Retina care is considered as one of the most important specialty in the US as it deals with the patient’s eye. Several million US citizens face several issues, and diabetic retinopathy is one of those issues. Here, you need to provide all the advanced treatments which deals with lasers, surgeries, and injections in the retina care to help these patients. Believe it or not, you will be shocked to know the impact of retinal disease in the US. The number rose from 13.6% from 2001 till 20.8% in 2021, which shows a rise in the number of patients needing retina treatments. The number of retina surgeries has also seen a major rise due to retinal detachment surgeries, as the eye handles around 833 surgeries yearly. As the healthcare staff stays busy with administrative hassles, this is why outsourcing to retina medical billing services can be considered as a feasible option.  

Describing Retina Medical Billing  

The medical billing is considered a systematic process that you can follow to manage claims, coding, and get necessary reimbursements for the patient’s payer. It is difficult to make the billing process accurate as it has a time-sensitive nature due to several surgeries. Macular holes, vitreous hemmorrage and diabetic retinopathy are such conditions where you need to use surgery to treat your patients. Always make sure to create a documentation process to justify all the patient’s medical necessities and complies with the payer regulations. Your major objective is to submit claims to the insurers to collect all the payments based on their insurance coverages. However, you cannot deny that a proper medical billing service is important for you to stay away from cash flow issues.   

Why Retina Billing is a Complex Affair?  

These reasons range from expensive treatments to maintaining strict payer guidelines. Let's dive into them one by one:  

Expensive Treatment Process  

Always be extra careful for injections like Avastin, Lucentis, or Eylea because the billing process of these injections are highly complex. You may have to spend $1200 to $2000 while purchasing Lucentis injection, while Eylea may range from $1800 to $2100. The patients may require injections every month, which can rapidly increase the cost. Always remember that a single mistake can lead to thousands of dollars' worth of revenue loss due to the expensive drugs. Hence, always make sure to do accurate coding, proper claim submission, and proper documentation process to give your patients the best care possible, and the outsourced retina medical billing services help with that.   

Managing Prior Authorization  

For the majority of retina procedures, always obtain the prior authorization approvals from the patient’s insurers and you can face major issue if you don’t do it dilligently. For example, if you use ongoing Eylea injection for a patient, you can still face claim denials because of not renewing prior authorization. Moreover, wrong CPT or HCPCS codes can also lead to claim denials as the insurers doesn’t refuse all the covered treatments for giving incomplete documentation procedure. The staff members may spend a long time resubmitting the PA request due to poor prior authorization service, which can also lead to claim denials. Always remember that none of the patients creates care delays, and you can face damage due to such issues.  

Complex Nature of Coding  

Always assign CPT codes for all the retina procedures and HCPCS codes for all the drugs, hence needing you to assign all the relevant codes perfectly. Some of the codes you need to assign include 67028, which is for intravitreal injection, 67108 for retinal detachment repair, and many more. A single coding mistake can create a major financial loss, as most patients need repeated surgeries. However, all the codes are frequently updated by the payers, and if not handled correctly, you may face claim denials.  

Strict Payer Guidelines  

The insurers have their own set of rules, and you need to give additional documentation to several insurers, and for others, you need to receive all the PA approvals on time. So, you need to stay updated to make sure no claim denial occurs. The clinics and patients suffer from retina billing as clinics face revenue loss and patients go through care delays. The administrative team faces staff burnout as they spend hours fixing claims instead of focusing on patient care. Here, the outsourced experts come in handy as they can tackle the billing procedures.  

How Do the Outsourced Retina Medical Billing Services Help?  

The third-party experts stay updated with the CPT, ICD, and HCPCS codes to protect patient data. Moreover, they can also reduce the clinic’s operational costs by 80% and work with 10% buffer resources to make sure no employee shrinkage occurs. Furthermore, these services provide dedicated account managers and the best infrastructure setup according to the client’s needs. These experts also help with other specialties like orthotics, gastroenterology, infusion, cardiology, and many more specialties. So, if you want to streamline your billing process, it can be a feasible option to outsource retina medical billing services in that matter. Hence, take the step today and see the difference.