You’re not alone.
Viewgol + Retina and OphthalmologyData Clarity + Control of Your Financial Vision
Transform your RCM challenges into opportunities for growth.
Empower your practice to create thriving communities through exceptional eye care.
Struggling to get fair reimbursement for your high-cost drugs?
Between underpayments, denials, and ballooning A/R, retina and ophthalmology practices have it tough.
We help you to resolve your revenue cycle headaches through customizable solutions and services.
With Viewgol, your practice will gain the modern RCM data insights and much-needed support, ensuring you can focus on what’s most important: giving your patients the best care possible.
Lack of
Data Transparency
Do you feel like you're making decisions in the dark?
Challenge: No visibility into reimbursement rates, denial trends, coding gaps, drug expenses, or actual payments received.
Impact: Impossible to control revenue leaks without tracking tools. Big financial surprises.
Reimbursement &
Denial Management
Are you barely keeping up with denials and reimbursing high-cost drugs?
Challenge: Underpayments due to incorrect rates, dosages, and exclusions; Claim denials from insufficient notes, coding gaps, and lack of authorizations.
Impact: Loss of hundreds of thousands in revenue annually. Significant costs and staff hours wasted appealing and resubmitting claims. Forced cutbacks on drug inventory – limiting treatment options.
A/R Struggles
over 90 days
Got a backlog of A/R that’s aging like wine, but not as enjoyable?
Challenge: Complex and neglected claims procedures lead to payments stuck in appeals and bureaucracy for 90+ days
Impact: Hundreds of thousands in patient payments delayed, severely slowing cash flow. Staff overwhelmed with claim status inquiries and payment requests.
Sights on Success
A Retina Practice's Turnaround Tale
A retina practice faced significant challenges with Medicare and commercial payer underpayments for recently launched drugs, threatening their financial stability.
Challenge 1
Lack of awareness or contract management led to the acceptance of underpayments, with claims being closed without further action.
Viewgol's Role
Helped recover underpayments from closed encounters, identifying that the practice had not loaded contracts or was unaware of established rates.
Outcome 1
Recovered $374,000 in previously unpaid claims and reduced the practice's accounts receivable (AR) balance from $11 million to $371,000, significantly improving cash flow.
Challenge 2
Medicare underpayments for two recently launched anti-VEGF drugs, identified by J3590 codes.
Viewgol's Role
Provided the data to execute targeted appeals to recover underpayments for the two recently launched drugs.
Outcome 2
Achieved a 95% success rate on expected recoveries, leading to an overall recovery of $205,000. For Q1 2023 alone, Viewgol achieved an 88% appeal success rate, recovering $138,000 in underpayments. This included an 86% recovery rate for Drug A ($98,319 out of $190,153 across 94 encounters) and a 100% success rate for Drug B ($40,603 from 18 claims).
Key Outcome
More than $500,000 recovered in underpayments and a major reduction in accounts receivable balance from $11 million to $371,000.
A Retina Practice's Success Story
An ophthalmology practice faced Medicare underpayments for two new drugs under a temporary code.
Challenge 1
Identified systemic underpayments for these drugs, impacting financial health.
Viewgol's Role
Pinpointed affected claims and submitted comprehensive appeals detailing the underpayment issues.
Outcome 1
Secured a 97% appeals success rate, recovering $332,000 in underpayments, marking a significant financial turnaround.
Challenge 2
The practice faced challenges related to National Clinical Trials (NCT) and Medicare requirements, impacting compliance and reimbursement.
Viewgol's Role
Identified and corrected issues related to NCT numbers on claims, ensuring compliance with Medicare’s requirements for clinical trials.
Outcome 2
Ensured proper acknowledgment and processing of clinical trial claims by Medicare, improving compliance and reimbursement for the practice.
Have you ever had one of those weeks where you just knew you needed a little bit of help & assistance to get you to the goal line? I've had one of those weeks and I could not be more grateful for the team at Viewgol. The ingenuity and creativity of this team is a step above the rest.
They never say no to a request and often provide data and results that I didn't even think of. You're only as good as those who support you, and the Viewgol team is the best in the business. If you're running RCM, don't do it without them.
Janna Mullaney
Senior VP of Operations at EyeCare Services Partners (ESP)
A Multi-Location Eyecare Practice's Financial Breakthrough
A multi-location ophthalmology practice faced underpayments and contract management issues after acquiring two new clinics.
Challenge
The practice inherited various payer contracts with complex factors affecting reimbursement rates. Decentralized contract management made tracking accurate rates difficult. Claims analysis revealed lower-than-expected payments across locations and disjointed denials and appeals processes.
Viewgol's Role
Implemented Viewgol’s Managed Care Contract Support.
- Obtained key payer contracts and meticulously constructed comprehensive fee schedules.
- Integrated schedules with historical claims data and identified more than $500,000 in underpayments.
- Determined errors in fee schedule configuration for newly acquired sites caused inaccurate reimbursements.
- Presented detailed findings on affected claims, demonstrating systematic underpayment.
- Assisted practice leadership in coordinating payer outreach and securing reconciliatory payments.
Outcome
Recovered more than $500,000 in historical revenue previously left unclaimed, streamlined understanding of contractual obligations across locations, and instituted centralized monitoring of accurate payments owed.
An Ophthalmology Group’s Billing Optimization Success
An ophthalmology practice encountered underpayments from a major national payer due to low charge rates on new drug codes.
Challenge
The practice was initially only receiving 35% of billed charges due to low list prices.
Viewgol's Role
Implemented recommendations to update charge rates for new drug codes.
Outcome
After updating and increasing drug charges per Viewgol's recommendations, the practice collected approximately 2 times higher reimbursements from the major national payer, even at the same 35% rate. Adjusted billing charges led to an increase in allowed amounts by more than double for Drug C, from $420 to $882 for 0.3mg dosage and from $700 to $1,470 for 0.5mg dosage. For Drug D, charge adjustments resulted in the allowed amount increasing from $1,050 to $2,310.
At the heart of Viewgol's success?
Viewgol puts people first to provide excellent patient financial experiences
Leveraging advanced data analytics often missed by PM systems to identify your practice’s billing and revenue cycle issues
Combined with the RCM intelligence of specialized RCM teams to deliver actionable insights and strategize solutions.
Drug Dashboard
Custom-built to provide a granular view into your drug inventory, billing, payers, and denials to optimize the financial management of costly drugs and treatments.
High-Cost Drug Reimbursement: Transforming the “buy-and-bill” model from a financial strain to a streamlined process. Maintain drug cabinet accountability and streamline underpayment resolution.
Ensure accurate billing and reimbursement for costly anti-VEGF injections, managing inventory flows and patient financial experiences.
Get Started: Drug Dashboard
Managed Care Contract Support (MCCS)
Supercharged payer reimbursement support where expert RCM teams keep you up-to-date and meticulously analyze your payer contracts to accurately model fee schedules, identify systematic underpayments, and help recover owed revenue.
First-Pass Claims Success: Picture claim submissions flowing effortlessly through the obstacles of payer requirements.
Translates intricate policies from payers like Medicare and UHC into clean claims paid without issue the first time.
Get Started: Managed Care Contract Support
Viewgol Analytics
Powerful analytics software uncovering and transforming PM system data into actionable insights for revenue optimization, operational excellence, and data-driven strategic planning.
Precision Data Reporting: Picture effortlessly navigating through detailed reports—drilling down by payer, provider, or even specific CPT codes, uncovering insights hidden in plain sight.
- Identify underpayments and detect issues with ASP calculations for newly launched retina drugs.
- Find detailed views into drug inventory levels, billing statuses, and reimbursement rates.
Get Started: Viewgol Analytics
Viewgol Engage
Hands-on RCM services combining Viewgol Analytics’ data insights with expert revenue cycle talent in business intelligence, payer outcomes, client success, denial management, and more to diagnose and resolve complex revenue cycle issues.
Streamlined Denial Management: Boost your bottom line when you convert denials into revenue opportunities.
Get guidance from BI and Payer Science teams and find the root causes of issues like improper documentation of NCT numbers for Medicare claims.
Accelerated A/R Recovery: Feel the satisfaction as you watch aged receivables shrink. Reinvest in patient care and practice growth!
Resolve complicated claims stuck in appeal status and identify the fastest paths to payment.
Get Started: Viewgol Engage
Viewgol Comprehensive
A complete, fully managed RCM billing service driven by powerful analytics and seasoned RCM leaders handling all aspects of the revenue cycle for improved efficiency, maximized profitability, and financial health. Your all-in-one RCM solution.
A Brighter Practice Outlook: Envision addressing drug or claims issues before they even emerge. With Viewgol, your practice gains proactive insights and RCM intelligence so you can make strategic decisions aligned with long-term goals.
Illuminate shifts in payer reimbursement rates, drug costs, denial patterns, and regulatory changes before competitors.
Get Started: Viewgol Comprehensive
Ready to Elevate Eye Care?
Is your practice ready to optimize financial outcomes, enhance operational efficiency, and ensure every dollar for high-cost drugs and specialized treatments is accurately reimbursed?
Partner with Viewgol to leverage specialized analytics and resolution expertise tailored for retina and ophthalmology practices.
