Premium IOLs, anti-VEGF billing, drug waste codes. Ophthalmology billing is not simple.
Premium IOL billing inconsistencies, anti-VEGF wastage that never gets captured, and ASC economics that your practice accounting swallows whole. Fifteen minutes, no cost, no sales pitch — we show you where to look first.
15 minutes. Custom financial scorecard for your practice.
At a glance
Is This Right for You?
This is for ophthalmology practice owners who:
Want ongoing financial oversight? Our Fractional CFO service for ophthalmology practices may be a better fit.
What We Analyze
Where Ophthalmology Practices Lose Revenue
We trace every dollar from claim submission to bank deposit in your ophthalmology practice.
Surgical Coding Accuracy
- •Cataract surgery coding review (66984 vs 66982, modifier usage)
- •Premium IOL upgrade billing compliance
- •Femtosecond laser billing and patient consent documentation
- •Complex anterior segment surgery coding
Injection & Drug Billing
- •Anti-VEGF injection coding and documentation review
- •Drug wastage billing (JW modifier compliance)
- •Buy-and-bill vs specialty pharmacy cost comparison
Medical vs Refractive Billing
- •LASIK/PRK consultation medical exam charge capture
- •Medical necessity documentation for surgical procedures
- •Cosmetic and elective procedure billing separation
Optical & Ancillary Revenue
- •Insurance billing for medically necessary eyewear
- •Contact lens fitting and supply billing review
- •Diagnostic testing charge capture (OCT, visual fields, photography)
Results
What Ophthalmology Practices Recover
| Finding | Typical Outcome |
|---|---|
| ASC reallocation | Corrected cost sharing increased practice reported profit by $340K |
| Premium IOL margin | 22% to 38% margin through pricing and implant cost negotiation, adding $121K annually |
| Optical shop improvement | 12% to 28% margin through vendor consolidation, adding $89K annually |
Case Study
Real results from a practice like yours
3-surgeon ophthalmology practice with ASC ownership, optical shop, and 2 employed optometrists. Total revenue across the practice and ASC was $8.2M, but the owner-surgeons each took home less than they expected. Nobody could clearly explain the financial relationship between the practice, ASC, and optical shop.
What we found:
- •ASC cost allocation was subsidizing practice overhead by $340K annually. The practice looked profitable, but only because the ASC was absorbing shared costs disproportionately
- •Premium IOL upgrades were generating $380K in patient revenue but the practice was only capturing a 22% margin due to untracked implant costs and underpriced upgrade fees
- •The optical shop was running at a 12% margin when the benchmark is 25 to 35%. Frame purchasing was fragmented across three vendors with no volume negotiation
- •Anti-VEGF drug wastage billing (JW modifier) was not being submitted, resulting in $74K of unbilled drug waste per year
The results
Corrected cost sharing increased practice reported profit by $340K
ASC reallocation
22% to 38% margin through pricing and implant cost negotiation, adding $121K annually
Premium IOL margin
12% to 28% margin through vendor consolidation, adding $89K annually
Optical shop improvement
“We were a $8 million practice and nobody could explain where the money went. The ASC was hiding half the problem.”
— Managing Partner, South
Common Questions About Revenue Cycle Analysis for Ophthalmology Practices
Find out where your ophthalmology practice revenue goes.
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