. Other strabismus surgery codes 67311 and 67314 have fallen by 20%.

As the complexity and the sophistication of the ophthalmology coding increase, it could get quite challenging for the in-house staff to keep up with the workload. Consider outsourcing the job to experienced revenue cycle management companies who can sort this out for you with their excellent resources and expertise in vision billing services.

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