Full-cycle optometry & vision billing: what it covers

The full-cycle workflow

Front end

Dual eligibility verification across medical insurance and vision plans.
Determining which payer applies to which portion of the visit before the exam.
Frame and lens allowance lookup ahead of checkout.

Middle

Medical diagnosis coding (such as a diabetic eye exam) kept separate from routine vision coding.
Claims submission to the correct payer for each service line.
Payment posting reconciled across both the medical and vision-plan payer.

Back end

Denial management for wrong-payer submissions and exhausted frame or lens allowances.
Appeals where the split billing was documented correctly but still denied.
Patient billing for the portion neither payer covers.

Oversight

Dual-payer reconciliation tracking so nothing falls between the two claims.
A/R aging and denial-rate reporting by payer type.

Where practices get stuck without it

A medical visit gets billed to the vision plan, or the reverse, and the claim denies outright.
Frame and lens allowances aren't tracked, so patients get billed for amounts a plan should have covered.
Dual-payer visits take longer to reconcile than front-office staff have time for.
There's no clear view of which payer type is driving more denials.
Patients get confusing, split statements that generate billing calls instead of payments.

What a RCVRY full-cycle billing team handles

Dual-Payer Verification

Sorts out medical versus vision-plan coverage before the exam starts.

Verifies both medical and vision-plan eligibility up front.
Determines which payer applies to which service line.
Tracks remaining frame and lens allowances.

Split Coding & Claims

Keeps medical and routine vision claims cleanly separated.

Codes medical and routine vision services separately.
Submits each line to the correct payer.
Catches wrong-payer submissions before they go out.

Denials, Appeals & Reporting

Resolves the split-billing issues that cause the most patient confusion.

Appeals denials and allowance disputes.
Handles patient billing for the uncovered portion, clearly itemized.
Reports A/R and denial rate by payer type.

Who this process is for

Optometry and ophthalmology practices juggling medical and vision-plan billing on the same patient visit, and multi-location optical groups that need the split standardized across every site.

Full-cycle optometry and vision billing: what it covers