Major Billing Hurdles Faced in Optometry

Major Billing Hurdles Faced in OptometryOptometry services have seen an increasing growth in present day healthcare industry. With healthcare reforms now allowing optometry practitioners to prescribe medications and perform minor procedures, people prefer to visit an Optometry clinic with minor eye-care troubles instead of booking an appointment with an Ophthalmologist. However, with increasing patient inflow and variety of services getting added to the care package of Optometry clinics; medical billing has become much more cumbersome. Some of the commonly faced hurdles in optometry billing include –

    • Untrained staff for data recording – With EMR and EHR becoming the norm of the day, medical staff incapable of recording patient data on a real time basis is fast becoming redundant in healthcare market. Collecting all the required information and recording it with appropriate codes is a crucial step, which if overlooked can ruin the entire coding and billing process for your optometry practice. Due to insufficient attention paid to data collection, technical and front end staff remains in constant conflict and results in poor database of patient health records.

  • Medicare and Medicaid billing – With millions more getting covered under Medicare by 2015, the patient base of your Optometry clinic is likely to include a large number of patients covered by government carriers. Although most private Optometrists don’t offer their services to Medicare and Medicaid patients, including Medicare and Medicaid provisions into your revenue cycle management can ensure greater claim settlement ratio.
  • Bad debts and Account receivables – On an average, 30% of an Optometry clinic’s annual revenue is lost to bad debts because of irregular follow-up and customer dissatisfaction.  Optometrists must employ regular follow ups and fulfill data requirements to settle account receivables.
  • Billing service provider not an Optometry expert – To avoid data recording errors and claim denials, many Optometrists outsource their billing process to professional billers and coders. However, with highly specific coding and billing requirements of Optometry, it is not necessary that every billing service provider would be well equipped to provide Optometry billing solutions. Therefore, at the time of outsourcing revenue management, it is important to ensure that the specialist being hired is aware of your specific needs and can deliver consistently.
  • HIPPA compliance – Adhering to rules and reforms of HIPAA for PHI (Patient Health Information) protection is must for any covered entity. Sharing of medical information with carriers such as Medicaid and Medicare for claim settlement makes an optometry practice a covered entity. Conforming to HIPAA norms, therefore, adds more pressure on the EMR and coding system of your optometry practice.
  • Claim settlement – Medicare, Medicaid and many private insurance providers require certain compliance standards and pre-authorization for Optometry procedures. For any practice to remain financially viable, a healthy claim settlement ratio is essential. Therefore, careful data collection, pre-authorization, HIPAA compliant data sharing, follow up of accounts receivable and timely resolution of queries regarding claims must be monitored to ensure 100% claim settlement. is a billing expert offering specialty billing and coding solutions to ODs and optometry practices. It is of utmost importance to a billing service provider to customize services in order to overcome hurdles faced in alternate medicine. With expanding scope of optometry, can be the best billing partner for your optometry practice.