Yes, vision vs medical plan crossover is costing most optometry groups real revenue. When an exam with a medical diagnosis is billed to a vision plan, the group collects a flat routine fee instead of a medical reimbursement that can be two to three times higher. When a routine exam is billed to a medical plan, […]
When weighing 90460 vs 90471, pediatric groups should bill CPT 90460 when a physician or qualified health professional counsels the family on a vaccine for a patient through age 18, and CPT 90471 when no qualifying counseling occurs or the patient is 19 or older. Consequently, that single decision determines how many billable units each […]
Yes. For most multi-location optometry groups, the proposed rule would reduce Medicare revenue in 2027, and the conversion factor cut is the smallest piece of it. CMS proposed lowering the non-QP conversion factor to $32.84, down 1.68% from $33.40 in 2026. The bigger risk comes from three policy changes most optometry billing teams haven’t modeled yet: […]
Global maternity billing hides revenue loss because your practice delivers up to ten months of care before a single claim is filed, so leakage never appears as a denial, an AR balance, or a variance alert. For multi-provider OB-GYN groups, that blind spot sits inside the highest-value service line in women’s health. MBC has already […]
Optometry prior authorization usually fails at the front desk, not in the exam lane. It breaks when a scheduler books a medical eye visit as a routine vision exam, accepts a red-white-and-blue Medicare card from a patient who is actually on a Medicare Advantage plan, or verifies the vision plan while never touching the medical […]
A dermatology billing partner should guarantee at least a 97% clean claim rate measured at payer acceptance, and that guarantee only means something when the contract also ties it to First-Pass Yield and Net Collection Ratio. On its own, the clean claim rate is the easiest number in revenue cycle management to inflate. Dermatology is […]
Your PDGM reimbursement fell because CMS’s CY 2026 recalibration redistributes payment value across all 432 case-mix groups in a budget-neutral way — a margin event that shows up on your P&L before it ever shows up in a coding audit. PDGM Reimbursement Decline: A Margin Problem, Not a Documentation Problem For a CFO reviewing a […]
Yes, Optometry Denial Management can meaningfully reduce timely filing losses, but only when it is built around root cause data rather than faster resubmission. Most optometry groups treat a timely filing denial as a speed problem and try to refile quicker. The actual problem sits upstream, in the workflow gaps that delay a claim long […]
If your wound care practice sits in the $100K to $150K monthly insurance collection range, you’re at exactly the size where unworked denials do the most damage and get noticed the least. You’re large enough that no single person can track every claim by hand, but not yet large enough to have a dedicated team […]
If your net collection ratio (NCR) is under 95%, then yes, you are below the 2026 benchmark, and the gap is costing you real money. The commonly cited MGMA-aligned target is 95% or higher, and top-performing groups reach 96% to 99%. Strong Optometry Billing Services close that gap by getting three things right: the medical-versus-vision […]
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