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Ophthalmology is often riddled with complications when billing out charges for various encounter types.

There are numerous CPT codes and conditions to deal with in order to correctly submit your claims.  Depending on your practice, you may bill for services provided in hospital settings as well as patients seen in your office.
Practicing ophthalmologists perform a variety of tests as well as exams on a given patient which will generate an abundance of claims, involve multiple payors and can result in a myriad of claims issues.  Having an experienced medical billing team, with visibility into performance, is vital to your practice’s financial health.

Etransmedia’s team of certified coders have the kind of experience necessary to ensure your Ophthalmology practice will maintain consistent cash flow while increasing collection rates. All of our coders are certified either through the AAPC or AHIMA and uphold the ethics and standards of the profession. Additionally, our billers and coders work with your staff to learn the nuances of your practice so as to be aware of known issues. They will provide feedback on coding scenarios that need attention and possible correction how

What we know…

  • Ophthalmology services are rendered on any age group and are at a higher level of complexity than that of an optometrist.

  • This specialty is more “disease” and “condition” related than simple visual acuity not affected by other conditions.

  • Refractions that are rendered in the office are not payable by insurances so should be treated as a “self pay” service, hopefully with that payment collected at the time of service.

  • Ophthalmology is considered “medical” as opposed to “vision” services by the insurances

  • Certain conditions can be age related (ie: cataracts, glaucoma).

  • There are specific CPT codes used by Ophthalmologists for their exams as opposed to standard E&M coding.

  • Corrective surgery can be done either in an ASC or in a hospital setting.

Here are some of the complications that are affecting Ophthalmology revenue collection procedure:

  • Omitting modifiers causes denials for “duplicate” tests.

  • Annual review and update of your fee schedule so as to add new CPT codes deactivate deleted codes, checking to be sure that your fees are priced correctly so as to maximize your payments.

  • Collecting the CO-Pay’s at the time of service as much as possible will help to minimize losses when patients do not pay after being billed.

  • Obtaining proper authorization for the services.

  • Making sure that you are in the patients “network” so as to ensure payment.


On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases. 

Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.


First Pass Clean Claim Rate


Boost in Revenue*


Reduction in Cost*

Amazing Result

We’re always on top of all the latest coding and billing updates for ophthalmology practices.
Additionally, to make sure all claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date of what is happening in their practice so that any issues can be addressed quickly. The outcome of these processes and more is our clients have a streamlined revenue cycle with increased collection rates.

Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.

*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others

Service and Technology Packages

Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice


Silver RCM Service

This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.


Gold RCM Service

This package includes the core RCM services with added denials, A/R management services, and full service patient billing


Ancillary RCM Services & Technology

Available to enhance any package


Improve your revenue by letting our services handle your revenue cycle process


Full-featured solution packages customized to focus on what your practice needs


Building, managing, updating, submitting, tracking, and verifying credentialing applications is a necessity


Connect2Care® is a turnkey solution that improves workflow and financial results.

The group at Etransmedia has handled my billing and managed my contracts for more than a decade. They are trustworthy … Read More >
- Stephen Lutz MD

President, Eastern Woods Radiation Oncology

When my former billing company decided to close abruptly, I contacted Etransmedia to help me set up my own business… Read More >
- Ann Aring, MD, FAAFP

Assoc Program Director, Riverside Family Practice Residency Program

Just a note to say ‘thanks’ – having Etransmedia handle the billing was one of the best decisions this Board has ever made … Read More >
- Paul Hardick

Cumberland Valley Counseling Associates

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