The 7 Most Frequently Asked Billing Questions in Eye Care Answered

Demystify insurance claims, coding, denials, and patient billing with expert answers that boost your practice performance.

Running a successful eye care practice means more than delivering excellent care—it also means getting paid accurately and on time. Revenue cycle management (RCM) can be challenging, especially when insurance requirements shift and staffing is tight.

Billing services and solutions should help support your practice in everything from claim submission to denial resolution.

Here are the top 7 billing questions we hear most often from optometry and ophthalmology practices.

1. How can I reduce claim denials and rejections?

Denials are costly, time-consuming, and frustrating. The top reasons for denials include missing data, incorrect coding, eligibility issues, or services not covered.

To reduce these denials, conduct front-end eligibility checks and scrub claims. Automated tools can help you prevent issues before submission. If denials do occur, designate a staff member to handle appeals and follow-ups to reduce any billing backlog. If your staff are spending too much time on handling appeals, working with an external billing expert is an option, especially if your front office is already busy with other projects and patient interaction.

2. What’s the difference between a vision plan and medical billing?

Vision plans typically cover routine eye exams, glasses, and contact lenses. Medical insurance covers health-related eye problems, such as glaucoma, conjunctivitis, or diabetes-related conditions.

The Fast Pay Health team often helps practices correctly categorize and code each encounter and bill the correct payer first to avoid costly confusion and ensure timely reimbursement.

3. How can I stay current with ICD-10 and CPT coding changes?

Code updates occur annually, and falling behind can result in lost revenue or compliance risks. Most practices need certified billing experts to stay on top of the latest changes and ensure claims are coded accurately. For example, at Fast Pay Health, we train staff on trigger-based coding built into the MaximEyes EHR—for faster, smarter charting that reduces audit risk.

4. What’s the best way to track unpaid patient balances?

Chasing balances can strain staff and damage patient trust.

The solution? Implement automated statements and patient-friendly payment options, including text-to-pay and patient portal reminders. Even better, work with an expert external team that monitors every account to ensure follow-through, without putting pressure on your front desk.

5. Is it possible to check insurance eligibility automatically?

Yes. And it’s a game-changer.

MaximEyes eye care software uses AI-driven eligibility tools to check insurance data 72 hours before a patient visit. We verify copays, coverage, and deductibles while you sleep. No more logging into five portals just to confirm a visit.

6. What KPIs should I monitor to know if my billing process is working?

Monitor and measure the following: Clean claim rate, days in AR, first-pass resolution rate, denial rate, and collection rate.

It’s important to work with an internal or external team member who can provide monthly reporting with plain-language dashboards that break down your performance metrics, and show what’s working and what’s not. Transparency is often the key to profitability.

7. Can Fast Pay Health integrate with my eye care EHR system?

Yes. Fast Pay Health is designed to integrate with MaximEyes and other optometry and ophthalmology EHR systems.

Our integration lets your clinical and billing teams share data securely and efficiently. From real-time charge capture to patient engagement tools, we keep everyone on the same page.

Practices using MaximEyes EHR combined with Fast Pay Health’s professional RCM services report seeing up to 3,000 more patients per year, with no increase in staff. Time-saving features, such as automated eligibility checks, integrated payment, and customizable workflows, allow you to focus on care while billing runs smoothly in the background.

Let’s Simplify Your Billing

It’s time to make billing the easiest part of your day. Whether you're getting started or ready to expand your practice, we have tailored solutions that improve cash flow and reduce stress.

Contact the Fast Pay Health team today to schedule a consultation.