Case Study: Non-Covered Charges & Missing Patient Acknowledgments in Ophthalmology
Ophthalmology practices often face denials for routine and non-covered services when patient responsibility isn’t communicated clearly. A New York ophthalmology clinic experienced repeated denials for refractions and diagnostic tests due to missing patient acknowledgments and incorrect billing of non-covered services.
Ophthalmology Practice Prevents $97,815 in Losses by Implementing Proper Patient Acknowledgment Procedures, With MBW RCM's guidance, the practice adopted refraction policies, ABNs, and upfront collection workflows to eliminate avoidable denials.
Client Overview
Location: New York, USA
Specialty: Ophthalmology Billing Services
Total Denied Claims: 264
Financial Impact: $97,815 in non-covered charges
Affected Services: Refraction (92015), OCT (92134), Topography (92025), Pachymetry (76514), B-Scan (76513)
Customer Situation
A New York ophthalmology practice experienced widespread denials for routine and non-covered services because patients were not informed of their financial responsibility prior to receiving care. In ophthalmology, many services fall under patient responsibility because most insurance carriers classify them as non-covered or routine. These commonly denied services included:
92015 – Refraction
92134 – OCT Retina
92025 – Corneal Topography
76514 – Pachymetry
76513 – Ultrasound, B-scan
The practice did not notify patients that refraction and routine eye exam components were not covered by many insurance plans. Additionally:
No payment was collected at the time of service
Patients did not sign a Refraction Policy or ABN (Advance Beneficiary Notice)
Staff assumed claims would be paid and billed insurance incorrectly
Because proper patient acknowledgment was not obtained, all denials became the practice’s financial responsibility.
Challenges
MBW RCM identified multiple gaps in the practice’s front-desk and billing workflow:
No signed Refraction Policy was obtained for CPT 92015.
No ABN or patient acknowledgment was collected for diagnostic services such as 92134, 92025, 76514, and 76513.
Payments were not collected at the time of service.
Staff incorrectly billed insurance for services that are routinely considered non-covered.
Patients were unaware of their financial responsibility.
Because these protocols were not followed, payers denied a large volume of claims.
A total of 264 claims across Aetna, UHC, Medicare, Fidelis, and Cigna were denied for non-covered services, resulting in $97,815 in outstanding balances. After MBW RCM presented payer policy evidence, the practice approved adjusting off the entire amount.
Solution
MBW RCM implemented a structured process to ensure compliance and prevent future denials.
1. Refraction Policy
The practice must implement a signed Refraction Policy for CPT 92015.
Typical refraction fees range from $20 or $50–$60.
Payment must be collected before the exam or at check-in.
If the provider chooses not to bill the patient, MBW RCM can adjust off the charges.
2. Advance Beneficiary Notice (ABN) / Patient Acknowledgment
For services such as 92134, 92025, 76514, and 76513:
Staff must obtain a signed ABN or non-coverage waiver before the service is performed.
Patients must be informed that these services are non-covered, and they will be responsible for the fee.
These steps ensure patient acknowledgment is documented and prevent future non-covered denials.
Results
Prevented future non-covered denials by enforcing ABN and patient acknowledgment requirements.
Improved front-desk collections by requiring payment for refractions and non-covered diagnostic services at check-in.
Eliminated unnecessary write-offs, avoiding losses like the previous $97,815 adjustment.
Strengthened compliance with payer rules and standardized patient communication.
Reduced billing errors related to routine and non-covered ophthalmology services.
Schedule a consultation
Missing patient acknowledgments and incorrect handling of non-covered services often lead to preventable write-offs. MBW RCM helps ophthalmology practices implement refraction policies, ABNs, and upfront collection workflows to reduce denials and protect revenue. To learn how we can support your practice, fill out the form below and our team will contact you soon.
