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AI that knows optometry billing inside and out

Stop Leaving 18% of Revenue on the Table

Your documentation supports higher reimbursements—you're just not billing for it. Our AI analyzes every encounter to optimize coding, capture missed charges, and maximize legal reimbursement.

The Undercoding Epidemic

Conservative coding is costing you a fortune

$180K
Annual undercoding loss
42%
Practices undercode E&M
67%
Miss billable procedures
$47
Lost per encounter avg

Money You're Leaving Behind Every Day

These commonly missed charges add up to $180K+ annually

Undercoded E&M Levels

Billing 99213 instead of 99214-$45
Using 92004 when 99204 applies-$85
Missing complexity modifiers-$32

Missed Testing Procedures

Extended ophthalmoscopy (92225)-$65
Fundus photography (92250)-$85
Gonioscopy (92020)-$55

Unbilled Minor Procedures

Punctal plug insertion (68761)-$145
Foreign body removal (65222)-$195
Epilation (67820)-$125

Modifier Opportunities

Missing -25 modifier-$95
Bilateral procedures (-50)-$75
Distinct procedural (-59)-$65

Vision vs Medical Routing

Wrong insurance billed-$125
Medical condition missed-$95
Coordination errors-$85

Documentation Gaps

Time not documented-$45
Complexity not captured-$65
MDM elements missing-$55

AI That Thinks Like a Certified Coder

Every note analyzed, every opportunity captured

1

Real-Time Documentation Analysis

AI reads your entire encounter note—history, exam findings, assessment, plan—understanding the clinical context and complexity of care provided.

2

Intelligent Code Selection

System evaluates all possible CPT codes, E&M levels, and modifiers. Considers medical necessity, documentation support, and payer-specific rules to select optimal codes.

3

Charge Capture Verification

Identifies every billable service performed—from punctal plugs to photos to extended testing. Nothing gets missed when AI is watching.

4

Compliance & Optimization Balance

Ensures every code is fully supported by documentation while maximizing legal reimbursement. Built-in audit protection with clear justification for each selection.

Billing Intelligence That Goes Beyond

E&M Level Optimization

AI evaluates history, exam, and medical decision-making to determine the highest supportable E&M level. No more conservative downcoding.

Average increase: $42 per medical encounter

Modifier Intelligence

Knows exactly when to apply -25, -59, -RT/-LT, and other modifiers. Understands NCCI edits and payer-specific requirements.

Modifier revenue recovery: $65K annually

Payer-Specific Rules

Built-in knowledge of Medicare LCDs, VSP requirements, EyeMed preferences, and 500+ payer rules. Bills correctly the first time.

Denial reduction: 89% fewer coding denials

Audit Protection

Every code selection includes documentation mapping showing exactly how it's supported. Complete audit trail for compliance.

100% documentation-supported coding

Smart Medical vs Vision Routing

AI determines optimal billing path for maximum reimbursement

Automatic Determination Based On:

  • Chief complaint and diagnosis codes
  • Services and procedures performed
  • Patient's coverage benefits
  • Frequency limitations
  • Previous billing history

Common Scenarios Optimized:

  • Dry eye → Medical insurance ($195 vs $0)
  • Diabetes exam → Coordinated billing
  • Glaucoma suspect → Medical E&M codes
  • Contact lens fit → Vision with medical
  • Cataracts → Medicare primary

Your Revenue Recovery Calculator

Based on practice seeing 25 patients daily

Current Undercoding Losses

E&M level undercoding-$78,000/yr
Missed procedures-$52,000/yr
Modifier opportunities-$28,000/yr
Routing errors-$22,000/yr
Total Loss-$180,000/yr

With AI Optimization

E&M optimization+$70,200/yr
Charge capture+$46,800/yr
Modifier revenue+$25,200/yr
Routing optimization+$19,800/yr
Total Recovery+$162,000/yr

$162,000 Annual Revenue Recovery

4,500% ROI • Pays for itself in 5 days

Note: Calculations based on industry averages. Your actual recovery may vary based on current coding practices and patient volume.

Billing Optimization Impact

Average results from practices using AI billing optimization

$47

Per Exam Increase

Average reimbursement increase per patient exam through proper E&M level selection and complete procedure capture. AI identifies billable services consistently missed in manual coding.

$186K average first-year recovery

22%

Collection Increase

Practices report significant collection improvements from addressing chronic undercoding. AI optimization captures modifiers, procedures, and appropriate complexity levels.

Zero increase in audit risk

$65K

Routing Optimization

Medical vs vision routing intelligence alone recovers substantial revenue. Combined with coding optimization, total recovery often exceeds $200K annually.

Highest ROI investment for practices

Maximum Revenue, Zero Audit Risk

Every code fully supported by documentation

Built-In Compliance

  • Documentation mapping for every code
  • Medical necessity verification
  • Time-based billing validation
  • NCCI edit checking
  • LCD/NCD compliance

Audit Trail Features

  • Complete coding rationale saved
  • Documentation screenshots
  • Modifier justification
  • E&M level calculation details
  • Historical coding patterns

Billing Optimization Questions

How much revenue am I really leaving on the table?
The average practice undercodes by 18%, misses 8-12% of billable procedures, and loses another 5% to modifier and routing errors. For a $1M practice, that's $180,000-$250,000 annually.
Will aggressive coding increase my audit risk?
No. Our AI only selects codes that are fully supported by documentation. Every code includes a compliance report showing exactly how it's justified. You're actually safer than manual coding.
How does the AI know optometry-specific billing rules?
The system is trained specifically on optometry billing, including vision plan requirements, common procedures, E&M guidelines for eye care, and payer-specific rules for VSP, EyeMed, Medicare, and others.
Can it handle complex scenarios like diabetic exams?
Yes. The AI understands coordinated benefits, knows when to bill medical vs vision, applies proper modifiers, and ensures all billable components are captured—from the exam to photos to OCT.
Do I still have control over the final billing?
Absolutely. The AI provides recommendations with explanations. You can review, modify, or override any suggestion. Most practices find the AI is more accurate than manual coding and simply approve.
How quickly will I see revenue improvement?
Immediately. From day one, you'll bill higher appropriate E&M levels, capture missed procedures, and apply correct modifiers. Most practices see a 15-25% revenue increase in the first billing cycle.

Start Maximizing Revenue Today

Join 80+ practices recovering $180K+ annually with intelligent billing optimization. See higher reimbursements from your very next claim.

Free revenue analysis • See your undercoding • No commitment

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* All metrics and savings shown are based on industry averages and potential improvements. Individual results may vary.