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Optometrist Credentialing

The credentialing process is one of the many areas where practices can maximize their revenue. However, it has many potential pitfalls, which solo and group practices will need to avoid. For the former, the Medicare application is a minimum of 30 pages, while for a corporation, it may go over 50 pages. Proper credentialing is essential to ensuring your acceptance does not get delayed. It is vital to find the right person or persons to complete the job so that the cash flow is not interrupted.

For optometrists, the credentialing process is very complicated, and there are quite a few factors to be considered unless going with the option of a third party vendor.

Type Of Practice

Based on the type of practice you have – independent, small group practice, or large group – you can find your own advantages and risks. Whichever is the case, meticulous planning, and due diligence can boost the RCM of your practices once it has been credentialed under a certain level.


When you start credentialing, it is important to figure out whether you prefer to be credentialed as a general practitioner, specialist or sub-specialist. While seeking appointment at an accredited facility, an optometrist certified ABCMO could be credentialed as a GP of optometry, or as specialist with broad certification in medical optometry.

Place Of Practice

Your choice of where to practice will affect the way your optometrist practice will be coded and billed, and some things like hospital Privileges can make a big difference. With changes in healthcare reforms, rules and regulations, as well as under the Obamacare Act, elderly patients are likely to need optometrists at long-term care facilities, at home, and even in hospitals. The latter will be one of the major sources of health care delivery, and optometrists who get credentialed with accompanying privileges stand to gain a lot.

Qualifications & Licenses

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Optometrist Practice

There will be a screening of professionals to determine their professional training, and to identify the range of services they can deliver. When being credentialed, optometrists are asked for information on education and professional background, current licensure to practice, DEA license (if applicable) and applicable certificates to dispense controlled substances or therapeutic agents.

All optometrists will need to show a valid license without QoC complaints, which is then verified by the AMA for MD’s and the National Practitioner Data Bank. Though this may take a while, getting through the process holds many benefits in the long-term.

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