Revenue Cycle Management for Optometry: Ultimate Tips for Optometrists

This blog was developed in partnership with TriZetto Provider Solutions, a trusted leader in healthcare revenue cycle management.

As the demand for efficient healthcare operations rises, optometry practices face mounting pressure to streamline workflows, reduce administrative burdens, and enhance patient experiences—all while staying profitable. With outsourcing services projected to reach nearly $40 billion by 2032, vision care providers are turning to advanced revenue cycle management for Optometry (RCM) to stay competitive and focused on clinical care.

Why Does Revenue Cycle Management for Optometry Matter?

In the world of optometry, delayed reimbursements, coding errors, and eligibility mishaps can add up quickly. This is especially true with a mix of medical and vision insurance plans in play. Whether you’re billing for routine eye exams, glaucoma management, or optical sales, every missed opportunity for clean claim submission can affect your bottom line.

Common challenges include:

• Overhead cost increases and staffing shortages
• Medical and vision payer rules management 
• Coding errors for procedures like optical coherence tomography (OCT), fundus photography, or contact lens fittings
• Revenue leakage from incorrect insurance eligibility or patient balances

Knowing the challenges and creating a strategy for overcoming them can reduce denials, improve collections, and help you gain a clear picture of your organization’s financial health.

What are The Benefits of Outsourced Billing?

While many optometrists prefer keeping billing in-house for control and convenience, outsourcing RCM to a specialized partner offers measurable advantages, especially when scaling, transitioning staff, or navigating payer changes. Small and medium-sized optometry practices often lack the resources for a dedicated in-house billing team with the expertise needed to manage the complexities of vision and medical RCM. 

Outsourcing can:

• Improve gross collections from both medical and vision claims
• Provide faster accounts receivable (AR) turnaround times
• Lessen claim denials from coding inaccuracies or missed eligibility
• Reduce staffing costs and dependency on internal billing teams
• Ensure compliance with HIPAA, payer-specific rules, and audit readiness

When you use a platform built specifically for optometry, like Eye Cloud Pro, your practice benefits from deep expertise, fewer training gaps, and smarter automation.

Unlike generic software, Eye Cloud Pro is an all-in-one optometry software designed for the unique needs of vision care, seamlessly connecting clinical documentation, billing, scheduling, and optical sales in one intuitive system. That means less time spent troubleshooting and more time focused on patient care and profitability.

What are The Benefits of In-House Billing?

While outsourcing revenue cycle management for optometry practices offers access to extended staff and resources, some practices still choose to keep billing internal, and with the right setup and technology, it can work well. 

If a practice has a long-standing billing team that’s familiar with both vision and medical billing, including coding, modifiers, and payer-specific requirements, keeping it in-house can make sense, especially if workflows are already efficient. An in-house billing professional can respond quickly to issues and may have knowledge of the specific nuances of the practice.

With experienced in-house billing staff, practices also have direct oversight of every claim, patient balance, and payer interaction. They should be able to track KPIs and implement a denials prevention plan. 

Impactful KPIs your practice should be tracking:

• Clean claim rate should be greater than 95%
• Avoidable write-offs should be run and reviewed monthly
• Resolution rates should be reviewed monthly, with 90% of the inventory resolved the first time it’s placed
• Denials percentage should be 5-10%

What are The Benefits of Technology-Enabled Revenue Cycle Management for Optometry Practices?

Digital transformation is reshaping healthcare, and optometry is no exception. While teleoptometry and remote patient monitoring expand, RCM technology is evolving to help vision practices streamline operations and boost performance. 

Automation and AI tools are making a difference in a number of ways:

• Eligibility bots can verify hundreds of vision or medical benefits daily, minimizing front desk time and reducing same-day cancellations.
• Proactive, AI-driven denial prediction tools can reduce administrative burdens for healthcare providers and find likely denials before a claim is sent.
• Claim scrubbing and coding engines reduce human error in CPT and ICD-10 coding (e.g., 92004, 92133and H52.4), helping ensure accurate, timely reimbursement.
• Analytics dashboards provide real-time visibility into collections, outstanding claims, and payer trends so your organization can spot bottlenecks before they impact cash flow.
• Robotic Process Automation (RPA) tools handle repetitive back-office tasks such as posting explanation of benefits (EOBs) or generating patient statements, freeing staff to focus on in-person care.

Practices that adopt these tools aren’t just keeping up—they’re gaining a competitive edge, with smoother workflows, fewer errors, and stronger financial outcomes.

Addressing the skills gap in vision RCM

Despite the tech surge, many practices struggle to train staff or afford the resources needed to implement robust RCM systems. More than 66% of provider organizations plan to invest in RCM analytics, yet over 75% say they lack the skills, bandwidth, or budget to move forward.

For optometry clinics, especially independent practices or small groups, outsourcing can be a strategic way to gain access to enterprise-level tools without large upfront investments. It can also help practices avoid staffing disruptions and the learning curve of frequent payer updates. When upskilling and technology are no longer a pressing issue, providers can get back to focusing on patient care and growing the optical side of the business.

Streamline Your Revenue Cycle Management With The Right Partner

The landscape of vision care is evolving, and so must the way we manage revenue. Whether you’re a single-location practice or a growing multi-site group, combining expertise, automation, and strategic outsourcing can bring revenue cycle management for your optometry practice into sharper focus. By partnering with a trusted RCM vendor that understands the nuances of optometry billing and workflows, you’re investing in the long-term financial clarity and health of your practice. Ready to get started? Click to explore TriZetto’s RCM solutions or schedule a demo with Eye Cloud Pro today!