Specialties We Support

We assist all ophthalmology professionals, including:

✅General Ophthalmologists (MD/DO) – Specialists in medical and surgical eye care.
✅Retina Specialists – Experts in treating retinal conditions like diabetic retinopathy and macular degeneration.
✅Glaucoma Specialists – Providers focusing on managing and surgically treating glaucoma.
✅Cornea & Refractive Surgery Specialists – Experts in LASIK, PRK, corneal transplants, and keratoconus management.
✅Pediatric Ophthalmologists – Specializing in childhood vision disorders, strabismus, and amblyopia.
✅Oculoplastic Surgeons – Specializing in reconstructive and cosmetic eyelid surgery.
✅Neuro-Ophthalmologists – Managing optic nerve diseases and neurological vision disorders.

All-in-One Ophthalmology Services

1. Credentialing & Payer Enrollment

Ophthalmology providers must be credentialed with both medical and vision insurance payers to bill for routine eye care, surgical procedures, and medical treatments. Our services ensure a hassle-free credentialing process with quick approval.

✅Medicare, Medicaid & Commercial Insurance Credentialing
✅Vision Insurance Enrollment (VSP, EyeMed, Davis Vision, Spectera, etc.)
✅EDI, ERA, and EFT Enrollment for Electronic Transactions
✅Re-Credentialing & Contract Renewals

2. Medical Billing & Coding for Ophthalmology

Ophthalmology billing requires expertise in both office visits and surgical coding, including cataract surgeries, glaucoma treatments, retinal procedures, and oculoplastic surgeries. We optimize claims processing to maximize revenue and reduce denials.

✅CPT & ICD-10 Coding for Eye Exams, Procedures & Surgeries
✅Medical vs. Vision Insurance Coordination for Proper Reimbursement
✅Pre-Authorization & Eligibility Verification for Eye Surgeries
✅Claims Submission, Denial Management & Appeals
✅Billing for Optical Sales, Contact Lenses, and Specialty Lenses

3. EHR/EMR Setup & Integration

Ophthalmology requires specialized EHR software to document visual acuity, diagnostic imaging, surgical procedures, and treatment plans. We assist in EHR selection, setup, and integration to enhance efficiency.

✅Ophthalmology-Specific EHR Setup & Customization
✅Integration with Optical Labs, Diagnostic Imaging, and Surgery Centers
✅Telemedicine & Remote Eye Exam Solutions
✅HIPAA-Compliant Data Security & Documentation Support

4. Compliance & Regulatory Support

Ophthalmology practices must comply with HIPAA, Medicare, and commercial payer guidelines to avoid compliance risks. Our team ensures adherence to all billing and documentation regulations to prevent claim denials and audits.

✅Medicare, Medicaid, and Private Insurance Compliance
✅MIPS & MACRA Reporting for Value-Based Reimbursement
✅Audit Readiness & Risk Management for Ophthalmology Practices
✅State-Specific Licensing & Credentialing Assistance

5. Revenue Cycle Management & Practice Growth

Our end-to-end revenue cycle management (RCM) solutions help ophthalmology practices streamline collections, minimize denials, and increase cash flow.

✅Financial Performance Analysis & Revenue Optimization
✅Payer Contract Negotiation & Fee Schedule Adjustments
✅Practice Expansion Consulting & Growth Strategies
✅Marketing & Referral Network Support for Ophthalmologists

Types of Ophthalmology Services Billed

✅Comprehensive Eye Exams & Medical Evaluations (CPT 92004, 92014)
✅Cataract Surgery (CPT 66982, 66984)
✅Glaucoma Laser Surgery & Treatments (CPT 65855, 66761, 66170, 66172)
✅Retinal Laser Procedures (CPT 67145, 67210, 67228)
✅Intravitreal Injections (CPT 67028)
✅Optical Coherence Tomography (OCT) (CPT 92133, 92134)
✅Fluorescein Angiography (CPT 92235, 92240)
✅Visual Field Testing (CPT 92081, 92082, 92083)
✅Corneal Transplant Surgery (CPT 65710, 65730, 65755)
✅LASIK & PRK Refractive Surgery (CPT S0800, S0810, 65799)
✅Blepharoplasty & Oculoplastic Surgery (CPT 15823, 67900, 67904, 67908)

Required Knowledge for Successful Ophthalmology Billing

1. Vision vs. Medical Insurance Billing

Understanding which services are billed to medical vs. vision insurance is critical. Routine exams and refractions go to vision insurance, while eye diseases, surgeries, and medical treatments are billed to medical insurance.

2. Pre-Authorization & Medical Necessity Documentation

Many ophthalmic procedures require prior authorization, such as cataract surgery, laser treatments, and intravitreal injections. Proper documentation ensures approval.

3. Surgical Modifiers & Coding Accuracy

Ophthalmic surgery billing involves specific CPT codes and modifiers that impact reimbursement rates. Understanding global periods, co-management billing, and postoperative care coverage is essential.

4. Medicare, Medicaid & Commercial Payer Policies

Medicare covers medically necessary eye treatments but not routine exams, while Medicaid varies by state. Knowing payer policies prevents denials and revenue losses.

5. Optical & Retail Billing Compliance

For practices that sell glasses, contact lenses, and specialty lenses, handling insurance reimbursement vs. cash-pay services correctly ensures compliance and profitability.

Why Choose Solubillix for Ophthalmology Practice Management?

✔ Seamless Credentialing & Insurance Enrollment for smooth reimbursements.
✔ Specialized Billing & Coding Support for Ophthalmic Procedures & Surgeries.
✔ Comprehensive EHR & Practice Management Integration for workflow optimization.
✔ End-to-End Revenue Cycle Management to Maximize Reimbursements.
✔ Compliance & Audit Readiness Solutions to Ensure Billing Accuracy.
✔ Custom Solutions for Individual & Multi-Specialty Ophthalmology Practices.

Get Started with Solubillix Today!

Let us handle the complexities of billing, credentialing, compliance, and revenue cycle management, so you can focus on delivering exceptional eye care. Contact us today to see how we can support your ophthalmology practice!