How to Avoid Common Ophthalmic Billing Rejections: Part 2

Referring Physicians on Ophthalmic Tests for Medicare


Continuing our series on “Common Billing Rejections,” we turn now to ophthalmic testing with Medicare patients. Many codes require a referring or ordering physician in order to process the claim. These include pachymetry, fundus photos and OCT.

Referring or rendering physician?

In most cases, the referring or ordering physician may be the same as the rendering physician. However, failure to include this information will result in a denial and delay payment on the claim. Medicare often splits codes off from the rest of a claim in order to process codes. For example, this is most often seen with pachymetry when billed concurrent with an exam—Medicare will split off the pachymetry to return a denial for missing referring physician while separately processing and paying on the exam.

Claim scrubbing edits help avoid delays in reimbursements

Some practice management systems do not include features that support claim scrubbing edits that alert you to a missing referring or ordering physician. The result? Claims are sent to insurance companies with errors, causing rejections and costly delays in reimbursements. Fast Pay billers are experts at making sure your claims are clean and free from errors. We know that being efficient and knowing how to prevent those rejections in the first place is the best cleaning solution to receive revenue quicker—that’s why we double check and scrub every claim before we submit them. As a result, you avoid delays in payments, a key benefit of using Fast Pay billing service.

About Fast Pay Billing Service: At Fast Pay, our billers take care of the billing hassle to maintain consistent cash flow and improve the turn-around time on your claims. We work with each of our offices to provide a solid billing solution. No two practices are alike and we pride ourselves on maintaining open communication between every office and their Fast Pay biller to stay in sync. Contact us for a free practice analysis to see how we can help you. Check out “our process” for more information and “customer insights” to hear what our customers are saying about Fast Pay.