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We provide expert solutions for all optometry professionals, including:
✅Optometrists (ODs) – Primary eye care providers diagnosing and treating vision and ocular health conditions.
✅Ophthalmologists (MD/DO) – Specialists performing surgical and medical eye care treatments.
✅Opticians – Experts in dispensing and fitting prescription eyewear.
✅Vision Therapy Specialists – Providers focusing on eye movement, coordination, and rehabilitation.
✅Low Vision Rehabilitation Experts – Professionals aiding patients with severe visual impairment.
1. Credentialing & Payer Enrollment
Credentialing in optometry involves both vision and medical insurance payers, ensuring providers can bill for routine vision exams, glasses/contact lenses, and medical eye care services. We simplify the process for seamless reimbursements.
✅Medicare, Medicaid & Commercial Insurance Credentialing
✅Vision Insurance Enrollment (VSP, EyeMed, Davis Vision, Spectera, etc.)
✅EDI, ERA, and EFT Enrollment for Fast Electronic Payments
✅Re-Credentialing & Contract Renewals
2. Medical & Vision Billing for Optometry
Optometry billing is unique because it involves both vision insurance (routine eye exams, refractions, corrective lenses) and medical insurance (ocular diseases, emergency eye care, and surgical co-management). We ensure the right claims go to the correct payers.
✅Medical vs. Vision Insurance Coordination for Maximum Reimbursement
✅CPT & ICD-10 Coding for Eye Exams, Procedures & Medical Conditions
✅Claims Submission, Reconciliation & Denial Management
✅Authorization & Eligibility Verification for Vision & Medical Services
3. EHR/EMR Setup & Integration
Optometry practices rely on EHR/EMR software designed for eye care to streamline patient exams, prescriptions, and insurance documentation. We assist in selecting and implementing the best system.
✅Optometry-Specific EHR Setup & Customization
✅Integration with Optical Lab & Lens Ordering Systems
✅Telehealth Solutions for Remote Eye Consultations
✅HIPAA-Compliant Data Security & Documentation
4. Compliance & Regulatory Support
Optometry practices must comply with HIPAA, Medicare, Medicaid, and private insurance regulations to avoid legal risks and billing errors. We ensure your practice follows all necessary guidelines.
✅Vision & Medical Insurance Billing Compliance
✅Medicare & Medicaid Documentation & Reimbursement Compliance
✅Audit Readiness & Risk Management
✅State Licensing & Credentialing Assistance
5. Revenue Cycle Management & Practice Growth
Optimizing revenue cycle management (RCM) ensures optometry practices receive timely payments while minimizing claim denials. We provide financial solutions to maximize reimbursement and improve cash flow.
✅Financial Performance Tracking & Revenue Optimization
✅Payer Contract Negotiation & Fee Schedule Adjustments
✅Practice Expansion Consulting & Business Growth Strategies
✅Marketing & Referral Network Support for Optometrists
✅Routine Eye Exams & Refractions (CPT 92002, 92004, 92012, 92014)
✅Comprehensive Eye Exams with Medical Diagnosis (CPT 92004, 92014, 92015)
✅Contact Lens Evaluations & Fittings (CPT 92310, 92311, 92312, 92313)
✅Medical Eye Condition Management (ICD-10 Codes H52-H59)
✅Glaucoma Screening & Treatment (CPT 92133, 92134, 92250, 92285)
✅Diabetic Retinopathy Exams (CPT 92250, 92134, ICD-10 E10.9, E11.9)
✅Optical Coherence Tomography (OCT) (CPT 92133, 92134)
✅Visual Field Testing (CPT 92081, 92082, 92083)
✅Dry Eye & Meibomian Gland Dysfunction Treatment (CPT 68761, 76514)
✅Low Vision & Vision Therapy Services (CPT 92065, 97110, 97112)
1. Differentiating Between Vision & Medical Insurance Billing
Understanding when to bill vision insurance (VSP, EyeMed) vs. medical insurance (Medicare, BCBS, UHC) is crucial to prevent claim denials and maximize reimbursement.
2. CPT, ICD-10, & Modifier Usage for Optometry Services
Proper coding of eye exams, disease management, and procedural treatments ensures accurate claim submission and prevents downcoding by payers.
3. Prior Authorization for Specialty Eye Procedures
Many advanced imaging, surgical procedures, and specialty lenses require pre-authorization, making verification an essential part of the billing workflow.
4. Medicare & Medicaid Rules for Optometric Care
Medicare covers medical eye exams and treatments, while Medicaid varies by state. Understanding these coverage policies helps prevent claim rejections and compliance issues.
5. Optical Retail & Sales Tax Compliance
Practices that sell eyewear, contacts, and optical accessories must handle sales tax compliance, itemized billing, and insurance coordination for cash-pay vs. insurance reimbursements.
✔ Seamless Credentialing & Insurance Enrollment to prevent billing issues.
✔ Specialized Billing & Coding Support for Vision & Medical Claims.
✔ Comprehensive EHR & Practice Management Integration for efficiency.
✔ End-to-End Revenue Cycle Management to Maximize Reimbursements.
✔ Vision & Medical Compliance Solutions to Ensure Audit Readiness.
✔ Tailored Solutions for Individual & Multi-Location Optometry Practices.
Let us handle the complexities of billing, credentialing, compliance, and revenue cycle management, so you can focus on providing exceptional eye care. Contact us today to see how we can support your optometry practice!
Solubillix offers comprehensive medical billing, credentialing, and revenue cycle management solutions to ensure seamless practice operations, faster reimbursements, and financial growth for healthcare providers.
We’re here to streamline your medical billing and coding, optimize revenue, and prioritize exceptional patient care.
Solubillix is a trusted provider of medical billing, credentialing, and revenue cycle management solutions. We help healthcare providers streamline operations, maximize reimbursements, and reduce administrative burdens so they can focus on patient care.
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