Feb 3, 2026
Written By Elizabeth Cifers
By now, most retina practices have at least glanced at their 2025 data. Some have reviewed it carefully. Others opened it, saw numbers they didn’t like, and decided to revisit it after coffee, the quarter, or possibly never. It’s already a bleak time of year, after all the merriment in November and December!
The reality: data isn’t a judgment. It’s not a critique of clinical care. It’s information, not unlike a diagnostic test. How did your revenue cycle perform last year? Like any good diagnostic tool, its value depends on whether you take the time to interpret it and then act on the findings.
As we launch into 2026, the most successful retina practices are using their data track revenue to determine whether the documentation truly supports what is billed. The most valuable insights come from analyzing data to identify patterns in payment delays, which usually intersect operations, revenue cycle, and documentation, and are where risk is either a red flag or a green flag.
The CPT codes are the first place to start. Not only is that how the data is organized, but it’s also often the easiest way to spot trends. The mistake isn’t looking at CPT codes; it’s looking at them in isolation. There are myriad ways to analyze the data:
When you analyze CPT data by modifier, payer, provider, and location, patterns emerge quickly. These patterns almost always point to documentation- and workflow-related coding issues. Don’t forget to include HCPCS and ICD-10 codes in the analysis to identify trends. They can be just as much a culprit in delays in claim payments.
When practices review 2025 data at the CPT level, they may notice specific office visit or diagnostic test codes with consistently high Days in A/R, indicating the practice isn’t getting paid for these services. On paper, everything appears fine. The codes seem appropriate, and the care was provided – everything appears to be in order.
Then the payer gets involved with a documentation request.
The result? In many cases, the data shows that services weren’t supported when payers reviewed the documentation. Not because the care was poor, but because the documentation and coding couldn’t withstand payer scrutiny.
Patterns tend to emerge when analyzing claims by payer, physician, and location that are not one-off but repeated:
While Days in A/R is a financial metric, high Days in A/R is also a warning sign of issues elsewhere in the revenue cycle, including documentation, utilization, and denial workflows. Reviewing patterns helps practices identify where revenue was quietly lost in 2025, identify the underlying issues, and then fix them before the same problems occur in 2026, aging the A/R once again.
One of the most valuable insights from the 2025 data is the inconsistency it reveals. If the same CPT code is paid for one physician but not another, that is a signal, not an accusation. What is different about the claims that are not being paid in a timely fashion? If the coding is the same, then documentation is usually the next source of information, especially if the payer requests medical records before paying the claim.
To reduce inconsistency, it is necessary to standardize documentation across the practice, but that doesn’t mean identical notes – cloned notes are a no-no. It means consistent communication:
Without clear, supportive documentation, the claim will most likely be denied upon chart review. The payer won’t “read between the lines” in the submitted chart documentation, even if staff routinely “know what the doctor meant”.
Although data can be used to create a performance scorecard, it is most effective when used to improve systems rather than to police individuals. Practices see better engagement in evaluating and correcting issues when conversations look like:
Conversely, when reviewing data, the quickest way to improve performance is often to analyze what is already working.
The goal for 2026 is not to document more, but to document in a way to meet code requirements, which translates into audit defensibility and more timely payments, even with payer documentation review.
Using 2025 CPT data layered with payer, physician, and location allows practices to:
Ignoring patterns does not make them go away. It just means payers will find them first. As a general rule, it is better to discover your own patterns than to have them highlighted in an audit letter.
If your 2025 data raised more questions than it answered, you’re not alone.
Sometimes, having a fresh set of eyes help distinguish potential risks and normal variations, as well as highlight areas where documentation needs to be clearer. Elizabeth collaborates with retina practices to review CPT-level patterns and documentation, proactively addressing issues before they result in audit findings.
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