Prevent
Ophthalmology Denials
AI revenue cycle automation built for ophthalmology practices — specialty-aware E/M vs. Eye code selection, prior auth, and denial appeals that protect your exam, testing, injection, and surgical revenue.
55%+
denials prevented
98%
coding accuracy
3 days
to onboard
Trusted by Industry Leaders
Why ophthalmology claims get denied
Ophthalmology mixes high-volume office visits, high-cost injectable drugs, and surgery with strict payer rules — a combination that produces avoidable denials. Most losses trace back to a handful of recurring coding gaps.
E/M vs. Eye code selection
Every office visit forces a choice between E/M codes (99202–99215) and ophthalmological service "Eye" codes (92002–92014). The right pick depends on payer rules, documentation, and frequency limits — and choosing wrong either underpays the visit or triggers a denial or audit.
Cataract global-period and modifier errors
Cataract surgery carries a 90-day global period and bilateral, staged, and unrelated-visit rules. A missing modifier 24, 25, 79, or RT/LT turns routine post-op and second-eye care into denials.
Anti-VEGF injection drugs slip through
Intravitreal injections of high-cost drugs (anti-VEGF agents) carry expensive J-codes, units, wastage, and step-therapy requirements. A mis-keyed unit or missing prior auth leaves thousands uncollected on a single injection.
Diagnostic testing frequency and bundling
OCT, visual fields, and fundus photography have payer frequency limits and bundling edits with the office visit. Billing them too often or alongside the wrong E/M code drives recurring testing denials.
Prior auth stalls injections and premium IOLs
Anti-VEGF injections, premium IOLs, and advanced procedures often require pre-auth and step therapy. Manual auth chasing delays care and a missing or expired authorization denies high-value claims outright.
Revenue lost to under- and over-coding
Eye exams and testing get coded below what the documentation supports — leaving earned revenue uncollected — while overcoding quietly builds audit and takeback exposure. Catching both by hand is slow and inconsistent.
Works with EHR & PMS
What Ember automates for ophthalmology
E/M vs. Eye code selection, decided correctly
Ember reads the documentation, payer rules, and frequency history to choose between E/M (99202–99215) and Eye (92002–92014) codes on every visit — capturing the higher-value, compliant option instead of leaving money on the table or risking a denial.
Cataract global-period and modifier scrubbing
Ember tracks the 90-day cataract global window and validates modifiers 24, 25, 79, and RT/LT against the record — so post-op visits, second-eye surgery, and unrelated care are billed cleanly instead of bundled away.
Anti-VEGF drug units and wastage, captured
Ember keeps J-codes, units, and documented wastage accurate on intravitreal injections, and confirms step-therapy and auth are in place — so high-cost drug claims are paid in full the first time.
Diagnostic testing frequency checks
Ember validates OCT, visual fields, and fundus photography against payer frequency limits and bundling edits before submission — stopping the recurring testing denials that erode ophthalmology revenue.
Prior authorization, handled
Ember checks eligibility, identifies which injections, premium IOLs, and procedures need pre-auth and step therapy, gathers documentation from the EHR, and submits through payer portals — so care doesn't stall.
Under- and over-coding analysis
Ember compares documentation against billed codes both ways — flagging undercoding that leaves earned revenue on the table and overcoding that invites audits and takebacks — so every claim matches the chart.
Outcomes ophthalmology teams can measure
55%+
of denials prevented before submission
98%
autonomous coding accuracy
50–75%
fewer staff hours on denial workflows
3 days
to onboard — value, not a year-long rollout
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
As Seen In
Frequently Asked Questions
Yes. Ember AI connects seamlessly with all major EHRs and PMS platforms — including Epic, Oracle Cerner, athenahealth, and eClinicalWorks — as well as payer portals. Our standards-based integrations automate prior authorization, eligibility verification, and claims submission, allowing you to preserve existing infrastructure while modernizing the revenue cycle.
Ember AI deployments are measured in weeks, not months. Most organizations complete pilot launch in under 30 days and scale enterprise-wide within a quarter. We provide a structured onboarding playbook, technical support, and change-management guidance so your teams achieve measurable ROI rapidly with minimal IT lift.
Yes. Ember AI is fully HIPAA and SOC 2 Type II compliant and signs Business Associate Agreements (BAAs) with all covered entities. Protected Health Information (PHI) is encrypted in transit and at rest, supported by role-based access controls, detailed audit logging, and continuous monitoring. Your organization retains complete ownership and control of its data.
Health systems, MSOs, and health plans using Ember AI typically achieve:
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
Ember reads the visit documentation, payer rules, and the patient's frequency history to decide between E/M codes (99202–99215) and ophthalmological service "Eye" codes (92002–92014) on every encounter — selecting the compliant, higher-value option so you don't underbill the visit or trigger a denial.
Yes. Ember's coding and scrubbing logic is specialty-aware — it understands eye exams, cataract surgery and its global period, intravitreal injections, and diagnostic testing rules, and validates documentation against payer medical-necessity criteria before submission.
Yes. Ember keeps J-codes, units, and documented wastage accurate on anti-VEGF and other injectable drugs, and confirms step therapy and prior authorization are in place — so expensive injection claims are paid in full the first time.
Yes. Ember validates OCT, visual fields, and fundus photography against payer frequency limits and bundling edits with the office visit before submission, preventing the recurring testing denials common in ophthalmology.
Ember connects to your existing EHR/PMS and payer systems with standards-based integrations — no rip-and-replace. Most teams pilot in days and see measurable ROI before scaling across service lines.
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