Keep eye care connected between visits and referrals.
Ophthalmology practices need reliable test follow-through, treatment reminders, referral closure, and communication with primary care. Some patients may also have a separately appropriate remote monitoring or care-management route—but eye care alone does not establish one.
START WITH THE PRACTICE QUESTION
Which workflow is worth improving first?
Choose by patient need and professional responsibility. A retinal image, a home physiologic reading, and a care-management month are distinct services with different payer rules.
Retinal imaging and referral closure
Track diabetic eye referrals, imaging completion, interpretation, abnormal-result routing, and return of findings to the referring clinician.
Payment route
Diagnostic retinal imaging has its own code, ordering, interpretation, and local-coverage pathway; quality-measure completion is not itself a payment guarantee.
Important boundary
Remote retinal imaging is not automatically RPM. Coverage for screening versus diagnostic services and code 92227/92228 varies with indication and Medicare contractor guidance.
Condition-specific monitoring
For selected patients, evaluate whether a clinically validated connected physiologic device provides actionable information between eye visits.
Payment route
Only consider Original Medicare RPM if the specific device, treating practitioner, clinical condition, data transmission, visit, and service requirements fit.
Important boundary
Do not market every home eye-pressure reading, consumer wearable, or patient-entered diary as billable RPM.
Care coordination and practice operations
Coordinate complex patients, medication access, missed appointments, surgery-related messages, and handoffs with primary care and other specialists.
Payment route
A distinct CCM, PCM, or TCM service requires its own eligibility and billing professional; otherwise this may be an operational service agreement.
Important boundary
Routine post-operative care may be included in a global surgical package. Do not project an extra claim from a reminder or follow-up call.
PATIENT → PRACTICE → PAYMENT
One accountable clinical owner, with the handoffs made visible.
PrimeVital can connect referrals, outreach, records, and selected monitoring operations. The ophthalmologist and other treating professionals retain clinical interpretation, care decisions, and claim authority.
01
Identify the patient gap
Ophthalmologist and care team
Choose a clinical goal: complete imaging, understand treatment adherence, or close a referral.
02
Choose the proper pathway
Practice clinical and billing leads
Separate diagnostic eye services from care management and from any qualifying remote physiologic monitoring.
03
Coordinate the work
PrimeVital under the agreed scope
Support scheduling, patient preferences, device logistics where applicable, records routing, and exception tracking.
04
Act on clinical findings
Treating clinician
Interpret images or trends, make treatment decisions, and return actionable information to the referring team.
05
Verify claim and result
Practice billing lead
Apply the exact payer policy and code rules; compare completed care and collections with the baseline.
BEFORE YOU PROJECT REVENUE
Verify the actual patient, service, professional, and contract.
Is the need a diagnostic eye service, a routine follow-up, or a separate medical care-management program?
Does the applicable Medicare contractor cover the imaging indication, code, ordering professional, and interpretation?
If RPM is considered, verify a qualifying connected medical device and an actionable treatment plan; do not substitute a generic app.
Check global-surgery inclusions, other clinicians’ care-management work, plan authorization, and patient cost share.
For 2027 RPM, include the final-rule initiating visit and updated valuation review before making a financial projection.
PrimeVital supports agreed operations and coordination. The eligible practice or professional remains responsible for clinical decisions, coverage determination, documentation, and claims. No payment or outcome is guaranteed.
