How Retina Medical Billing Experts Turn Denials into Profits

 

Retina care is considered as one of the most important cares in ophthalmology. You care for patients who suffer from complex eye problems, perform several tests, and manage surgeries and laser treatments. You can run your clinic smoothly when the clinical side stays strong and is dependent on the outsourced experts. However, the reality is that handling the retina billing procedure is not an easy affair as it has a specific code set.  

You need to handle all the strict rules set by Medicaid, Medicare, and private payers. So, you may face denials, revenue loss, and payment delays for a single documentation process. Most clinics get overwhelmed with billing issues, but with the right approach, you can convert that to significant revenue opportunities. As the clinical staff stay busy with administrative hassles, that’s why outsourcing to a reputed retina medical billing company can be a feasible option. But before diving into how they can help, let's understand all the challenges of retina billing in detail: 

Challenges in Retina Billing 

Retina billing is a different procedure than the ophthalmology billing process. The billing process of laser photocoagulation, intravitreal injection and vitreoretinal surgery are highly complex. Each of them has different components, and coding reflects the correct service levels. Each small error can trigger audits significantly.  

Documentation Issues 

It is highly important to ensure previse documentation to make sure no issue occurs. Most clinics cannot justify the patient’s medical necessity and face claim denials because of incomplete documentation. Always remember that a claim can be denied if your patient note doesn’t justify retinal injection. 

Prior Authorization 

There are several procedures which need prior authorization from the patient’s insurers, which add significant administrative burden to the clinics. The clinics lack resources and cannot submit all the claims on time. Hence, this delay slows down the treatment process. 

Payer Audits 

Audits are a necessary part of billing as the private and government payers audit the ophthalmology clinic. Always remember that external audits eat a lot of time and resources. So, you will face penalties and payment issues if you are not prepared for audits. 

Regulatory and Compliance Risks 

The retina process incorporates several compliance risks as you need to be aware of the HIPAA, Medicare rules and other policies. However, you can face fines and audits if you do not comply properly with the billing process. It is highly important to provide constant education to your staff members.  

Resource and Staff Limitation 

Most of the small retina clinics don’t have staff members to manage billing jobs. All the in-house staff members lack specialized RCM knowledge and eventually end up with loss of payment and denials. The staff members may make more mistakes when they are overburdened. 

How Can You Convert These Challenges into Revenue? 

It is possible to turn the table to make retina billing as your revenue source. Below are some strategies which you can use to increase cash flow, boost clinic’s profitability, and reduce denials. 

Investing in Training 

It is important to train your members in a proper manner to make sure no issue occurs. Each member of the team should understand all the retina codes and procedures to streamline the claim submission process. These members also need to stay updated with all the latest rules and regulations to make sure no claim denial occurs. 

Improving the Documentation Process 

Accurate documentation process is the key to improving your clinic’s revenue. All the staff members need to record all details when they use all the checklists, templates, and also standardized forms. Clear notes are highly important to prove the patient’s medical necessity; hence it reduces the chance for claim denials.  

Leveraging Technology 

The efficiency of your clinic increases significantly when you use the right technology. You can track claims, automate claim submission process, and manage the coding process using a robust system. The advanced systems are useful to detect errors before claim submission.  

Improving the Prior Authorization Procedure 

Prior authorization is one of the important components of retina medical billing which often delays the revenue process. You need to use clear workflows, communicate effectively with payers to ensure timely PA submission requests to keep your revenue on track. 

Performing Regular Audits 

Always identify and fix problems by streamlining the internal audit system. These audits are helpful to check documentation issues, coding accuracy, and claim status. So, timely internal audits are highly important to prevent claim denials. 

Why There’s a Dire Need to Outsource Retina Medical Billing Services 

As the healthcare staff stay busy with administrative hassles, that’s why it can be a feasible option to outsource external experts in that matter. These third-party companies can reduce your operational costs by 80% and work with 10% buffer resources to make sure no issue occurs. They also provide dedicated account managers and the best infrastructure setup to make sure no issue occurs. Moreover, these outsourced companies provide less than two days of turnaround time.  

They stay updated with all the latest coding regulations such as CPT, ICD, and HCPCS codes. Moreover, these outsourced services also know how to streamline the PA process to make sure no issue occurs. They know how to work with the clinic’s EHR process and know the Electronic Prior Authorization (ePA) procedure to submit claims electronically. So, if you want to streamline your billing process, it may be a feasible option to outsource retina medical billing companies in that matter.