Billing is the practice function owners think about least until it breaks — and by the time it visibly breaks, it's usually been leaking for a year. Claims going out late, denials aging in a folder, patient balances nobody chases. Optometry billing has a particular wrinkle that makes this worse: every day mixes vision-plan claims and medical claims, two systems with different rules, and the person doing both is often also covering the front desk.
Here's how to tell when billing has outgrown your staffing, and what your options actually are.
The symptoms that matter
Skip the gut feelings; billing health shows up in four numbers. Days in AR — how long between service and payment; if yours drifts past the mid-thirties and keeps climbing, something upstream is slow. Denial rate — what share of claims bounce; persistent double digits means claims are leaving dirty. AR over 90 days — the share of your receivables going stale; a growing over-90 bucket is money quietly becoming uncollectable. And clean-claim submission lag — how many days after service claims actually go out. Pull these four this week. If two or more are unhealthy and nobody in your building has dedicated hours to fix them, you have a structural problem, not a bad month.
Your three options
Percentage-based billing companies. The traditional model: a billing service takes over claims and collections for a cut of collections, commonly in the mid-single digits. Strengths: they're professionals, they scale, and their incentive aligns loosely with yours. Weaknesses: you're one client among many, vision-plan expertise varies widely (many billing companies grew up in general medical and treat VSP and EyeMed as annoyances), and the percentage grows with your practice forever.
A dedicated remote billing specialist. The staffing model: one trained person, full-time or part-time, working your billing inside your own PM system — submissions, posting, denials, AR follow-up, patient balances. Strengths: they work only your accounts, they learn your payer mix including the vision plans, the flat rate doesn't scale against you, and you keep full visibility because everything happens in your system. Weaknesses: it's a staffing relationship — onboarding, management, the works — and a single specialist has a ceiling; very large practices need more than one.
The hybrid. An in-office biller or office manager who owns strategy and the tricky cases, with a remote assistant handling the daily volume: submissions, posting, status checks, routine denials. This is the fastest-growing arrangement in eye care for a reason — it keeps institutional knowledge in the building while giving it the daily execution hours it never had.
How to evaluate any provider
- Vision-plan fluency, verified. Ask them to walk through billing a routine exam with materials to VSP, then a medical visit for the same patient the next week. Hesitation is your answer.
- Your system or theirs? Billing done inside your PM system keeps your data, your visibility, and your exit option. Billing done in a provider's proprietary system is a subtle form of lock-in.
- Reporting cadence. Weekly numbers you can read in two minutes: submitted, paid, denied, appealed, aged. Anyone who resists routine reporting is telling you something.
- References from eye care. Not healthcare generally — optometry or ophthalmology specifically. The vision/medical split is exactly where generalists stumble.
The honest bottom line
Outsourcing billing isn't an admission of failure; it's an acknowledgment that billing is a full-time discipline being done part-time in most practices. Whether you choose a percentage service, a dedicated remote specialist, or the hybrid, the deciding factors are the same: eye care fluency, your-system transparency, and daily execution hours that actually exist. Our cost guide breaks down the pricing math across models — and if the dedicated-specialist model fits your shape, that's the corner of this market we know best.
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