Ophthalmology Billing Services
Get Paid Faster, Reduce Denials, and Keep Patients Happy
Running an eye care practice means caring for vision, performing delicate procedures, and building trusting relationships with patients. The last thing you or your team should be doing is wrestling with confusing payer edits, ever-changing CPT codes, and claim denials. At Sirius Solutions Global we specialize in ophthalmology billing: we know the codes, the documentation, and the payer quirks that matter to eye doctors. Our goal? More accurate submissions, faster reimbursements, and fewer surprises so you can focus on patient care.
Our Ophthalmology Billing Services
We offer a comprehensive, customizable service set tailored to ophthalmology practices of all sizes:
Insurance & Benefits Verification (Pre-visit)
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Real-time eligibility checks, co-pay/deductible capture, and identification of services needing prior authorization (e.g., certain imaging or surgical services).
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Patient financial conversations scripted for higher collections at check-in.
Ophthalmology-Specific Coding & Charge Capture
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Accurate use of eye/procedure codes, E/M coding, diagnostic imaging codes (OCT, OCTA, FA), and surgical codes with correct modifiers and laterality. We stay current with CPT and Medicare changes.
Clean Claim Submission & Smart Scrubbing
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Automated and manual scrub workflows to catch obvious edits and payer-specific issues before claims go out improving first-pass acceptance.
Denial Management & Appeals
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Root-cause analysis for denials, targeted appeals, and long-term process fixes to prevent recurrence. We treat denials as data not just exceptions.
Accounts Receivable (A/R) Management
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Daily follow-up on outstanding claims, aging reports, and recovery workflows to reduce days in A/R and improve collections.
Patient Billing & Collections
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Eye-care friendly statements that separate medical vs retail charges, online payment options, payment plans, and patient support to minimize friction and preserve relationships.
Compliance, Audit Readiness & Documentation Support
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Documentation reviews, chart audits, and compliance monitoring (Medicare/local coverage rules) to reduce risk of recoupments. We provide checklists to help clinicians document medical necessity for high-value procedures.
Why Sirius Solutions Global?
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Lower denial rates and faster appeal resolution.
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Increased first-pass acceptance and improved net collection rates.
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Reduced A/R days, improved cash flow, and fewer administrative headaches.
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Proven track record in increasing collections for ophthalmology practices.
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Tailored RCM solutions with flexible engagement models.
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End-to-end billing services with 100% transparency.
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Back-office and compliance support to ensure smooth operations.
Why Ophthalmology Billing Needs a Specialist
Ophthalmology blends routine office visits with sophisticated diagnostic testing and high-value surgical procedures. That mix creates billing complexity:
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Eye-specific procedure codes (the “eye codes”) must be paired with precise diagnosis codes to pass automated payer edits. Mistakes lead to denials or underpayments.
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New and evolving codes for example, updates around OCT and OCTA coding require constant attention so your practice bills correctly and avoids rejected claims. (Notably, CPT updates in recent years added codes for OCTA and changed how some imaging is reported.)
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Ophthalmology often mixes clinical medicine and retail (glasses/contact sales). Reconciling retail revenue with medical billing requires careful workflows.
Because of these nuances, a general medical biller will miss opportunities and make costly errors. An ophthalmology-savvy RCM partner reduces denials and increases net collections.
Common Ophthalmology Billing Challenges & How We Solve Them
1. Incorrect Code Pairings & Laterality Errors
Problem: Eye procedures often require laterality (left/right) and specific modifiers; wrong combinations trigger denials.
How we solve it: Our coding team enforces laterality checks and automated validation rules before claim submission. We run weekly audits to catch systematic coding drift.
2. Imaging & Diagnostic Confusion (OCT, OCTA, Fundus Photography)
Problem: Payers have strict rules about what imaging qualifies for reimbursement and whether imaging can be billed separately. New codes and edit logic (e.g., OCTA code updates) add complexity.
How we solve it: We map each imaging procedure to payer rules and use claim-scrubbing logic that reflects current CPT guidance, so imaging claims pass edits or include the required supporting diagnosis.
3. E/M Coding After Guideline Changes
Problem: Changes in documentation and E/M guidelines caused miscoding at some practices.
How we solve it: We train your clinical staff on documentation best practices for E/M services and use templates that align with current guidelines to support billed levels.
4. Prior Authorization & Medical Necessity Roadblocks
Problem: Surgeries and advanced imaging sometimes require prior auth; missing those leads to denials.
How we solve it: We check prior auth requirements at scheduling, secure authorizations, and store approvals in the patient chart to prove necessity during appeals.
5. Mixed Retail/Medical Revenue Streams
Problem: Practices must separate retail (glasses/contacts) from medical services; misallocated charges cause accounting confusion and payment disputes.
How we solve it: We implement clear charge capture flows and statements that separate retail receipts from medical claims, improving patient clarity and accounting.
6. Denial Recurrence & Process Gaps
Problem: Same denial repeats because root causes (documentation patterns, payer rules) are not addressed.
How we solve it: We present denial trend analytics, recommended process changes, and staff training which reduces recurrence over time.
The High-Value Benefits You’ll See
When you partner with a specialized ophthalmology billing team, typical improvements include:
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Lower denial rates and faster appeal resolution.
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Increased first-pass acceptance and improved net collection rates.
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Reduced A/R days, improved cash flow, and fewer administrative headaches.
AI in Ophthalmology Billing
Artificial Intelligence (AI) is changing the way ophthalmology clinics handle billing. Sirius Solutions Global includes AI-driven tools that:
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Find coding inconsistencies automatically before claim filing.
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Utilizing past claims information, predict payer rejections.
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For Medicare audits, improve compliance in papers.
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Provide real-time dashboards for financial performance monitoring.
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Improve charge collection for regular vision treatment as well as medical.
Using artificial intelligence, we help ophthalmology clinics raise revenue integrity and cut claim refusals by up to 30%.
Who Benefits Most from Our Ophthalmology Billing Services
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Solo ophthalmologists who want to focus on patient care instead of paperwork.
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Multi-provider specialty practices and ambulatory surgery centers that perform cataract, retina, glaucoma, and corneal procedures.
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Practices adding retina/OCT/OCTA services that need precise coding and reimbursement expertise.
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