Other than making the case for “Hooked on Phonics” in a way that only a word with so many twists and turns could. Ophthalmology billing is tricky because you have “eye codes” and “evaluation and management codes”. While this does make billing for this specialty more flexible, it also adds a little confusion. There are so many variables in the coding that goes with the claims you submit. To begin you have to confirm that your diagnosis code meets the medical necessity. This is a tricky spot because each payer’s standards for this are completely different. You’ll also want to make sure that you use the correct code, if the visit is strictly visual and contains no medical elements or treatments you should use an eye code. You’ll also want to review a patient’s history because eye codes have use of frequency edit. Some codes can only be used one time in a 12-month period. You’ll also want to verify the guidelines that are set out by the payers that you are billing, the eye codes are known to vary from payer to payer. If you’re billing out of network you may be opening yourself up to an increased number of denials, late payments, and even fraud and abuse lawsuits. The best thing you can do if you’re treating a patient who is out of network is be transparent about this and let them know upfront what is expected of them, verbally and in writing. You will do your best by estimating how much they will have to pay prior to being treated. This all seems like it might be such a standard practice, but in many practices, it isn’t. If you’d like to simplify your Ophthalmology billing, the Gables Medical Billing team is ready to get your revenue cycle management working the way you need it to, and get your payments posted in a timely manner.
