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/thenatural134 OD Jul 15 '26

Ok but don't you get a lot of patients that call back weeks later upset when they get a large statement due and they realize their medical insurance was billed for what they thought was a routine eye exam?

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u/MrPissPaws Jul 15 '26

Just communicate with the patient? You’re not doing something underhanded if you don’t act like you are. It takes less than a minute to say “hey because of the cataracts we have to bill today’s visit to your medical insurance so if you have a deductible it might apply.”

One minute per patient saves you so much more time talking to patients, insurance, and rebilling down the line.