Facts about Optometry Billing,Collections and RCM



The demand for vision care is increasing, and indeed exceeding the current resources available in the US. As there are more than 7,000 optometrists in communities throughout US which leads to a better geographical distribution, they are more reachable than other eye care experts. In fact, about 4,500 of these communities have access to only optometrists as primary vision care providers. According to a report, “The Bureau of Labor Statistics expects more than 24 percent growth, or 8,500 new jobs, for the profession through 2018.”

It is a known fact that apt billing, coding and a sound documentation ensures the success of optometry billing services and enhancement of compensation. A few facts of optometry billing and collections are:

1. The value of vision industry is approx. $36 billion ($15 billion: services, $21 billion: sale of lenses and glasses).

2. A growth of approx. 1% to 2% is expected in the near future.

3. Optometrists cover around $14 billion annually in vision services and product spending.

4. The annual growth from 2011 to 2016 has been in the range of 3.4%.

5. Optometrists are the third largest independent healthcare professionals in the US.

6. It is important for billers and coders to be updated at all times as insurances such as Medicare and other rules constantly change.

8. As eye care is a large market, revenues can be increased per patient visit wherein wealthy patients cater to generating higher revenue (80/20) as per other customers.

10. Sale of eyeglasses tends to garner the highest share on revenues as also the sale of contact lenses that contributes to the growth of optometric practice.

11. In the optical chain market, the low-price mass merchandisers tend to gain the maximum revenues as they have a strong supply chain advantage.

12. A very basic question that results in revenues is a patient/customer who visits for only an eye test can be asked if he/she is looking towards buying new glasses on that particular day. Optometrists must aim for $500 gross revenue per exam.

13. Gross revenue can be measured in two ways: optical and clinic. Optical revenue per exam measures the net production from the sale of frames, lenses and accessories (i.e. patient contribution + reimbursement from a third party, including dispensing fees) divided by the number of refraction’s within a time period. Whereas Clinic revenue per exam measures the net production of all professional fees and the sale of contact lenses (i.e. patient contributions + reimbursements from a third party for professional fees and contact lens materials) divided by the number of refraction’s within a time period. (optometricmanagement.com).

Lack of attention to this medical practice can create dissatisfaction and lower revenues, hence optometrists need to differentiate their services to attract patients and increase collections. This along with, as aforementioned, a sound Optometry medical billing and coding practice can significantly improve collections bringing in higher profitability.

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