Everything an Optometry Practice Needs

Optometrists are licensed by state boards, which write and enforce the rules that put their state's optometry laws into practice. Each board sets its own licensing requirements and its own continuing education rules for renewal. The Association of Regulatory Boards of Optometry runs COPE, a national accreditation program for the optometric continuing education courses that license renewal requires, and its OE TRACKER lets optometrists keep a record of the courses they have attended.

Each state is its own application. We prepare it with your school transcripts, exam results and verifications of every license you hold, follow up with the board until the license is issued, and track your renewals and continuing education hours in every state where you are licensed.

What an optometrist may do depends heavily on the state. States differ on prescribing therapeutic drugs, on which controlled substances, if any, an optometrist may prescribe, and on procedures. Some states allow qualified optometrists to perform certain laser procedures. In Virginia, for example, optometrists who obtain certification from an accredited college of optometry, with classroom and hands-on training, may perform YAG laser capsulotomy, selective laser trabeculoplasty and laser peripheral iridotomy, under rules set by the state board.

Scope matters for billing as well as for licensing. Medicare treats a doctor of optometry as a physician for every service the optometrist is authorized to perform under state law, so a service that is within scope in one state may not be billable in the next. We confirm what your license and certifications allow in each state before you add a service, and we keep those certifications on file with every payer.

Optometrists usually need two sets of contracts. Vision plans cover routine eye exams and eyewear, while medical plans, including Medicare, cover the diagnosis and treatment of eye disease. They are separate networks with separate applications, fee schedules and claims rules, and being in one does not put you in the other.

Vision plans set their own eligibility rules. VSP, for example, asks for an NPI and a current CAQH profile, and accepts applicants who own and control a practice and dispensary or who are employed by a VSP network provider. Medical plans have their own requirements, and many also rely on CAQH. We build and attest your CAQH profile once and use it for every application, vision and medical alike.

To bill Medicare for medical eye care, each optometrist and the practice enroll through PECOS. Optometrists are among the physicians CMS allows to opt out of Medicare and treat Medicare patients under private contracts, but most practices that see older patients stay enrolled because medical eye care is a large part of their revenue.

If you furnish items Medicare pays for separately, such as the prosthetic lenses a patient needs after cataract surgery, you also need a separate enrollment as a DMEPOS supplier on form CMS-855S, which lists optometrists among the suppliers that must use it.

Medicare excludes routine vision care: eyeglasses, contact lenses, and eye examinations for the purpose of prescribing, fitting or changing them. Refractions are excluded no matter who performs them or why, so a refraction is never paid by Medicare even during a medical visit. The patient pays for it, or a vision plan covers it if the patient has one.

The exclusion does not apply to services for eye disease, such as glaucoma or cataracts, and Medicare's routine checkup exclusion specifically does not apply to glaucoma screening exams. Medicare also covers post-surgical prosthetic lenses after cataract surgery, and permanent prosthetic lenses for a patient who lacks the natural lens of the eye. Every covered service must still be reasonable and necessary for the diagnosis or treatment of an illness or injury.

Because the same visit can involve a vision plan, a medical plan and a patient balance, we check eligibility for both kinds of coverage before the appointment, code the visit from the chart, and send each part to the payer that owes it.

In states that allow optometrists to prescribe controlled substances, you need a DEA registration to do it. DEA registers a practitioner only when the state authorizes them to dispense controlled substances, and the schedules you may handle follow what your state allows. A separate registration is required for each principal place of practice, so an optometrist with locations in more than one state needs one in each. We confirm your state's authority first, then handle the registration and every renewal.

Splitting medical and routine care starts in the chart. We set up your EHR with exam templates that record the reason for the visit, keep the refraction as its own line, and carry the diagnosis through to the claim, so the medical part of a visit can be billed to the medical plan and the routine part to the vision plan or the patient. Scheduling and online intake collect both vision and medical insurance before the patient arrives, and e-prescribing is set up for the medications your state allows you to prescribe.

Eyewear and contact lens sales add a retail side to the practice. We set up card, HSA/FSA and ACH payments, so frames, lenses and self-pay services are collected at checkout and reconciled with insurance payments in the same monthly report.

Patients choose an eye doctor close to home, usually after a search. We build and run your website, local search and AI search visibility, Google and Microsoft ads, and review requests, with pages for the services you want to grow, from comprehensive exams and contact lens fittings to dry eye, myopia management and medical eye care. Because the same team runs your billing, your marketing promotes the services your plans and your self-pay pricing actually support.

Medical eye care claims are judged against the chart. The record must show the complaint or condition that made the visit medical, the findings and the plan, and it must keep any refraction separate from the covered service. We review documentation against claims before they go out and answer payer record requests with complete charts.

Optometry practices hold protected health information in the EHR, in imaging devices and in optical ordering systems. We run your HIPAA security risk assessment, write your policies, train your staff and collect business associate agreements from every vendor that handles patient data, then repeat the assessment every year.