The Rising Demand for Retina Medical Billing Service amid Growing Surgeries

Retina care is one of the vital opthalmology that people in the US often face. Millions of US citizens Experience various issues related to retina and diabetic retinopathy is one of them.

You often need to provide advanced treatments that deal with injections, lasers and surgeries in retina care to help those patients.

You would be shocked to hear about the data on retinal disease in the nation. It rose to 20.8% in 2021 from 13.6% in 2001, indicating a significant rise in patients requiring retina treatments.

The overall number of retinal surgeries has also seen a steep rise because of retinal detachment surgeries as the Mass Eye and Ear itself handles almost 833 such surgeries every year.

The good thing is that ophthalmologists are also seeing a great success rate of 95% reattachments in single surgeries but that definitely comes with more post-operative care and hassles of managing retina medical billing services. Vitrectomy, a vital surgery behind treating most retina issues, has also taken the front-seat in the world of eye-surgeries with 250,000 procedures performed every year. The overall demand retinal medical billing services has been increased a lot because of the gigantic number of different retina surgeries.

It’s time to understand what retina medical billing service is and how a professional RCM company can help you.

Related Reading: Retina Medical Billing Services: Overcoming Biologic Drug Cost Challenges

Know what a retina medical billing service is:

A medical billing service for retina surgery is a systematic process that you need to follow for managing claims, coding and receiving proper reimbursements from your patients’ insurance companies.

You often perform vital surgeries and use injections like laser procedures, anti-VEGF drugs, OCT scans, etc and most of them are actually expensive procedures.

You don’t want to lose the money that you deserve for saving your patients from vision loss by performing severe surgeries like vitrectomies, retinal detachment repairs, and macular procedures. It is really imperative to follow an accurate billing process because of the delicate and time-sensitive nature of such surgeries. One of such complex surgeries is Vitrectomy. Diabetic retinopathy, macular holes, or vitreous hemorrhage are conditions where this surgery is used for treating. Each of these surgeries requires performing precise coding from your end and you can face a claim denial because of just one coding error. Ophthalmologists can face the loss of thousands of dollars as retina surgeries like retinal detachment are performed in a sheer volume. Your billing process becomes even more challenging as many retina procedures require you to combine drug therapies. You need to ensure comprehensive documentation process to properly justify the medical necessity and comply with payer regulations to bill each procedure perfectly. Your sole objective is to submit claims to your patients’ insurance companies to collect payments based on the coverage. We cannot deny the fact that a proper retina medical billing service has become imperative for you to stay away from poor cash flow and revenue loss.

The reality is that if you think managing a retinal billing process is just like handling the billing for other ophthalmology practices then you are wrong. Why? The following are the reasons-

Reasons that make retina medical billing service a complex affair:

Expensive treatments:

You need to be extra careful for injections like Lucentis, Eylea, or Avastin when it comes to ensuring a smooth billing process. The reason is simple: the expensive nature of those injections. It costs around $1200 to $2000 to purchase an injection called Luncetis, while Eylea may range from $1,800 to $2,100. What makes these expenses a real concerning matter is that your patients may need those injections on every month, making the costs add up rapidly over the course and creating a huge financial burden for you and patients. A single mistake can cost you thousands of dollars in terms of revenue loss because of such expensive drugs. You must ensure accurate coding, proper documentation and diligent claims submission in your billing process to get paid on time as it is the only way to provide your patients with the optimal level of care.

The hassles of managing prior authorization:

The majority of critical retina procedures need you to obtain prior authorization approvals from patients’ insurance companies and you can face big issues afterwards for not doing so. Your patients may face care delays in receiving urgent injections or going through surgeries they really need and you end up with revenue loss because of missing PA. Here is an example- you have already used an ongoing Eylea injection for a patient but you can still face denied claim because of not renewing PA. The uncalled denials can also be caused by using the wrong CPT or HCPCS code. Insurance companies tend to refuse covering treatments for providing incomplete documentation. Your staff members may need to spend extra hours on appeals and PA request resubmission because of a poor prior authorization service, leading to delays to payments and patient care. No patient appreciates care delays, and you can face reputational damage because of such issues.

Complex coding nature:

You need to assign CPT codes for retina procedures and HCPCS codes for drugs, requiring you to assign both the codes accurately. Some of the frequent codes that you often need to assign are-

• Intravitreal injections-67028
• Retinal detachment repair: 67108
• Panretinal photocoagulation: 67228
• Vitrectomy: 67036
• Aflibercept (Eylea): J0178

A single mistake in your coding process can cause a huge financial loss since most of your patients need repeated injections and surgeries.

We all know that codes are frequently updated by insurance payers and you can face immediate claim denials and hampered cash flow for assigning inaccurate codes.

Strict guidelines set by payers:

Each insurance body has its own set of rules. You may need to focus on providing additional documentation to some insurance payers while for others, you should receive PA approvals on time. Hence, you need to always stay updated to avoid the chance of facing claim rejections.

No wonder that both providers and patients suffer for poor retina billing services as providers face revenue loss and patients go through frustrating care delays. Your admin team also faces serious burnout as they need to spend hours on fixing claims instead of focusing on patient care.

Fortunately, you can still avoid all the challenges coming with the retina billing services. Wondering how? You can simply partner up with a professional retina medical billing company. Professionals in a medical billing company always know what it takes to implement the best RCM strategies to avoid all the major challenges that are mentioned above and ensure the best financial outcomes for your practice.

Related Reading: How do Ophthalmology Billing Services Deal with Modifier Misuse?

SunKnowledge: Your ready-to-go retina medical billing service partner

We are one of the leading RCM companies that work as your perfect operational extension in building a strong financial foundation. Our experts always know how to manage the end-to-end revenue cycle, covering both the pre and post-billing steps. Our experts also offer state-of-the-art virtual medical assistance services to streamline your practice management. The great thing is that you won’t even need to bother about training or knowledge transfer as we are one of the rare billing companies working on all the major billing software.

Our clients enjoy a 97% first-pass rate and save up to 80% in collection costs by partnering with us. We also have excellent references across multiple specialties including HME, DME, cardiology, radiology, gastroenterology, infusion, orthotics, and prosthetics at the most competitive-price of $7/hour only.