Ophthalmology Coding Audit & Compliance Services

Leverage VMG Health’s expert-led utilization analysis, audits, and education to ensure compliance and drive excellence. 

Utilization Analysis

A utilization analysis of your practice will compare the frequency of provider code utilization compared to CMS claims paid data across ophthalmology and optometry to identify key variances that may warrant further evaluation within a chart audit. We compare each provider’s CPT® code use to CMS utilization rates, identifying areas where CPT utilization may fall above or below the U.S. average.  

Our team of experts analyzes the following key areas during the utilization analysis process: 

• New and established patient visits, including evaluation and management (E/M) and ophthalmic (eye) codes, as well as modifier use 
• Diagnostic testing, such as dry eye tests, OCT, visual field tests  
• Surgical procedures, including cataract, MIGS, retinal injections, lasers, and blepharoplasty   

Chart Audits   

VMG Health’s seasoned experts provide both retrospective audits and prospective audits. Medical records are reviewed for code requirements met, including CPT codes, HCPCS codes, modifiers and ICD-10 codes, documentation plausibility, reconciliation with what was billed, claim specifics, and more.   

We provide a report on our findings that includes specific findings, the gravity of errors, and action items. Our chart audit results and corresponding reports serve as a roadmap and resources to help providers and their staff look at the overall compliance operations of the practices.    

Regulatory Audits (RAC, SMRC, and TPE) Support & Additional Documentation Requests 

Our experts provide RAC, SMRC, and TPE audit support by reviewing requested charts, preparing cover letters, and ensuring all documentation is audit-ready. We offer support tailored to your needs—whether you require full-service assistance or strategic guidance. 

We help ensure your submissions are thorough, accurate, and positioned for success during review. 

Training & Education 

Accurate billing and coding rely on every team member having the information they need to support a successful and efficient reimbursement process. Our experts stay abreast of evolving rules and regulations and provide training to ensure the practice is up to date on standards and equipped to uphold best practices.