Will you bill both medical and vision claims?

Yes. We separate workflows and ensure each claim goes to the right payer or retail channel.

How do you handle contact lens and DME billing?

We map HCPCS codes, collect POD, and handle prior authorizations when required—so supply claims clear cleanly.

Can you work with our current EHR/PM?

We integrate with most systems by HL7/FHIR feeds or secure file exchange to minimize manual entry.

How quickly will I see improvements?

Many practices notice better claim acceptance and fewer denials within 45–90 days after cleanup and process changes.

Do you provide reports and a dedicated contact?

Yes. You’ll have a single account manager and regular KPI reports that make financial decisions easy.

Optometry medical billing for vision care and diagnostic imaging - Talk to an Expert button

Optometry Billing Services

You care for eyes. We care for the billing behind them. Optometry combines optical retail, diagnostic imaging, medical eye illness control, and regular vision care. That blend produces particular billing complications: differentiating medical from vision benefits, coding sophisticated imaging (OCT, visual fields), billing DME (therapeutic contact lenses, specialist lenses), and dealing with payer anomalies for refractive and comanagement. At Sirius Solutions Global we take that complexity off your desk. We build workflows that capture every legitimate dollar, reduce denials, and let your team spend time with patients - not on paperwork.

Talk to an Expert

End-to-end optometry billing services

We focus on practical, measurable improvements that fit optometry workflows.

Eligibility & Benefits Verification (Upfront)

Confirm medical vs. vision coverage before the visit.
Flag refraction exclusions, frequency limits, and DME requirements.
Provide clear patient estimates to reduce surprise balances.

Accurate Coding & Chart Alignment

Map encounter notes to the exact CPT/HCPCS/ICD-10 codes payers expect.
Separate technical (TC) and professional (26) components for imaging.
Correctly apply modifiers (RT/LT, 59, 25, 52) so services are paid.

Diagnostic Testing & Imaging Billing

OCT, visual fields, fundus photography, and angiography mapping.
Ensure interpretation notes justify the professional component.
Reconcile tech logs with billed charges to prevent audit triggers.

DME & Contact Lens Billing

Correct HCPCS for bandage, scleral, or specialty therapeutic lenses.
Proof-of-delivery (POD) capture and supplier coordination.
Billing cadence and replacement rules to prevent denials.

Procedure & Minor Surgery Billing

Capture supplies, anesthesia (if applicable), and procedure complexity.
Document and bill for removal of foreign body, chalazion excision, simple laceration repair, etc., with correct modifiers.

Telehealth & Remote Care Billing

Bill video, audio-only, and e-visits correctly according to payer guidance.
Document modality, time, and medical necessity for tele-encounters.

Claims Scrubbing & Submission

Payer-specific edits applied before claims leave our system.
First-pass acceptance focus fewer pends, fewer denials.

Denial Management & Appeals

Rapid triage, root-cause fixes, and aggressive appeals with supporting documentation.
Trend analysis to stop recurring denials at the source.

Patient Statements & Friendly Collections

Clear, separate statements for medical vs. retail charges.
Flexible payment plans and patient-first communications to preserve relationships.

Reporting & Business Intelligence

Dashboards: denial reasons, first-pass rate, AR days, net collection rate, and test-level profitability.
Actionable items you can address in staff meetings.

Realistic outcomes you can expect

Fewer denials and re-submissions for imaging and refractions.
Higher first-pass acceptance rates and shorter AR days.
Recovered revenue from targeted appeals and underpayment audits.
Clearer patient statements and fewer billing calls for front-desk staff.

Why optometry billing is different

Many practices assume vision billing is simple. In reality, small mistakes add up fast.

Vision vs. medical separation. Usually noncovered are regular refractions and optical sales; glaucoma treatment, diabetic retinopathy, and urgent ocular visits are medical.
Diagnostic imaging rules. OCT, visual fields, fundus photography and angiography carry interpretation vs. technical components, bundling rules, and payer-specific edits.
DME / contact lens nuances. Medically necessary contact lenses and specialty devices require HCPCS coding, proof-of-delivery, and sometimes prior authorization.
High-volume, low-dollar claims. Urgent walk-ins and routine checks create many small claims errors multiply quickly.
Telehealth & refraction policy shifts. Payer guidance changes often; staying current is essential.
Co-management complexities. Post-op visits and global period rules must be split correctly between surgeons and optometrists.

A single missed modifier, incorrect TC/26 split, or improper refraction claim can mean weeks of follow-up and lost revenue.

Optometry billing workflow: EHR integration and KPI reviews

5 revenue-first actions we add to your center

We don’t force your team into a rigid process. We adapt to your EHR, staff, and patient flow.

Discovery & baseline audit. We review sample claims and denials to find quick wins.
Workflow mapping. We align EHR fields, test catalogs, and retail flows.
Pilot & parallel run. We run claims side-by-side until you’re confident.
Go-live & continuous improvements. Weekly check-ins initially, then monthly KPI reviews.

Most practices notice cleaner claims and fewer rebills within 45–90 days.

Documentation advice that actually saves money

We provide your doctors powerful and payer-strong, user-friendly short temp

Link the refraction to a diagnosis e.g., "vision change following trauma" or "postop refractive evaluation" for medically essential refractions.
Note the indication and how findings will influence management when ordering OCT or visual fields.
Document contact lens fit trial results and medical rationale (e.g., keratoconus, severe dry eye) for contact lens fitting.
On same-day treatments, create one sentence clarifying why the E/M visit differs from the procedure.

Without piling more documents, these little alterations considerably lower refusals.

Optometry documentation tips for medical necessity and refunds

Optometry billing technology: automated claim scrubbing and reporting tools

Technology we use

We use secure, modern billing systems and automations to reduce repetitive tasks never to replace human judgment.

Automated claim scrubs catch missing modifiers, wrong TC/26 flags, and refraction mis-bills.
Integration tools reduce double-entry between EHR and billing; we map your test catalog to billable CPTs.
Reporting tools show the few things costing your practice the most each month so you can act.

We pair that with expert coders and a real account manager who knows optometry.

Improve optometry revenue with expert billing - Call Now button

Ready to stop chasing payments and start focusing on patients

If billing is taking time away from patient care, let’s fix it. Contact us for a complimentary baseline audit and a clear action plan. Tell us one thing that frustrates your team most about billing, and we’ll include quick wins for that in our audit.

Call Now