How To Use Medical Billing for Optometry to Grow Your Practice

How to Use Medical Billing for Optometry to Grow Your Practice

As an ambitious optometrist or investor in the optometry industry, you naturally want to get the most out of your practice, whether you have an existing practice or are looking to open your first. An effective way to maximize your profits is to implement medical billing for optometry. With effective management, engaging in medical billing for optometry can lay the groundwork for expanding your practice. Let’s take a look at exactly how medical billing of this kind works, its boons and challenges, and some additional ideas for how to grow your practice, like franchising with Pearle Vision.

How Medical Billing for Optometry Works

Medical billing for optometry is the practice of submitting health insurance claims to get reimbursed from insurance providers for various optometry procedures. This form of medical billing allows optometrists to provide services beyond basic vision plans, which typically only cover basic exams and eyewear costs. With medical billing, you can also provide other procedures, broadening the scope of your practice.

To provide medical billing as an optometry practice, you (or your practicing optometrist) need to be accepted and credentialed with the medical insurance plans available in your practicing area, such as Medicare. You also need to familiarize yourself with billing and coding requirements, especially those specific to optometry. You also need to understand Medicare’s Merit-Based Incentive Payment System (MIPS), which provides both bonuses and penalties based on performance measures.

It’s important to create patient education procedures as well; you need to explain to your patients why various tests and follow-ups are necessary, and how some of these tests aren’t covered by their vision plans, instead requiring health insurance reimbursement.

Medical Billing Pros and Cons

Medical billing has some strong incentives that can help your practice grow, but there are challenges to overcome, especially for an independent practice where you have to take on all the responsibilities.

Pros

Increased practice revenue beyond what vision plans provide.
An expanded number of diagnostic and treatment options to offer patients.
The ability to broaden your practice’s scope to provide a comprehensive range of eye health services.
A means to circumvent diminishing reimbursement rates from vision plans.

Cons

A need to make sure you (or your practicing optometrist) have full approval and credentials from an insurance provider before submitting claims.
The responsibility of keeping up with claim submission deadlines.
The need to avoid overusing codes, unnecessary testing, and drastically varying in code use from neighboring practices.
The requirement to submit orders for diagnostic imaging and testing before they can be performed, and then document the test results in patient charts.

It should be noted most of the challenges with medical billing as an optometrist are matters of record keeping and certification. Accuracy in billing is vital to avoid delays, denials, and audits. Digital billing service BillFlash reported in January 2023 that 80% of medical bills in the U.S. contained some kind of error. You’ll have to handle all these responsibilities by yourself if you operate an independent practice. However, joining a franchise like Pearle Vision will provide you with administrative support for proper optometry coding and the necessary certifications while you maintain your compliance with insurance regulations and insurance carriers’ credentialing requirements.

Additional Practice Growth Ideas

Franchising with brands like Pearle Vision can help you grow your practice in more ways than billing assistance. They also provide you with a network of industry contacts through your fellow franchisees, supply chain assistance, site selection, and in the case of brands like Pearle Vision, a scalable business model. Other ways to grow your practice include:

Partnering with another healthcare provider or business.
Expanding/improving services through technology or enhanced facilities.
Using digital marketing tools to attract more patients and boost your practice’s visibility.
Starting a referral program to encourage your patients to refer others to your practice.

Franchise with Pearle Vision

We’re proud to offer you the opportunity to join our brand and discover how you can profit by franchising with us. We’ll be with you every step of the way, from onboarding to training, from site selection to marketing your grand opening, and more. Get started today by filling out a form to find out more about franchising with Pearle Vision.