MedCare MSO is committed to making your RCM system more efficient than ever before. We provide ophthalmology billing services built around certified, experienced coders and billers who understand the clinical and payer-specific nuances of eye care so your practice gets paid accurately and faster.
MedCare MSO is dedicated to providing outstanding ophthalmology medical billing services as part of a full revenue cycle management solution, including certified & experienced coders and billers who stay current on CPT changes, payer policy shifts, and documentation requirements unique to ophthalmology.
Ophthalmology billing requires knowledge of various coding procedures. Billing errors can cause difficulties with claims. Many of the eye care services fall under more than one kind of insurance, such as Medical Insurance and Vision Plan. Medical insurance carries protection against cataracts, glaucoma, and eye diseases, while vision plans take care of regular check-ups and spectacles. Additionally, insurers and government payers frequently change their policies and plans, and coverage rules may even vary by state. This is exactly why practices turn to dedicated ophthalmology billing services rather than trying to keep every rule current in-house. MedCare MSO’s ophthalmology billing services assist clinics in accurately following billing procedures with both medical and vision insurance, thereby minimizing rejections and improving payments.
Ophthalmology is not just one specialty, but a collection of specialties, each of which imposes its own requirements for coding and documentation. Our qualified ophthalmology billing service caters to all the subspecialties so that the clinics deal with a single vendor in all their related endeavors.
All this change makes it impossible for busy medical staff to keep up with the latest billing guidelines. Outsourcing to a professional medical billing company like MedCare MSO has proven to be very successful for practices of all sizes. Because our ophthalmology medical billing services are not medical, but only focused on the revenue cycle management (RCM) aspect, we are able to stay up to date on billing and coding changes so your clinical staff can stay focused on patients.
Streamline your ophthalmology revenue cycle with expert support built around your practice needs.
Medical codes are complicated, and it is difficult for individual billers to stay abreast of all the changes. MedCare MSO provides an innovative approach to billing and coding, with a staff that is not only certified but also experienced in ophthalmology insurance billing. Billing done in-house can be thrown completely off if one person becomes ill or is called away on an emergency, but our large staff has someone ready to step in if the regular person doing the billing is not available. One of the clearest advantages of choosing to outsource ophthalmology billing services rather than manage it internally.
Ophthalmology billing modifiers must be used with basic medical billing codes to notate whether both eyes were affected, or if it was left or right. If a minor procedure is done on the same day as an office visit, a modifier is needed. Billers and coders must also know how to code for multiple procedures in the same setting, etc. Getting this right consistently is one of the reasons practices trust dedicated ophthalmology billing services instead of general medical billing vendors.
Charges for services are often bundled together, which simplifies coding, but it also requires medical billers and coders to be aware of what is in each bundle because sometimes the physician may determine that something additional is needed or substitution is required. Billers must know how to document additions and exceptions properly, or those services will be considered unnecessary and rejected by payers. Our ophthalmology billing & coding services team tracks these bundling rules closely so nothing gets left unbilled or incorrectly billed.
Our ophthalmology billing experts handle a wide range of commonly used CPT codes, including 92002–92014 for ophthalmological evaluation and management services, 92081–92083 for visual field examinations, 92133–92134 for OCT imaging of the retina and optic nerve, 92250 for fundus photography, 66984 and 66982 for cataract surgery with IOL insertion, 67028 for intravitreal injections, and 65855 for laser trabeculoplasty. We also accurately apply key modifiers such as RT, LT, 50, 25, and 59 to ensure proper laterality, same-day service reporting, and accurate claim submission.
Ophthalmology may be covered by insurance companies, and it is also covered by Medicare/Medicaid, but billers also have to be aware of which to bill. Before billing Medicare, the biller must make sure that no other insurance can be billed, including a spouse’s employer plan, Railroad Retirement, if the patient is a member of certain unions or has VA benefits, and even whether there is an injury covered by no-fault insurance. This kind of payer coordination is a routine part of our ophthalmology billing and collection services, and it’s exactly the kind of detail we build into every engagement.
With 7–14-day claim turnaround and expertise across 50+ specialties, streamline your practice’s billing, reduce delays, and recover more revenue with MedCare MSO.
The billing processes we employ offer a consistent and transparent structure. We ensure that every aspect of our ophthalmology billing services is organized to maintain the quality of the results and meet our clients’ expectations.
Verification of eligibility for the appointment, insurance benefits available, and vision versus medical plan coverage.
Use of proper coding standards for the processing of charges on the basis of the provided documentation.
Examination of all claims to ensure their compliance with payer requirements prior to submission to improve chances for acceptance.
Posting of payment information and adjusting it to ensure correct matching with claims received.
Early detection of refusal cases and preparation of the necessary claim files for the repeat submission process.
Analysis of all claims processed helps physicians to be aware of what happens with their claims.
Behind our full, end-to-end AI-driven ecosystem designed to reduce manual work at every stage of the revenue cycle. Together, these tools support our ophthalmology billing RCM services.
An EHR built to work seamlessly with our billing and coding workflows, reducing the back-and-forth between clinical and billing teams.
Ambient AI scribing that captures the encounter and helps generate documentation to support clean, defensible claims.
AI-assisted coding support that helps apply accurate CPT, ICD-10, and modifier combinations based on clinical documentation.
Practice management software that keeps scheduling, eligibility, and billing data connected in one place.
Yes. MedCare MSO provides medical billing and revenue cycle management for both ophthalmology and optometry practices. Our certified, experienced coders understand the coding and payer requirements unique to eye care, so claims are accurately submitted and reimbursed for the full range of services your practice provides.
Ophthalmology billing requires precise modifiers to show whether the left eye, right eye, or both eyes were treated. MedCare MSO’s ophthalmology coders apply the correct modifiers when a minor procedure is performed on the same day as an office visit, or when multiple procedures occur in one setting, preventing denials.
Yes. Payer credentialing is part of MedCare MSO’s full suite of ophthalmology billing RCM services, alongside denial management, compliance reviews, and annual payback. We keep providers properly credentialed with payers to help prevent claim delays and keep the revenue cycle running smoothly.
Yes. MedCare MSO’s ophthalmology medical billing services work alongside your existing ophthalmology EHR/EMR and practice management software, so there’s no need to switch systems. We can also provide our own AI Scribe, AI Coder, and ophthalmology billing software if your eye care practice would like to upgrade.
Yes. MedCare MSO’s ophthalmology billing specialists are trained on HIPAA best practices, so your patient information is always managed appropriately and securely. Compliance is built into how our certified billers and coders handle every claim, keeping your practice protected and audit-ready.
Before billing Medicare, MedCare MSO’s ophthalmology billers confirm no other insurer should be billed first, including a spouse’s employer plan, Railroad Retirement, certain union or VA benefits, or no-fault injury coverage. Our specialized ophthalmology billing services prevent rejections and ensure your claims are paid correctly the first time.
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