Achieve Profitable Growth through Cardiology Medical Billing
Ophthalmology practices operate in a highly specialized environment that demands accuracy, compliance, and efficiency in medical billing. From complex diagnostic testing to advanced surgical procedures, ophthalmology billing requires in-depth knowledge of CPT, ICD-10, and modifier coding rules, along with a thorough understanding of Centers for Medicare & Medicaid Services (CMS) guidelines. At Max Healthcare Billing, we help ophthalmology providers achieve profitable and compliant growth by managing every aspect of their revenue cycle. Our dedicated billing team ensures accurate claim submission, timely reimbursements, and adherence to all CMS and payer-specific policies.
Professional Achieve Profitable Growth through Ophthalmology Medical Billing—With CMS Compliance
Ophthalmology practices operate in a highly specialized environment that demands accuracy, compliance, and efficiency in medical billing. From complex diagnostic testing to advanced surgical procedures, ophthalmology billing requires in-depth knowledge of CPT, ICD-10, and modifier coding rules, along with a thorough understanding of Centers for Medicare & Medicaid Services (CMS) guidelines.
At Max Healthcare Billing, we help ophthalmology providers achieve profitable and compliant growth by managing every aspect of their revenue cycle. Our dedicated billing team ensures accurate claim submission, timely reimbursements, and adherence to all CMS and payer-specific policies.
Understanding the Importance of CMS Compliance
CMS compliance is the foundation of accurate and sustainable medical billing. In ophthalmology, following CMS guidelines protects your practice from claim denials, payment delays, and potential audit risks. Common areas that require close attention include:
- Correct CPT and HCPCS Code Usage:
Procedures such as visual field testing (92081–92083), fundus photography (92250), and OCT imaging (92133/92134) must meet CMS documentation and medical necessity requirements. - Global Surgical Package (GSP) Rules:
CMS defines specific global periods for ophthalmic surgeries such as cataract extraction (66984). Services provided during the global period are bundled unless modifier exceptions (e.g., -24, -79) are applicable. - Appropriate Modifier Application:
Modifiers including -25, -59, -RT, and -LT must be applied correctly to ensure proper reimbursement and compliance with CMS claims processing rules. - Medical Necessity and Documentation Standards:
Each billed service must be justified by medical necessity and supported by complete, clear, and accurate documentation as per CMS guidelines. - Adherence to NCCI Edits and Bundling Policies:
The National Correct Coding Initiative (NCCI) defines which CPT codes can be billed together. Regular updates from CMS must be reviewed to prevent unintentional billing errors.
Our Key Performance Indicators
Customer Retention
Revenue Improvement
Number of Claims
Turn Around Time
Reduction in A/R
Account Receivable
Value of Claims
First Pass clean claims rate
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