As an Ophthalmology Practice, you have unique billing issues.

Whether it is how to bill appropriately for cataract surgeries or understanding payer rules for billing refractions.

At Strategic, we monitor changes in your specialty area that result from CPT-4 changes, new coding edits, or even areas of focus from the Office of the Inspector General.

We communicate with Practices through our one-on-one meetings and through our Billing Alerts to ensure you understand the ever-changing payer rules.

Ophthalmology is one of the more complex billing areas and has been faced with several challenges over the last few years:

  • Surgical Procedures. We understand the complex guidelines for surgical procedures including bundling rules, decision for surgery requirements, modifiers, and global periods. By providing the right documentation at the time of claims submission, we improve your cash flow. By understanding the payer’s internal edits, we improve your collections.
  • Thorough denial review process. At times, an insurance company’s internal edits result in an inappropriate denial. All denials are reviewed by our certified coders and appealed when needed. Nothing is adjusted off unless the denial is valid, so you can be assured you are getting paid the money you deserve.
  • Variations among payers on how and when to use modifiers. We know what each major insurance company expects and work with you to get the right information to payers, so your claim gets paid correctly the first time.
  • Routine versus medically necessary eye care. Our knowledge in this area helps you avoid situations where patients may be left with large balances—ones that may never get paid.


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