AI-Powered RCM Built for Ophthalmology Practices
From intravitreal injection J-codes and cataract surgery to modifier-heavy diagnostics and denial management — SCALE delivers revenue cycle intelligence purpose-built for ophthalmology groups, ASCs, and MSOs.
Injectable & J-Code Billing
Anti-VEGF drugs, buy-and-bill & wastage (JW/JZ)
Cataract & Surgical Coding
Premium IOLs, ASC facility & global periods
Diagnostic Testing Modifiers
OCT, visual fields & bilateral/component modifiers
Prior Authorization
Injectables, MIGS & specialty procedures
Real-Time RCM Analytics
Live dashboards via SCALE's analytics platform
Ophthalmology billing is uniquely complex. We know it cold.
High-complexity care comes with high-complexity billing — and most generalist RCM vendors aren’t equipped to handle it. SCALE is.
Drug Acquisition & J-Code Risk
Anti-VEGF buy-and-bill, wastage (JW/JZ), and unit accuracy expose practices to large write-offs when mishandled.
Modifier-Intensive Diagnostics
OCT, visual fields, and imaging require precise bilateral, component, and frequency modifiers to avoid denials.
Premium & Surgical Complexity
Premium IOLs, ASC facility billing, and global periods blend insured and self-pay components that demand clean separation.
How SCALE solves it
Ophthalmology Prior Authorization
We manage injectable, MIGS, and specialty-procedure authorizations end to end — including peer-to-peer.
Ophthalmic Coding & Charge Capture
Automated review flags J-code unit, wastage, and modifier errors across drug and testing claims.
Ophthalmology Denial Management
Payer-specific appeal templates for drug, modifier, and medical-necessity denials.
Injectable & Drug Revenue Integrity
Accurate buy-and-bill, JW/JZ wastage, and unit capture for high-cost injectables.
End-to-end RCM for every Ophthalmology encounter
Automation handles volume and velocity. Our experts handle exceptions, edge cases, and strategic optimization — creating a closed-loop system that continuously improves performance over time.
Discovery & Audit
We analyze 90 days of claims data to identify coding gaps, denial patterns, and authorization bottlenecks specific to your practice.
EHR Integration
Seamless connection to your EHR and practice-management system — no new software for your team to learn or manage.
Go-Live & Handoff
SCALE's dedicated team takes over day-to-day RCM operations with transparent reporting from day one.
Continuous Optimization
Monthly performance reviews, payer-policy monitoring, and AI-driven recommendations keep revenue growing over time.
Representative results across SCALE clients
Representative results across SCALE Healthcare clients. Individual outcomes vary by organization size, payer mix, and baseline RCM maturity.
Reduction in average days to pay across SCALE-managed client portfolios
Reduction in cost-to-collect through AI automation and workflow optimization
Reduction in A/R aging beyond 90 days through proactive denial management
Reduction in overall denial rates powered by DenialShield predictive scoring
Works inside the EHRs your team already uses
Let’s build your Ophthalmology RCM roadmap together
Book a free 30-minute strategy call with a SCALE Ophthalmology specialist. We’ll review your current denial rates, authorization backlog, and coding performance — at no cost.