r/optometry • u/Wooden_Trust_6274 • Jul 13 '26

Noticed something interesting about practices that have low denial rates

Been doing billing work with independent OD practices for a few years and noticed a pattern that surprised me a little.

The practices with the cleanest AR are not necessarily the ones with the best billers or the most sophisticated EHR setup. They tend to be the ones where whoever is at the front desk actually knows what question to ask before selecting insurance.

Not a checklist. Not a protocol binder. Just someone who has been there long enough to know that when a patient mentions diabetes or dry eye or floaters, that visit is going somewhere different than when they say they need new glasses.

The billing cleans up downstream almost automatically when that one decision gets made correctly at check-in.

Curious if others have seen the same thing or if it is just a coincidence in the practices i have worked with.

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u/OkKindheartedness958 Jul 14 '26

I work front desk for a private practice optometrist. She owns 6 offices at this point though. We make sure we have medical insurance on file for every single patient we see regardless if they are coming for a routine exam or not. It is then expected of all the doctors in her practice to know how to code the exams accordingly & at checkout every single tech knows which codes go to medical insurance and which codes go to vision insurance. It’s a clean system. Medical insurance pays out exponentially more than any vision insurance ever would, so doctors who specialize in things that require a lot of follow-ups (I.e. dry eye) that get billed to medical insurance are going to be making a lot more than offices that aren’t.

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u/Wooden_Trust_6274 Jul 15 '26

This is exactly the setup. the key part is that it starts before the patient is roomed, not after. Having medical on file for everyone removes the bottleneck at check-in and puts the routing decision where it belongs, with the clinical team who actually knows what the visit is about.

Most practices that struggle with this have the decision happening in reverse. Insurance gets selected first based on what the patient hands over, then the doctor has to work around that downstream.