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Billing, Coding, and Compliance

Let us help you navigate Medicare coding and compliance.

Our expert consultants have been helping practices better understand Medicare coding, billing, documentation, and compliance for more than 40 years. From common, everyday questions to major policy changes, our eye care specialization allows us to focus on the issues that matter most to our ophthalmic customers.

Face the future in confidence. As a division of BSM Consulting, we offer reliable guidance, superior training, targeted education, and day-to-day compliance support helping our clients to optimize reimbursement and reduce regulatory risk.

We take a personalized, client-first approach. Our expertise allows us to serve more than 1,000 customers across the country, physicians, practice management companies, law firms, ophthalmic ASCS, ophthalmologists, ophthalmology societies, and optometrists.

E. Ann Rose and Patricia Kennedy explain the benefits of Billing, Coding, and Compliance

We can help meet your regulatory needs with our full-range of services. 

Billing and Coding Connection

The Billing and Coding Connection program connects your billing staff with our team of experts, who are available to answer billing and coding questions, provide important reimbursement tools, and help you stay up-to-date with educational resources — all of which enable you to navigate Medicare’s complex billing and coding requirements.

The Billing and Coding Connection program includes:

  • Unlimited billing and coding advice. 
  • Subscription to The Messenger newsletter.
  • Prescheduled Bi-Monthly member webinars on relevant billing and coding topics.
  • Member discounts including 20% off your annual chart audit.
  • Customized annual Medicare Payment Rates tool for eye care providers.

Medicare Payment Rates for Eye Care Providers

This easy-to-use tool is customized to meet the needs of eye care professionals like you. Use it to help you:

  • Save time by easily looking-up the Medicare allowable for your geographic location.
  • Optimize reimbursement by creating an accurate baseline for practice fees.
  • Easily integrate reimbursement rate data directly into your electronic practice management system.
  • Be at ease knowing that expert consultants designed this tool with over 40 years of industry specific knowledge.
  • Quickly look up reimbursement rates by CPT code without the extra steps.

Medical Record Audits

Specifically designed for ophthalmic practices and ambulatory surgery centers to assess the extent of compliance with the sometimes-ambiguous Medicare rules and regulations. Here’s how it works:

  1. We review a sampling of patient medical records and billing reports either onsite or remotely to make sure the appropriate medical necessity is documented for services billed to Medicare or other insurance.
  2. We look for errant billing practices and under-billing errors to help ensure each practice, ASC, and/or optical is optimizing reimbursement while maintaining compliance.
  3. We utilize the same methods as Medicare during a post-payment audit.
  4. Our findings and recommendations are included in a doctor/patient spreadsheet and detailed in a written report.
  5. We furnish corrective actions to assist you in improving your compliance and face the future with confidence.

Evaluation & Management Services

This service is slightly different from CPT ophthalmological exam codes in that it requires significantly more documentation and medical decision making to support the level of service billed. This off-site audit evaluates if the service documented in the chart is being appropriately billed to Medicare. It typically involves 20 dates of service and includes a report containing our key findings and recommendations.

Access to On-demand Consultations

When you need assistance with any Medicare reimbursement issue, we are here to help. Special projects include research, chart audits, and Medicare correspondence. Services are billed at regular hourly rates and invoiced monthly.

Virtual or In-Person Training Seminars

We are passionate about training and providing targeted education that meets the needs of the entire staff. Training topics include:

  • Medicare basics
  • Reimbursement and compliance staff training
  • Technician coding
  • Evaluation and management (E&M) coding
  • Ambulatory Surgery Center (ASC) coding and compliance

Our training programs include webinars and on-site, customized training where needed. Keeping your staff well-trained and informed is an important step in maintaining compliance.

Stay connected with compliance updates delivered straight to your inbox.

The Messenger Newsletter

A bimonthly digital newsletter providing the latest information on Medicare coding and billing requirements for ophthalmology practices and ASCs.

Let’s set up an initial complimentary consultation.

Sometimes it’s helpful to talk things through. A complimentary consultation with a member of our billing, coding, and compliance team provides an opportunity to discuss your specific needs and mutually identify the level of support you might need. Since every engagement is unique, an initial consultation can help build a scope of work tailored to your needs.

Read what our clients are saying.

“We rely on Rose & Associates’ exemplary knowledge and expertise in ophthalmic billing and coding and engage Rose & Associates for our voluntary audits.”

Sondra Hoffman
CEO/Administrator, Florida Eye Clinic

"Coding and compliance is a complex and continuously changing environment fragmented over numerous regulatory bodies. That's why, for over 15 years, our team has relied on the expertise of Ann Rose and her associates at BSM Consulting."

Paul G. Klingensmith
CEO/Administrator, John Kenyon Eye Centers