A multi-location ophthalmology practice was feeling financial pressure. On top of the complexity of dual vision/medical billing, modifier pitfalls, and denials, leadership was bracing for shrinking reimbursements on high-volume procedures like cataract surgery. Without change, their margins would tighten further.

The Challenge: Complexity Meets Declining Rates

Ophthalmology faces a perfect storm: complex billing rules combined with payer reimbursement trends that continue to compress margins. For this practice, the biggest risks included:

• Missteps with medical vs. vision insurance
  
  
• Modifier and bundling errors
  
  
• Denials tied to payer policy changes
  
  
• Global period misclassifications
  
  
• Lagging patient collections
  
  

With reduced reimbursement rates looming, any error was magnified—turning what once felt like a small mistake into a significant revenue loss.

The Solution: Ember’s RCM Platform

The practice partnered with Ember to build resilience. Ember supported them across the full revenue cycle:

• Billing & coding audits ensured documentation matched payer requirements and reduced compliance risk.
  
  
• Real-time claim scrubbing prevented common errors before submission.
  
  
• Payment posting automation reconciled payments quickly, flagged variances, and identified underpayments immediately.
  
  
• Denial prevention & appeal support reduced rejections at the front end and streamlined the appeals process when denials did occur.
  
  
• Patient pay automation improved upfront collections and follow-through.
  
  

The Results

Within 3 months, the practice saw:

• Noticeably fewer denials and faster reimbursement.
  
  
• Cleaner, more accurate payment posting that reduced missed revenue.
  
  
• Higher net collections, even with declining reimbursement rates.
  
  
• More staff time freed up to focus on patients instead of paperwork.
  
  

“With Ember, we know our coding is accurate and our payments are correct. The difference is huge.”