Insurance write-offs are an inevitable cost of providing medical services. Some are to be expected, like contractual agreements and negotiated rates with insurance companies. Others are in an effort to provide compassionate care, such as donated services to individuals facing financial hardships. However, every dollar billed and uncollected due to procedural, documentation, or other avoidable errors are dollars that directly impact your bottom line — and hurt your practice and your staff. 

And since denial rates generally fall between 5 to 10%, this can add up quickly.

Let’s say your practice conducts $100,000 in exams and procedures. In ophthalmology, the average claims denial rate is usually around 8%. If that’s written off due to avoidable issues, that translates to $8,000 in lost profit. Better systems and proven strategies to stop leakage can help you lock in more of the revenue you’re owed.

What Counts as an Insurance Write-Off?

Write-offs in optometry and ophthalmology billing typically fall into one of two categories:

1. Contractual Write-Offs

Also referred to as contractual adjustments or allowances, these are agreed-upon discounts that providers accept based on their contracts with insurance payers. Common examples include:

• The difference between the provider's standard charges and the insurance carrier’s allowable fees
  
  
• Discounts related to promotions or special pricing arrangements
  
  
• Small balance adjustments when the cost of invoicing or collecting a nominal amount exceeds its value
  
  

These write-offs are a routine part of doing business with third-party payers and are generally non-negotiable.

2. Avoidable Write-Offs

This category represents missed revenue — and the area where strong denial management strategies can make a real impact. Avoidable write-offs often stem from:

• Coding errors (e.g., incorrect CPT or ICD-10 codes)
  
  
• Missing or incomplete documentation
  
  
• Eligibility issues, such as inactive insurance or unverified coverage
  
  
• Untimely filing, where claims are submitted after the payer’s deadline
  
  

Many of these are preventable with the right front-office protocols, staff training, and billing system workflows.

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3. Other Common Write-Off Scenarios

In addition to the standard categories above, providers may encounter write-offs due to operational or patient-centered decisions:

• Charity care: Practices may choose to waive some or all of a bill for patients facing financial hardship, especially for medically necessary services.
  
  
• Small balances: Even outside of payer contracts, providers might manually write off minor amounts (e.g., under $10) where the cost of collection outweighs the potential return.
  
  
• Administrative errors: Mistakes like incorrect patient demographics, missing modifiers, or billing the wrong payer can lead to denials or unnecessary adjustments.
  
  
• Bad debt: If a patient account remains unpaid after repeated collection efforts, it may be written off as bad debt and potentially sent to collections.

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While lost revenue potential is a cost of doing business in nearly every industry, there are strategies you and your team can employ to mitigate lost revenue. What follows are nine proven, repeatable, and scalable strategies for reducing your risk of insurance write-offs for your eye care practice.

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9 Proven Ways to Reduce Insurance Write-Offs for Your Practice

1.      Diagnose the problem with data

Setting aside contractual write-offs, you can find clues in your practice management analytics. To begin, pull aged accounts receivable (A/R) and associated denial codes from your practice management or EHR system.

Generate aging reports that break A/R into standard buckets (0-30, 31-60, 61-90, 91-120, and 120+ days past due). Eye care practices that are running smoothly typically collect 40-60% of charges within 0-30 days. Collectability generally declines thereafter. If your accounts are aging past industry standards, you may have a revenue cycle problem.

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2.      Identify denial trends by payer, CPT, and location

Next, review denial codes alongside aged A/R to spot trends, like recurring codes or missing modifiers. Segment your write-offs by payer, CPT, and location.

Denial rates vary by payer. Private insurance plans face denial rates of about 15% on average, but they can vary by company. Medicare also has a significant denial rate, which can have a real impact on your reimbursement. 

The frequency in Medicare’s vision claim denials is largely due to strict documentation requirements and frequent changes in coverage policies. Common reasons for denials include missing or insufficient chart notes, incorrect use of modifiers, lack of medical necessity, or failure to meet frequency limitations for routine exams and diagnostic testing. Because Medicare auditors closely scrutinize eye care claims, especially for services like visual field testing, OCT, and refractions, practices must stay vigilant in coding accuracy and eligibility verification. Even small oversights can lead to delays or lost revenue if claims are denied and not corrected promptly.

Some codes are more prone to denials due to documentation and coverage rules. Billing for 92083 CPT code, 92283, and 95919 are known for triggering insurance write-offs in eye care. Look for patterns in denials.

If your practice operates in multiple locations, you can use this process to uncover gaps in training, workflow, or payer discrepancies. There may be region-specific rules or inconsistencies between locations.

3.      Strengthen coding and documentation

Are you coding and documenting ophthalmic tests properly? 92083 CPT code (visual field), 92060 (EOM sensorimotor), 92283 (D-15), and 95919 (pupillometry) have very different coding and documentation processes. Usually, denials are caused by lack of documented medical necessity, missing modifiers, or bundling conflicts.

Incorrect or missing modifiers, like -25, -59, -26, TC, or laterality modifiers -RT and -LT are easy to overlook. Misusing modifiers or missing technical/professional components frequently leads to claim rejections as well.

For more on medical necessity billing, watch this video clip from our webinar, Mastering Vision Field Testing.

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In eye care, it’s especially important to provide sufficient clinical indication for visual field testing or diagnostic imaging. Even though visual field tests should be part of any comprehensive exam, there needs to be justification.

Medicare reimbursement for visual field testing usually applies when deemed medically necessary, especially for conditions like glaucoma or neurological disorders. Document all relevant details, including the patient’s symptoms and diagnosis, to help ensure reimbursement.

4.      Streamline your revenue-cycle workflow

Reliable eye care revenue cycle management is built on simple, repeatable processes that reduce errors and speed up payments. Ensure every patient encounter starts with consistent intake, insurance verification, and authorization checks. Submitting claims in daily batches, rather than letting them pile up, also keeps your revenue flow moving and reduces risk of untimely filing.

Clean-claim scrubbing tools integrated with your practice management system or clearinghouse can check for coding errors, missing modifiers, documentation mismatches, and payer-specific rules before submission.

5.      Verify eligibility and prior authorization before the visit

Eligibility issues and missing prior authorizations remain two of the top reasons for claim denials in ophthalmology and optometry practices. Consider automating insurance eligibility verification for faster checks and reduced denials due to eligibility errors. A pre-visit checklist that ensures the patient is currently covered by the payer, that your practice has a contractual agreement with their vision coverage network, and that an authorization for services has been obtained by the carrier for high-cost tests will help mitigate your risk of claim denials.

6.      Establish a denial management process

Even with clean claims and accurate coding, denials still happen. When they do, timing matters. To help reduce insurance write-offs, eye care practices should review their applicable workflows. With a denial rate in mind, you can systematically analyze error patterns. A proactive response is key. Many revenue cycle management experts recommend initiating investigation and correction of denials within 24–48 hours of receipt. Keep in mind, however, that full claim resolution can take up to 30 days on average, so prompt action on the front end will support your recovery efforts and accounting practices.

7.      Engage payers proactively

Now that you have data and understand the claims, payers, CPT codes, and root causes of many write-offs, you can negotiate fee schedules or challenge high denial rates. Direct communication and sharing clinical workflows can make a difference.

Use your documented medical necessity and clean claims history as leverage to secure improved coverage or reimbursement terms. Provide payers with clear documentation and justification for high-cost or frequently denied procedures. Use analytics platforms to generate detailed, real-time reports, then track outcomes.

8.      Implement a staff training and accountability loop

To implement a staff training and accountability loop, implement quarterly coding audits and monthly key performance indicator (KPI) huddles.

Offer thorough staff training, including a standard operating procedure and training manuals that cover coding, billing, documentation, and denial management. Train existing staff and new hires, and be sure to emphasize eye care-specific billing challenges to help reduce write-offs.

A monthly KPI huddle that focuses on the billing, clinical, and admin teams to review key performance indicators (KPIs) like denial rates, aged A/R, clean claim rates, and collections. Together, you can find the root cause of write-offs and workflow bottlenecks, then create an action plan for improvement.

9.      Measure the success of your loss mitigation tactics and continue to iterate

Finally, set clean goals and measure your success. If you’re beginning with the average 8% write-offs (many of which are contractual and unavoidable), set achievable target metrics. A good goal could be:

• ≤ 3 % avoidable write-offs,
• ≥ 95 % first-pass acceptance,
• Days in A/R < 30

By experimenting with ways to mitigate write-offs, ophthalmology practices can see an increase in revenue and better documentation.

Visual Field is billable in the United States and Canada, and although the procedures differ, the message is the same. Eye care revenue cycle management matters, and you can reduce insurance write-offs if you take a closer look at potential gaps.

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