6 Tips to Successfully Prevent Vision Insurance Billing Audits

Updated: Dec 23, 2021

Vision insurance billing audits can be very frustrating. The scrutiny by insurance carriers can expose various inaccuracies, errors, and can lead to substantial fines and penalties. Having sound policies and operational frameworks in place can be the best way to make sure your optometry practice does not have to undergo a vision insurance billing audit.


Here are 6 useful tips that can help you protect your optometry practice from vision insurance billing audits.


Error-free Claims Processing


Mistakes in billing processes or claim errors often lead to vision insurance billing audits. The common claims processing mistakes are entering incorrect patient information, not verifying patients’ insurance and benefits, etc. Reducing these errors can play a crucial role in decreasing the threat of audits. A dedicated optometry revenue cycle management system can ensure that all your claims are clean and free of errors.


Proper Documentation


An important prerequisite to prevent vision insurance billing audits is proper documentation. Along with ensuring you get paid for your optometry services, adequate documentation is also required to prove that the services you provided were medically necessary. The documentation should include information such as credentialing and licensing details of the provider, assessment of patient’s condition, justification of diagnosis and treatment plan, and other relevant details.


Self-auditing


Prevention is better than cure. And the best way to prevent vision insurance billing audits is to do one yourself. It is always better to catch potential problems before they lead to significant errors, disrupt your system, and cause major payer audits. Although a huge burden on the billing team, conducting annual or biannual self-audits can save your company from critical hassles. This, in turn, can be beneficial in boosting optometry billing reimbursements.


Medical Coding Precision


Coding issues are one of the most common reasons that trigger vision insurance billing audits. Although upcoding or under-coding can be considered accidental, such mistakes in a particular pattern and over a period of time can have critical legal ramifications. Using certain ICD-10 (International Classification of Diseases - 10) codes or CPT (Current Procedural Terminology) codes in excess can also result in vision insurance billing audits. It is thus recommended to have an optometry coding specialist to ensure accuracy and compliance in your billing tasks at all times.


Outsource Billing to Industry Experts


Vision insurance billing audits can take a significant toll on the financial health of your optometry practice. To prevent this, it is imperative for optometry providers to take a proactive approach to medical billing and claims processing. Having industry experts bear the burden of your billing procedures can be an excellent way to stay away from payer audits. Outsourcing optometry billing can not only enhance your practice’s profitability but will also enable you to focus more on providing optimal patient care.


Patient Satisfaction


Patients have the provision of getting in touch with the insurance carriers if they have any issues pertaining to the bills. These issues generally involve instances where patients are billed for services they did not receive. A great strategy to prevent this from happening is to offer patients an outlet to gain information or make complaints. This can help you resolve the issue before it reaches the insurance carrier, thereby eliminating the possibility of a vision insurance billing audit.



Staying away from payer audits is quite simple and stress-free. All you need to do is incorporate the above mentioned strategies and take the necessary steps to not commit any grave billing mistakes. Get in touch with CS Eye to gain outstanding optometry billing services. Let us help you stay compliant with all necessary regulations and prevent the threat of critical insurance audits.


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