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Thread: Is reconciling VSP, Eyemed and Spectera payments a waste of time?

  1. #1
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    Is reconciling VSP, Eyemed and Spectera payments a waste of time?

    We used to have a system whereby we billed VSP but did not post any line by line charges or payments into our billing software. The person who instituted this system told me that VSP is so accurate that you would waste more time meticulously posting and reconciling every charge and payment, than you would save in found mistakes. So for years we would simply enter the charges on the VSP website and wait for the checks to come in. This saved a lot of time but it made me uneasy because it felt kind of sloppy and overly trusting. So 3 months ago we instituted a meticulous system whereby every item's charge is posted line by line and is then reconciled when the EOP comes in. This is quite laborious and I paid a biller a fairly hefty salary each payperiod for doing the work. However, the bottom line is that I have paid far more in salary than was saved. The person doing this has apparently found extremely few mistakes and is concluding that it's a waste of time and money. Have others had the same experience?

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    IMO yes... But I dislike paperwork almost as much as I dislike specterrible.

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    Quote Originally Posted by adoc View Post
    We used to have a system whereby we billed VSP but did not post any line by line charges or payments into our billing software. The person who instituted this system told me that VSP is so accurate that you would waste more time meticulously posting and reconciling every charge and payment, than you would save in found mistakes. So for years we would simply enter the charges on the VSP website and wait for the checks to come in. This saved a lot of time but it made me uneasy because it felt kind of sloppy and overly trusting. So 3 months ago we instituted a meticulous system whereby every item's charge is posted line by line and is then reconciled when the EOP comes in. This is quite laborious and I paid a biller a fairly hefty salary each payperiod for doing the work. However, the bottom line is that I have paid far more in salary than was saved. The person doing this has apparently found extremely few mistakes and is concluding that it's a waste of time and money. Have others had the same experience?
    Hmm maybe. The person doing this job has decided VSP makes so few mistakes, they should not bother, and be terminated. This is ingenious!
    Sponsored by the VSP accounts payable department. Too funny!

  4. #4
    Optical Thingymajig OptiBoard Gold Supporter PartTimer's Avatar
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    The short of it is that I guess it depends on how you go about it. If you are paying a biller to do exactly this, it is not a win vs what you are paying them, at all. Of course, if you have multiple locations, a biller becomes more viable.

    We use existing staff; it takes them no more than a few hours' downtime every couple of weeks to burn through sometimes tens of thousands of dollars worth of payments. Our software makes it easy to produce a "line billing," and anticipates payment amounts because it contains the backend programming for it. Most of the EHR and billing systems I have used make this pretty intuitive. I have never worked in an office that did not do line billing. It adds a minute or two per patient to do this once they are used to it, and you will not have patients asking for line billing, it makes materials and procedures billed through insurance much easier to explain when patients have questions, makes you look less sloppy, etc. This is time many employees would just use to wander mentally between patients, anyway.

    It is useful for more than just reconciling payments, as well. We can self identify when people are billing things incorrectly, since someone is double checking every invoice upon reconcile, and it is much easier to catch fishy employee behavior when you have a few people looking at these types of things constantly. Of course, you have to train staff do do this themselves, but it doesn't take much time, and it makes them more useful to you. Managers and supervisors should be familiar with the process, anyway.

    This goes right along with daily reconciliation of credit and cash transactions, and reconciling bank deposits. It's good accounting, and if you spread the work out, you spread risk through shared responsibility and culpability, and have little, if any, impact on payroll. So, no: paying a biller won't net you more money because these plans incorporate all the plan details into the online submission process, anyway, and it's all done by computer. It's the other details that make it worth your staff's time. Which is, of course, just my opinion.

    Whether you stick with it or not, good luck, and stay busy!

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    There was some doc that stated here on OB that VSP had been billing him a shipping fee for marchon frames drop-shipped to the lab ( 5 bucks a pop) for years and it was supposed to be n/c the whole time. I'd keep checking my statements if I were you. I don't give blind trust to anybody.

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    Optical Thingymajig OptiBoard Gold Supporter PartTimer's Avatar
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    Quote Originally Posted by optical24/7 View Post
    I don't give blind trust to anybody.
    Yes, and from what I recall, they weren't giving him retroactive credit. You speak the word.

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    Parsing through the math

    Quote Originally Posted by PartTimer View Post
    The short of it is that I guess it depends on how you go about it. If you are paying a biller to do exactly this, it is not a win vs what you are paying them, at all. Of course, if you have multiple locations, a biller becomes more viable.

    We use existing staff; it takes them no more than a few hours' downtime every couple of weeks to burn through sometimes tens of thousands of dollars worth of payments. Our software makes it easy to produce a "line billing," and anticipates payment amounts because it contains the backend programming for it. Most of the EHR and billing systems I have used make this pretty intuitive. I have never worked in an office that did not do line billing. It adds a minute or two per patient to do this once they are used to it, and you will not have patients asking for line billing, it makes materials and procedures billed through insurance much easier to explain when patients have questions, makes you look less sloppy, etc. This is time many employees would just use to wander mentally between patients, anyway.

    It is useful for more than just reconciling payments, as well. We can self identify when people are billing things incorrectly, since someone is double checking every invoice upon reconcile, and it is much easier to catch fishy employee behavior when you have a few people looking at these types of things constantly. Of course, you have to train staff do do this themselves, but it doesn't take much time, and it makes them more useful to you. Managers and supervisors should be familiar with the process, anyway.

    This goes right along with daily reconciliation of credit and cash transactions, and reconciling bank deposits. It's good accounting, and if you spread the work out, you spread risk through shared responsibility and culpability, and have little, if any, impact on payroll. So, no: paying a biller won't net you more money because these plans incorporate all the plan details into the online submission process, anyway, and it's all done by computer. It's the other details that make it worth your staff's time. Which is, of course, just my opinion.

    Whether you stick with it or not, good luck, and stay busy!
    I agree with these points because we also run a medical practice and it would be financial suicide to not check the payments made to us. The insurance companies make a lot of mistakes and there are enough denials to absolutely justify meticulous parsing through the EOB's, patient statements etc. However, our optical shop is a small part of our practice and it is the optician who is entering in all the data and reconciling EOP's (ie: we do not have the issue of different people involved). We also do not have a dedicated back-end process for this in our EMR so every line item is posted by hand into the software after the sale and then reconciled with the EOP's. My employee definitely spends more than a "few minutes" per claim sorting all of this out. Since our optical shop data is still on paper index cards she often has to pull these cards to verify info. Also, she often needs to go into the EMR to check why an exam wasn't paid (eg: exam paid on previous visit) etc. Over the last 3 months she spent 50 hours dealing with 250 claims ($68,000 gross VSP revenues). She claims that during this time she found about 4 "mistakes" which we are now appealing with VSP. She is fairly meticulous so I am assuming that VSP made about $1000 worth of errors within that $68,000 of gross revenues. So we spent much more in salary to catch $1000 worth of errors. As your excellent response pointed out this may be worth it for the other intangible reasons of good accounting, but the other problem is that her time is limited and it's possible that those 50 hours could have gone towards increasing profitability in other ways. By the way, she also feels that error rates for Spectera, MES, Davis, Eyemed are similarly low (my analysis was for VSP alone but we also deal with these other 4).

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    I agree it's a good idea to monitor the reimbursements for each claim. Maybe line-item recordkeeping is overkill, but it still deserves at least an eyeball---and not the eyeball of the person(s) filing the claims. Even assuming the insurer is pretty accurate, denials and underpayments because of bad filing can crop up and mushroom if the filer is having an off week. Especially if opticians are the ones filing the claims for their own sales---their brains are not wrapped around insurance nuances like they are the rest of their job.

    This isn't just an A/R function, it's a managerial one.

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    If your system allows for you to input a fee schedule so it will auto calculate an estimated payment, that is the ideal solution. Then check estimated to actual and it is only a minute or two per claim.

    While I get what is being said about labor vs actual mistakes/potential losses, it would still be worth while to do an audit on them every few months. It keeps everyone honest.
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

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    Quote Originally Posted by pknsbeans View Post
    IMO yes... But I dislike paperwork almost as much as I dislike specterrible.
    lols.. me too :)

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    Wow...

    Yes, you need to reconcile your payments. It's way less about payment errors (which are mostly automated), and way more about billing errors.

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    Lightbulb Spectera and using your own frames! Be Careful and check the math.

    I was informed that Spectera is set up for using their frames and you collect the upcharge when you sell your own frame but they keep the money anyway!
    Yes, that is correct if you use a frame off your board they will charge you more than using their frames.

    Check your statement with using a frame off your board and see how you lose.

    I have known for months and did not post until this thread.

  13. #13
    What's up? drk's Avatar
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    One of the issues is the problem getting the reimbursement schedules from the VCPs.

    VSP has relatively few, but EyeMed has untold jillions. And now you must log on to a separate location to see these reimbursement schedules listed by group (whereas before it would be linked to the patient's individual benefits webpage, which was handier).

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