{"id":31011,"date":"2026-07-16T21:09:32","date_gmt":"2026-07-16T15:39:32","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=31011"},"modified":"2026-07-16T21:10:31","modified_gmt":"2026-07-16T15:40:31","slug":"questions-before-hiring-optometry-billing-company","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/","title":{"rendered":"Questions to Ask Before Hiring an Optometry Billing Company"},"content":{"rendered":"

If you’re vetting an optometry billing company<\/strong>, ask these six questions first: How do you separate medical from vision-plan claims? What’s your clean claim rate for eye-care CPT codes? How do you handle coordination of benefits? What’s your Days in AR for optometry clients specifically? Can you show real client metrics, not averages? And who owns compliance if an OIG audit letter arrives?<\/p>\r\n

If a vendor can’t answer all six with specifics, keep looking. The rest of this guide breaks down why each question matters and what a strong answer actually sounds like.<\/p>\r\n

Why the Right Optometry Billing Company Changes Your Bottom Line<\/h2>\r\n

Most administrators shop for an optometry billing company the way they’d shop for a copier vendor: lowest per-claim fee wins. That’s the wrong lens.<\/p>\r\n

The CMS CY 2026 Medicare Physician Fee Schedule final rule set two separate conversion factors: $33.5675 for qualifying APM participants and $33.4009 for everyone else, alongside a facility practice-expense reduction that directly affects groups billing from hospital outpatient or ASC settings. A vendor who isn’t already rebuilding your fee schedule logic around this change is billing you for last year’s rules.<\/p>\r\n

At the same time, the OIG Work Plan continues to list ophthalmology and optometry billing as a sustained audit focus area, with particular attention on the documentation trail separating medical encounters from routine vision visits.<\/p>\r\n

Under the False Claims Act, filing a medical encounter as routine to dodge scrutiny carries the same civil penalty exposure as upcoding \u2014 up to $27,894 per false claim. That’s not a detail your billing vendor can afford to get wrong, and it’s not one you can afford to discover after the fact.<\/p>\r\n

The Six Questions That Actually Separate Vendors<\/h2>\r\n

1. How do you classify medical vs. vision-plan encounters at intake?<\/h3>\r\n

This is the single biggest revenue leak in eye care. A patient presenting with diabetic retinopathy, glaucoma, or Demodex blepharitis should be routed to medical insurance and coded to E\/M<\/a> (99202\u201399215) or ophthalmologic codes (92002\u201392012), never filed to a vision plan by default. Ask the vendor to walk you through their intake protocol in specific terms. If the answer is vague (“our coders review it”), that’s a red flag.<\/p>\r\n

2. What’s your clean claim rate, and is it optometry-specific?<\/h3>\r\n

A generic “95% clean claims” figure means little without context. Ask for the rate on eye-care CPT codes specifically, and ask how they handle bilateral imaging codes like 92133\/92134\/92137, which already include both eyes in a single unit and are frequently over-billed with duplicate units or an unnecessary modifier -50.<\/p>\r\n

3. How do you manage coordination of benefits (COB)?<\/h3>\r\n

Many practices lose $55\u2013$110 per visit simply by filing to one plan and closing the claim when a patient has dual coverage. A capable vendor should describe an active COB workflow, not a passive one that depends on staff remembering to check.<\/p>\r\n

4. What’s your Days in AR, benchmarked to multi-location groups?<\/h3>\r\n

Ask for real numbers, not marketing language. A vendor managing revenue for multi-provider or PE-backed eye care groups should be able to state a current average and explain what’s driving it: automated scrubbing, denial-cause tracking, or manual follow-up.<\/p>\r\n

Bonus question: What happens during the first 90 days?<\/h3>\r\n

A strong optometry billing company<\/strong> should walk you through a concrete onboarding plan: how existing AR gets worked down, how new claims go live without a coverage gap, and when you’ll see your first performance report. Vague answers here often predict vague answers later.<\/p>\r\n

5. Can you show client outcomes with a timeframe and facility size?<\/h3>\r\n

Any credible medical billing and coding services<\/strong> provider should have testimonials with real before\/after numbers, not “great service, very responsive.” If they can’t produce a client result with a dollar figure and a timeframe, they likely haven’t measured their own performance either.<\/p>\r\n

6. Who owns compliance risk, and how do you monitor it?<\/h3>\r\n

Ask directly how they track OIG Work Plan updates and whether they run pattern analysis, for example flagging a practice where 85%+ of encounters go to vision plans despite high diabetic or glaucoma volume, a pattern payer algorithms already flag automatically. This is where a true revenue integrity partner<\/strong> distinguishes itself from a transactional vendor: the monitoring happens before the audit letter, not after.<\/p>\r\n

Vendor Evaluation at a Glance<\/h2>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
What to Ask<\/strong><\/td>\r\nStrong Answer (Green Flag)<\/strong><\/td>\r\nWeak Answer (Red Flag)<\/strong><\/td>\r\n<\/tr>\r\n<\/thead>\r\n
Medical vs. vision classification<\/td>\r\nDocumented intake protocol tied to chief complaint<\/td>\r\n“Our coders figure it out”<\/td>\r\n<\/tr>\r\n
Clean claim rate<\/td>\r\nSpecific, eye-care CPT-level rate with methodology<\/td>\r\nGeneric “95%+” with no context<\/td>\r\n<\/tr>\r\n
Coordination of benefits<\/td>\r\nActive, systemized COB workflow<\/td>\r\nManual, staff-dependent process<\/td>\r\n<\/tr>\r\n
Days in AR<\/td>\r\nCurrent number, explained drivers<\/td>\r\nNo benchmark offered<\/td>\r\n<\/tr>\r\n
Client results<\/td>\r\nNamed metrics, timeframe, facility size<\/td>\r\nGeneric praise, no numbers<\/td>\r\n<\/tr>\r\n
Compliance ownership<\/td>\r\nNamed process for OIG Work Plan tracking<\/td>\r\n“We follow all applicable laws” (no specifics)<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

What This Means for Multi-Provider and PE-Backed Groups<\/h2>\r\n

If you’re evaluating optometry billing services<\/a> for a multi-location group or a PE-backed practice network, the stakes compound with every additional site.<\/p>\r\n

A single misclassified-encounter pattern across five locations isn’t a one-time error; it’s a systemic exposure that shows up the same way at every site, which is exactly what makes it visible to payer audit algorithms.<\/p>\r\n

This is why groups at this scale increasingly move away from generic medical billing services<\/strong> and toward an optometry billing company<\/strong> that treats optometry as a defined specialty practice, with protocols built for eye care rather than adapted from primary care billing.<\/p>\r\n

The same logic applies to staffing decisions. An in-house biller may know your patients well but rarely has bandwidth to track quarterly OIG updates, payer-specific COB rules, and CPT code changes across an entire eye-care specialty at once.<\/p>\r\n

That’s the gap a dedicated eye-care billing specialist is built to close, not by replacing your front-desk team, but by giving them a system that catches what manual review misses.<\/p>\r\n

Before you sign anything, it’s worth understanding what a properly structured engagement should cost relative to the revenue it protects. You can review typical engagement models and structures<\/a> to compare against any proposal you’re evaluating.<\/p>\r\n

If your team is currently weighing in-house hires against outsourced RCM services<\/a>, the honest answer is that both can work, but only if the vendor you choose can answer the questions above with specifics, not reassurances.<\/p>\r\n

For a direct conversation about your current billing setup, MBC’s team can walk through a facility-specific review. Call 888-357-3226<\/strong><\/a> or email info@medicalbillersandcoders.com<\/strong><\/a> to schedule a CFO-level briefing before you commit to a vendor.<\/p>\r\n

FAQs: Optometry Billing Company<\/h2>\r\n\r\n
\r\n
1. How long does it take to switch optometry billing companies without losing revenue?<\/strong><\/strong>\r\n

A clean transition typically takes 30\u201345 days, with old claims run out under the previous vendor while new intake protocols go live immediately with the new one. Ask any prospective vendor for their transition timeline in writing, including how they handle claims already in process, before signing anything.<\/p>\r\n<\/div>\r\n

2. Should a small solo optometry practice use a different vetting standard than a multi-location group?<\/strong><\/strong>\r\n

The six core questions apply regardless of size, but multi-location groups should add one more: how the vendor standardizes protocols across sites so one location’s error doesn’t become a network-wide audit pattern.<\/p>\r\n<\/div>\r\n

3. What credentials should an optometry billing company’s coders hold?<\/strong><\/strong>\r\n

Look for coders with CPC or COC certification and demonstrated eye-care-specific experience, since ophthalmologic codes (92002\u201392012) and diagnostic imaging codes carry different rules than general E\/M billing.<\/p>\r\n<\/div>\r\n

4. How much revenue does poor medical-vs-vision classification typically cost a practice?<\/strong><\/strong>\r\n

Industry patterns show losses in the $120\u2013$180 range per misclassified encounter, compounding across every recurring diabetic or glaucoma patient routed incorrectly.<\/p>\r\n<\/div>\r\n

5. Does a lower per-claim fee usually mean lower total cost?<\/strong><\/strong>\r\n

Not necessarily. A lower fee paired with a lower clean claim rate or missed COB opportunities often costs more in lost reimbursement than it saves in vendor fees. Before comparing quotes, ask each optometry billing company for their average Net Collection Ratio and Days in AR, then weigh total revenue recovered against the fee, not just the line-item price.<\/p>\r\n<\/div>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"

If you’re vetting an optometry billing company, ask these six questions first: How do you separate medical from vision-plan claims? What’s your clean claim rate for eye-care CPT codes? How do you handle coordination of benefits? What’s your Days in AR for optometry clients specifically? Can you show real client metrics, not averages? And who […]<\/p>\n","protected":false},"author":8,"featured_media":31015,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[469],"tags":[],"class_list":["post-31011","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-optometry-billing-services"],"yoast_head":"\nQuestions to Ask Before Hiring an Optometry Billing Company<\/title>\n<meta name=\"description\" content=\"Explore the key questions to ask when selecting an optometry billing company to ensure strong compliance and clean claim rates.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta 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Ask any prospective vendor for their transition timeline in writing, including how they handle claims already in process, before signing anything.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/#faq-question-1784216180907","position":2,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/#faq-question-1784216180907","name":"2. Should a small solo optometry practice use a different vetting standard than a multi-location group?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The six core questions apply regardless of size, but multi-location groups should add one more: how the vendor standardizes protocols across sites so one location's error doesn't become a network-wide audit pattern.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/#faq-question-1784216191221","position":3,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/#faq-question-1784216191221","name":"3. What credentials should an optometry billing company's coders hold?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Look for coders with CPC or COC certification and demonstrated eye-care-specific experience, since ophthalmologic codes (92002\u201392012) and diagnostic imaging codes carry different rules than general E\/M billing.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/#faq-question-1784216202932","position":4,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/#faq-question-1784216202932","name":"4. How much revenue does poor medical-vs-vision classification typically cost a practice?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Industry patterns show losses in the $120\u2013$180 range per misclassified encounter, compounding across every recurring diabetic or glaucoma patient routed incorrectly.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/#faq-question-1784216213672","position":5,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/questions-before-hiring-optometry-billing-company\/#faq-question-1784216213672","name":"5. Does a lower per-claim fee usually mean lower total cost?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Not necessarily. A lower fee paired with a lower clean claim rate or missed COB opportunities often costs more in lost reimbursement than it saves in vendor fees. 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