Every patient who sits in your exam chair forces a billing decision before anyone touches a claim. Is this a medical visit or a routine vision exam? Pick wrong and the claim bounces. Or it pays, and the money gets taken back months later. MBC’s optometric billing solutions are built around getting that call right, […]
Debridement depth coding means choosing a CPT code for the deepest layer of tissue actually removed, not for how deep the wound looks. Subcutaneous tissue goes to 11042, muscle or fascia to 11043, and bone to 11044. Surface work above the subcutaneous layer belongs in the 97597 range. When documentation doesn’t name the tissue removed, […]
HCC V28 coding protects internal medicine risk scores only when every chronic condition is documented with MEAT support and V28-level specificity, because CMS removed more than 2,000 diagnosis codes from payment and constrained the coefficients that once rewarded complexity. With payment year 2026 running fully on V28, the phase-in cushion is gone. Every Medicare Advantage […]
Yes, medical vs vision billing for optometrists is costing most eye care groups revenue they have already earned. When diabetic exams, glaucoma monitoring, dry eye care, and acute visits are billed to vision plans, the group collects a flat routine fee instead of a medical reimbursement, leaves diagnostic tests unbilled, and loses the follow-up visits […]
Multi-provider OBGYN groups are leaving generalist billing vendors in 2026 because global maternity episodes, mid-pregnancy payer changes, and rising commercial audits now penalize billing logic built for single-encounter specialties. However, the shift is rarely about responsiveness or service complaints. Instead, it is about net realized revenue that quietly disappears inside a 40-week episode that generalist […]
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 […]
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