Medical Billing for Optometry Practices
Optometry billing lives in two worlds at once — medical insurance on one side, vision plans on the other — and claims fall through the crack between them: medical diagnoses sent to the vision plan, refractions tangled up with the exam, eye-code versus E/M choices that invite denials when billing is handled part-time.
Doctors One Solution handles the full revenue cycle for optometry practices — claims routed to the right plan the first time, eligibility checked up front, and denials followed up every week.
Where optometry billing leaks money
- Wrong-plan claims. A medical visit billed to the vision plan (or the reverse) isn't a small error — it's a denial, a rebill, and weeks of delay. The routing decision has to be right at intake, based on the reason for the visit.
- Refraction confusion. Refraction is handled differently by medical plans and vision plans, and bundling it incorrectly with the exam creates denials and patient-balance surprises.
- Eye code vs. E/M choices. Choosing between ophthalmologic exam codes and E/M codes isn't one-size-fits-all — the documentation, the payer, and the plan type all matter, and the wrong habit repeated daily gets expensive.
- Coordination-of-benefits tangles. When a patient has both medical coverage and a vision plan, who pays first depends on why they were seen. Getting COB wrong means chasing the wrong payer while A/R ages.
What we handle for optometry practices
- Eligibility and benefits verification for both medical insurance and vision plans
- Claim routing and scrubbing — right plan, right code set, before submission
- Denial management — worked, appealed, and tracked to resolution
- Payment posting and ERA reconciliation
- A/R follow-up on aging claims, with denial patterns trended by payer and plan type
- Monthly reporting on collections, denial reasons, and days in A/R
A billing team that knows this specialty
Most billing services treat optometry like general medicine with glasses. The medical/vision split is the whole game, and it's where we focus: routing discipline at the front end, and relentless follow-up at the back. We start every engagement with a free review of your A/R aging and recent denials, so you can see where the money is stuck before you commit to anything.
Get a free optometry billing review
Get a free optometry billing review. We'll look at your A/R aging and recent denials — including how your medical and vision claims are being routed — and tell you honestly what we'd work first. 15 minutes, no obligation.
Contact us | (855) 570-4077
FAQ
Do you bill vision plans as well as medical insurance? Yes — both sides, and the coordination between them. Correct routing based on the reason for the visit is the core of optometry billing.
Do you only work with certain EHRs, or can you bill in ours? Any of them — we work with all major EHRs. Doctors One Solution is a Tebra RCM Partner and a partner of IMS by Meditab, but we're not limited to either: we bill inside whatever system your practice already uses, with no software switch or migration.
What size practices do you work with? Independent practices from solo providers up to about ten — optometry is one of our core specialties.
How do we start? With the free review. If we're not a fit, you keep the findings.
Related reading: More on our billing process