Best Practices for Retina Medical Billing in 2026

 

The retina billing process is highly intricate as it incorporates advanced procedures, complex modifiers, and costly injections. However, the payer rules for drugs like Lucentis or Eylea is highly strict as small errors leads to significant financial loss. That is why you need to stay updated with the latest rules to make sure no claim denial occurs. It is important to optimize the billing and coding process to make sure no claim denial occurs. It reduces payment errors and speeds up the reimbursement process. As your healthcare staff stay busy with administrative tasks, that’s why it can be a feasible option to outsource retina medical billing services in that matter. But before diving into how they can help, let’s understand the best billing practices for your clinic. 

Best Practices in Retina Medical Billing 

Timely billing promotes quicker payments and reduces all the AR balances, which can significantly increase the clinic’s cash flow. However, delayed patient statements can significantly lead to several revenue collection challenges, which is why establishing a consistent billing cycle helps the patients know all their financial obligations. The retina billing starts from conducting insurance billing daily to keeping DSO under 45 days. Let’s dive into all of them one by one: 

Conducting Insurance Billing Daily 

Submitting all the insurance claims daily improves the clinic’s cash flow, minimize billing backlogs, and reduces claim processing. Prompt and accurate claim submission makes the payers detect all the errors early, which reduces the aging AR and write-offs for timely filling. That is why all the charges need to be submitted and coded within 1-3 days of the service date. Hence, scrubbing all claims prior to submission verifies coding accuracy and reduces claim rejection.  

Completing Patient’s Insurance Eligibility Verification 

Verifying the insurance eligibility in two weeks or around 24 hours before patient appointment can significantly prevent all the coverage issues and reduce claim denials. Moreover, you also need to confirm the patient’s coverage; pre-authorization requirements and co-payments are also highly beneficial. The retina medical billing services are highly proficient at this. 

Monitoring All the Collection Ratios 

Tracking all the collection ratios over time can improve your revenue cycle process significantly. However, the challenges may include payer delays, systematic issues, and coding inaccuracies which need immediate action. Here, always calculate your monthly net collection ratio and compare it to all same periods over previous years and months to identify trends. So, regular meetings with your staff ensure all the billing inaccuracies are found and solutions are correctly implemented. 

Limiting AR Ove 90 Days 

A high AR percentage of over 90 days can signify all the payer issues and collection inefficiencies. However, keeping this metric below 15% makes sure cash flow is stable. Monitoring all the AR aging reports is important to identify the delinquent account for prompt resolution. All the staff need to follow up with patient balance and outstanding claims. Finally, make sure all the procedures and policies are in place for timely payment resolution. 

Keeping DSO Less than 45 Days 

Take time to monitor and manage Days Sales Outstanding (DSO) and measure the average days to collect payment for all the rendered service. However, maintaining a DSO of 40-45 days is important, as higher DSO can increase the risk for revenue loss significantly. DSO is also beneficial to track the speed of payment collection, identify the late payers, and provide early warnings into potential issues.  

How Does the Outsourced Retina Medical Billing Services Help? 

The retina billing companies stay updated with all the latest CPT, ICD and HCPCS codes to make sure no claim denial occurs. Moreover, they also streamline the prior authorization process by verifying the patient’s insurance eligibility, collecting important documents, and then submitting PA requests to make sure no issue occurs. However, the in-house teams come with a high cost because you need to train them and also buy expensive office space for them. On the contrary, the outsourced experts stay updated with the latest regulations and don’t need any separate office space. Finally, they also know how to work with the clinic’s EHR system to protect patient data and know all the complex processes of the Electronic Prior Authorization (ePA). 

These outsourced experts help with patient intake, eligibility verification, prior authorization, coding, claim and denial management, finally, Accounts Receivable (AR) management. These outsourced retina medical billing services can reduce your operational costs by 80% and work with 10% buffer resources. They also provide dedicated account managers at no extra cost and have no binding contract or restrictive clause. These experts also provide assistance with other specialties like DME, gastroenterology, infusion, cardiology, and many more specialties. These companies provide dedicated employees having US phone numbers and have less than two days of turnaround time. So, if you want to streamline your billing process, it might be a feasible option to outsource external experts in that matter. Hence, take the step today and see the difference.