Sightview
Revenue cycle management (RCM) may not be the most exciting part of running an eye care practice, but it’s critical to ongoing survival. When billing and payments run smoothly, your practice benefits from faster cash flow, stronger profitability, and more time for patient care.
But when parts of your RCM workflow start to slow down, the impact is substantial. What looks like a two-minute workaround or a “fix it later” billing issue can snowball into aging A/R, preventable denials, profit loss, and staff burnout. This blog will walk you through the most common bottlenecks in eye care billing today and how to start addressing them.
1. The Medical vs. Vision Billing Challenge
Eye care is one of the only specialties that has to navigate two payer types: medical and vision. Staff must determine whether services fall under medical or vision insurance (or both), if documentation supports that distinction, and if the correct modifiers and codes are being used.
A single mistake can cause a denial, forcing staff to make corrections, and resubmit claims. It also prolongs payment and decreases profitability due to the costs of reworking the denials. The medical vs billing confusion disrupts cash flow, frustrates patients, and drains time and revenue.
Quick Tip: Use a clearinghouse that delivers enhanced medical and vision eligibility verification with a broad payer network, so staff can quickly and easily understand coverage details before the appointment. It’s also important to thoroughly train staff on medical vs. vision billing and have a quick refresher every year.
2. Eligibility Surprises at Check-In
Few things slow down the revenue cycle and frustrate patients more than last-minute eligibility surprises. For many practices, this is a common occurrence when the patient’s plan becomes inactive, deductibles reset, benefits don’t cover expected services, or staff have outdated information about copays or coinsurance.
This creates a bottleneck at the beginning of revenue cycle management and leads to:
- Billing patients for an amount they don’t expect
- Delayed or unpaid balances
- Correcting errors and rebilling
- Frustrated patients who lose trust in your practice
Quick Tip: Verify eligibility before the appointment and again at check-in with a clearinghouse that has updated payer benefit information. Proactive and accurate eligibility checks ensure patients understand their bill upfront, and the right payment amount is collected at the time of service.
3. Manual, Fragmented Billing Process
When your billing process relies on multiple systems and manual steps just to submit a claim, revenue slows down well before it ever reaches the payer. Nearly 48% of healthcare providers still process claims manually, leading to preventable errors, rework, and delayed payments.
Common sources of friction include:
- Entering the same information in multiple systems
- Manually uploading documentation and diagnostic imaging
- Copy-pasting codes between platforms
The more hands and systems that a claim passes through, the more opportunities there are for errors and delays.
Quick Tip: Look for a platform that consolidates billing tools into a single, integrated workflow that handles every major transaction type. Practices that use Sightview benefit from our TriZetto clearinghouse integration, which brings eligibility verification, claim scrubbing, submissions, and more directly into your workflow, helping reduce denials and manual work.
4. Documentation Gaps That Lead to Avoidable Denials
Most denials in healthcare result from insufficient documentation. According to Medicare improper payment data, insufficient documentation accounts for more than half of claim errors, and the pattern is similar across commercial payers.
In eye care, this often looks like:
- Missing proof of medical necessity
- Incomplete images or test results
- Missing interpretation notes
- Incorrect or incomplete chart documentation
- Coding that isn't fully supported by documentation
Nearly 85% of denials are preventable and can be overturned, but a staggering 65% are never reworked. Resolving denials means extra work from staff, such as involving the provider, locating missing documentation, or updating chart notes. As a result, denied claims frequently stall or fall off the radar, leading to lost revenue.
Quick Tip: Consider customizing provider profiles around their usual visit types to support ease of use, and ensure documentation stays specific to the patient and supports billed services. Pair this with claim scrubbing before submission to flag missing modifiers, documentation mismatches, or common coding issues early.
5. Underpayments That Slip Through Unnoticed
One of the most expensive (and silent) revenue slowdowns is payer underpayment. Many times, it goes unnoticed because staff don’t always have immediate access to contracted rates or the ability to cross-verify every posted payment. In fact, a study in Becker’s Hospital Review revealed that providers can forfeit 1-3% of their annual net revenue due to underpayments from commercial payers, while some may experience underpayment rates as high as 7-12%.
These losses accumulate slowly but steadily. A few dollars here and there, multiplied across thousands of claims, add up to a meaningful revenue gap. But the impact isn’t just lost revenue. It’s the time spent identifying and resolving every underpaid claim. Without automated checks or strong reporting, many practices aren't aware that the issue exists.
Quick Tip: Prioritize underpayment reviews by focusing on high-volume payers and high-dollar services first. Regularly review EOBs and ERAs to compare allowed amounts against expected reimbursement, and address discrepancies. Tracking these issues over time helps your team identify payer patterns and know when to escalate appeals.
6. Slow or Outdated Payment Processing
Even if claims move quickly, outdated payment workflows can slow down revenue. Today’s patients expect modern digital payment options, reminders, transparent estimates, and a fast checkout experience. Practices relying on paper statements, mailed invoices, and manual follow-up often struggle to meet those expectations.
When payments slow down, balances age and become harder to collect over time. And because patients associate the payment experience with the overall quality of care, outdated workflows can also affect satisfaction. In fact, 77% of patients say the ability to make digital payments would positively impact their relationship with their healthcare provider.
Quick Tip: Adopt tools that enable a flexible, digital-first payment experience while reducing staff manual work. Providing clear cost estimates at check-in helps reduce confusion and encourages same-day payment.
Sightview Pay powered by Global Payments, helps practices modernize patient payments with tools like Pay-by-Link, Text-to-Pay, Card-on-File, and automated reminders, creating a smoother experience for patients and faster payments for practices.
7. Disjointed Workflows Between the EHR, Clearinghouse, and Payment Processing
Practices that rely on multiple systems that don’t communicate with each other face even more billing challenges. Every handoff between systems brings delays, duplicate work, and opportunities for errors. Over time, these disconnects don’t just affect revenue. They frustrate staff, reduce productivity, and make it harder for practices to maintain a smooth day-to-day workflow.
Quick Tip: Consider switching to a unified ecosystem like Sightview, where EHR, Practice Management, billing, and payments all live in one consolidated platform. Consolidation reduces handoffs, minimizes errors, and streamlines your revenue cycle.
8. Lack of Visibility into Revenue Cycle Management Performance
You can’t fix what you can’t see. Yet many eye care practices lack clear, consistent access to the metrics that reveal how their revenue cycle is really performing, including:
- First-pass resolution rate (FPRR)
- Net collection rate (NCR)
- Denial rate and denial trends
- Underpayment patterns
- Days in A/R for insurance and patients
- Cost to collect
- Payer-specific performance
Without clear insight into where slowdowns occur, teams end up reacting to problems after revenue has already been delayed or lost, rather than addressing the root cause early.
Quick Tip: Use centralized revenue cycle management reporting that brings key metrics into an easy-to-read dashboard. Real-time visibility helps your team spot trends sooner, prioritize the right fixes, and make decisions that strengthen your practice’s financial performance over time.
Strengthen Your Billing, Strengthen Your Practice
Every RCM slowdown adds up. The good news is that the common bottlenecks in your revenue cycle can be addressed with connected tools, more efficient workflows, and a partner who understands the challenges of eye care billing.
Sightview’s RCM team works with optometry and ophthalmology practices to reduce denials, speed up payments, and capture as much revenue as possible.
If you're ready to eliminate bottlenecks and improve your cash flow, contact our RCM team to get started.