Separating the two benefits
A diabetic eye exam is medical. A refraction and glasses prescription may be vision or self-pay. When the two are combined carelessly, the medical claim can be denied and the patient receives a bill they did not expect.
We set up the claim structure so each service lands in the right bucket, with front-desk language that matches, and reporting that separates the two revenue streams.
- Medical versus vision benefit determination
- Refraction and optometry service billing rules
- Surgical codes with global periods and laterality
- Injectable drug billing and payer-specific requirements
High-volume, small-dollar visits
Ophthalmology runs a large number of short encounters. A small coding inconsistency repeats across thousands of claims, so pre-submission review pays for itself quickly.
We review patterns by provider rather than auditing every claim, which keeps the process efficient while still catching drift.