Top 3 Challenges with Optometry Billing Services
                     TOP 3 CHALLENGES WITH OPTOMETRY BILLING 
SERVICES
Nowadays, the financial health of your eye care practice depends more on the continuous 
cash flows than ever. In fact, keeping up with proactive optometric billing solutions in this 
ever-changing industry is putting strains on the optometrists and their staff worldwide. All 
this have resulted in either the closure of many eyecare practices or alteration of office 
hours as per the guidelines from AAO,CDC, and AOA.
That’s why there is a need to focus more on the performance of claim audits before it is 
too late to receive the complete amount of reimbursements. One such move of the claim 
audits is to understand the challenges faced by the optometry practices in billing and 
coding their tasks. Let’s have a deep understanding of the top 3 challenges faced by the 
optometrists in billing and coding their services:
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Use of Incorrect Modifiers, Resulting in Claim Denials
Modifiers are the best choice to describe a service accurately, but they can lead to claim denials if used 
incorrectly. Therefore, you need to be very careful while using modifiers for your optometry practice.
Some of the frequently used modifiers for optometry practices include:
•RT/LT for the right and left eye or lid along with the E1-E4 modifiers used for differentiating the right and 
left & inferior and superior lids.
•- 24 modifier is applicable when a doctor undertakes an office visit during the period of an unrelated 
procedure. For instance, a visit performed by a doctor when a patient who had an eye cataract surgery 
in the last 90 days and comes up with an unrelated ocular issue in the other eye.
• To get the reimbursement for the office visit, you have to add a -24 modifier while submitting the claim 
to the payer.
•- 25 modifiers are used for performing two unrelated and separate eye procedures on the same day.
•- 55 modifiers are necessary to be used when you co-manage a surgical eye procedure and perform only 
the post-operative care with a surgeon.
•Additionally, if you perform post-operative care on a patient who had a surgical repair on both eyes, you 
need to use a -79 modifier to code the second eye. Otherwise, your reimbursement will be denied on 
account of duplicate procedures.
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Submissions Before Being Fully Credentialed or Improper Credentialing
Unless your application gets processed and approved, you should not see patients on 
that specific insurance plan. Though you can use backdate claims in Medicare, you 
should establish a starting date before attending the Medicare patients. The starting date 
is mostly when Medicare initiates the processing of your application for the claim.
Additionally, if you want to receive the complete reimbursements, then you must submit 
a claim to Medicare within a year of the date of service. Otherwise, submitting a claim 
after 12 months indicates the claim denials and entitles you to collect only 20% of the 
exam fee from the patient, not covered by Medicare. Furthermore, other insurance 
carriers might have a deadline of 60 days from the date of service. So, make sure to 
check the deadlines thoroughly and submit your claims accordingly.
Also, you must have the signature of either patient or the guardian for the under-aged 
patients on the ‘Signature on File’ form to share your clinical information with the 
insurance payers for processing your application. Therefore, you won’t receive the 
reimbursement amount from the insurance carriers if you neither share the required 
information (need patient’s permission) nor submit the claims with the correct coding.
[email protected]             https://www.247medicalbillingservices.com/        888-502-0537
Staying Updated with the Regulations
Did you know that the ‘Meaningful Use’ has shaken the entire healthcare 
industry with significant mandates? In fact, now the main concern for the 
eye care practices is regarding the MACRA and MIPS. Additionally, a long 
list of ICD-10 codes changes is waiting in the queue for reporting. 
However, staying on top of these ever-changing regulations can prove to 
be quite a difficult task. Apart from these frustrating changes, the changes 
are also there to ensure that your patients get quality care whenever they 
are in need.
One way to remain updated with these regulations is to select the best 
EHR and practice management platform. This solution comes up with the 
support of a clinical decision and the capability to generate and verify the 
ICD-10 codes..
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Billing Service Provider not an Optometry Expert  
Being a billing service provider and an optometry expert is a different 
thing. How can you expect yourself as an optometry expert to 
undertake medical billing and coding like a pro? That’s why many 
optometrists choose to outsource optometry billing services  to 
professional billers and coders simply to avoid claim denials and other 
data recording errors. In fact, optometry billing requires high-quality 
specific billing and coding, which is something not every billing service 
provider can handle. Therefore, outsourcing to the 24/7 Medical 
Billing Services is the solution to your problem that has a team of 
specialists with updated knowledge of all the specific requirements.
Read more : 
[email protected]             https://www.247medicalbillingservices.com/        888-502-0537
ABOUT US
• We are a medical billing company that offers ‘24/7 Medical Billing Services’ and 
support physicians, hospitals, medical institutions and group practices with our end to 
end medical billing solutions. We help you earn more revenue with our quick and 
affordable services. Our customized Revenue Cycle Management (RCM) solutions 
allow physicians to attract additional revenue and reduce administrative burden or 
losses.
• Our company was founded in 2005 and is now a leading organization of highly 
motivated and certified coders & billers in the US medical billing industry. Our current 
employee strength is 500+ and we have ambitious plans to grow more rapidly.
• As a leading Medical Billing Outsourcing Company we take care of the complete setup 
& enrolment in about one to four weeks time depending on the complexity of the 
project. We have certified trainers with 10+ years of experience to train the 
newcomers so they can get acquainted with the specialty jargons & stay updated with 
the recent coding developments.
[email protected]             https://www.247medicalbillingservices.com/       888-502-0537
CONTACT US
24/7 Medical Billing Services
16192 Coastal Hwy,
Lewes, DE – 19958
USA
Phone no : 
+1 888-502-0537
Email Address :
[email protected] 
[email protected]             https://www.247medicalbillingservices.com/       888-502-0537