Important Claims Stats You Should Know in 2020

Posted by Shane Shepherd on Mon, Aug 31, 2020 @ 11:08 AM

Statistics can be manipulated to prove any point you want through the way they’re presented. This is true for all healthcare and other industries, hence why data visualization is such a burgeoning field.

In fact, 85% of all people already know that. However, numbers don’t lie. The numbers are your bottom line in your practice and being aware of certain stats can increase your sense of control during these unprecedented times.

VisionWeb’s RCM service processes between 25-30k procedures billed to Health Insurance Companies a month. Over the years, we’ve collected some important statistics we’d like to share and explain.

2020 Optometry Billing Statistics

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Claims Volume is over ninety percent of what it was at this time last year. I know there are practices that are still shut down or are severely limited. Having said that, the majority of optometrists’ patient volume is being limited due to capacity rather than demand. The demand is still there.


Thirty-four percent of all claims denied from Medical Insurance Payers are for adjustment code 96. That code is defined as: Non-Covered Charges. There are exceptions to this, but generally this is due to a routine vision exam being billed to a health insurance policy that doesn’t have a preventative service. This can be reduced by checking the benefits prior to seeing the patient. Also, understanding that some policies have coverage for a general vision screening but not a comprehensive eye exam.

19 Days

That’s how long it takes the average practice to successfully submit all of their claims. Now you may say to yourself, “I submit my claims much quicker than that!” That may indeed be the case, you initially submit your claims in a couple of days. However, you might want to focus on how quickly your rejections and denials get worked. That figure is what inflates the average successful submission time. If your initial submission time is 3 days and the overall average is 19 days, what does that tell you about your rejections and denials? Don’t just assume you are better than average when it comes to this metric.


Thirty-seven percent of all patient payments, as they relate to medical insurance are due to deductible. That means that 63% of payments are due to copay and co-insurance. Does that ring true with what your staff is telling you about the number of patients that have deductibles that apply to your services? If you are being told that more than half your patients will have a deductible for any given test, you probably should consider verifying that information is being obtained correctly.

So, what should we take away from these stats?

  1. Work on faster processes (while being safe) because the demand is there!
  2. Audit your Benefit Acquisition process to make sure the staff knows how to verify routine coverage and what will and will NOT go to deductible.
  3. Take a look at your aging report and/or clearinghouse to make sure the rejections and denials.

Visionweb’s Revenue Cycle Management team is ready to work your rejections and denials so that you can focus on patient care. Learn more about their service here.

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Tags: Coding & Billing

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