A single coding error on a 92004 exam can cost your practice $180 in lost revenue. Your remote optometry billing specialist handles claims submission, denial management, and payment posting across both vision plans and medical carriers.
Your billing specialist owns the full revenue cycle from charge entry to final payment. They understand the difference between a 92014 and a 99214, and they know when medical necessity documentation supports billing medical instead of vision.
Your specialist codes and submits claims using the correct 920xx ophthalmology CPT codes, applies appropriate modifiers like -25 for separate E/M services, and ensures ICD-10 codes match medical necessity. They handle both electronic and paper claims for carriers that still require them.
When a claim comes back denied, your specialist investigates the reason code, corrects the issue, and resubmits within the payer's timely filing window. For complex denials involving medical vs. vision routing or prior authorization failures, they draft appeal letters with supporting documentation.
Every ERA and EOB gets posted the same day it arrives. Your specialist reconciles payments against expected reimbursement, identifies underpayments, and works accounts over 30 days with systematic follow-up calls to payer representatives.
Our billing specialists arrive trained on the clearinghouses and PM platforms optometry practices rely on daily.
Absolutely. Your billing specialist knows the routing rules for VSP, EyeMed, Davis Vision, Superior Vision, and all major medical payers. They determine whether a visit should bill to the vision plan, medical carrier, or both, based on the diagnosis and services rendered.
They work daily with the 920xx ophthalmology series (92002, 92004, 92012, 92014), refraction codes (92015), visual field testing (92081-92083), OCT (92134), fundus photography (92250), and contact lens codes (92310-92326).
Your specialist applies modifier -25 when a separate E/M service is performed during the same visit as a routine eye exam. They verify that documentation supports medical necessity for the additional service and that the correct ICD-10 diagnosis is linked to each CPT code.
Most optometry practices see denial rates between 10% and 20%. Our specialists typically bring that below 5% within 90 days by fixing recurring coding patterns, verifying benefits before visits, and submitting clean claims on the first pass.