Charge Entry for Eye Care Claims Across the USA
Eye care charge entry in the USA carries details many specialties never use. Each line we enter includes the fields below, because a missing field is a denial waiting to happen.
- CPT or HCPCS code with RT, LT, 50 or E1 to E4 modifiers
- ICD-10-CM codes in the right order, with laterality and stage
- Drug units and the 11-digit NDC for injectables, with JZ or JW
- Referring or ordering provider where the payer requires it
- Place of service and the rendering provider under the right group
Charges are entered within 24 to 48 hours. We also reconcile the daily schedule against entered charges, so a visit with no charge is found the next day, not at month-end.
ERA and EOB Payment Posting
Most payers now send ERA 835 files, but eye practices still receive paper EOBs from some vision plans, workers compensation carriers and smaller payers. We post both. Each payment is matched to its claim by patient, date of service, code and billed amount. Contractual adjustments, patient responsibility and denials are posted line by line, not as a lump sum.
| Adjustment group | Meaning | What we do next |
|---|---|---|
| CO (contractual obligation) | Amount the practice cannot bill the patient | Compare with contract, flag if the allowed amount is short |
| PR (patient responsibility) | Deductible (PR-1), coinsurance (PR-2) or copay (PR-3) | Move to patient balance or bill the secondary plan |
| OA (other adjustment) | Adjustments outside the other groups | Review and correct the claim if needed |
| PI (payer initiated) | Payer reduction not billable to the patient | Check against contract and appeal where wrong |
Underpayments Flagged at Posting
An underpayment has no denial code, so it passes through most billing offices unseen. We load each payer's contracted rates into the posting workflow. When the allowed amount on a line falls below the expected amount, the line is flagged for review. Common eye care examples include multiple procedure reductions applied wrongly to bilateral tests and drug lines paid at an old average sales price. See our fee schedule review service for the contract side of this work.
Daily Deposit Reconciliation After Payment Posting
Each day's posted payments are reconciled to that day's bank deposits and lockbox receipts. Unmatched deposits are researched the same week, not at month-end. This matters for eye practices with optical sales, where card payments, vision plan payments and medical payments all arrive in the same account.
What Happens After Payment Posting?
Posting is the start of the next step, not the end of the claim. After each ERA posts, we take four actions the same day.
- Send secondary claims when the primary has paid and Medicare did not cross the claim over automatically.
- Route denials to denial management with the CARC and RARC attached.
- Move patient balances to patient billing so statements go out promptly.
- Flag credit balances for review so overpayments are refunded on time.
Charge entry and payment posting are part of our ophthalmology revenue cycle management service and can also be outsourced on their own.