How do you keep track of all the vision plans in your EMR?

[adoc]

Here goes a rather vague, confused and rambling post....! We are having a very difficult time keeping track of all the different vision plans and their sub-plans. We have a medical EMR which is great for medical insurance but not really designed for the minutiae of vision plans. We have not really been able to figure out how to keep track of VP's dispensing fees, chargebacks, expected payments on our EHR. Consequently, we've been keeping dealing with it entirely seperately eg: using excel spreadsheets, calendar files, checking EOB's by hand/paper etc. It's gotten so confusing that when we get an Eyemed, Davis, VSP or MES patient we're never completely sure about what our reimbursement will be, chargebacks, dispensing fees etc. We usually know what the patient benefits are because we print this out from the various VP websites, but everything else gets confusing. Some plans let you do in-house finishing, some do not. Some plans compensate you for various options, others don't. Some plans give dispensing fees, some do not. It's especially hard for us to figure out the particular profit approach with the various plans eg: with some of the plans you can very easily wind up selling a frame for the same price you bought it for. I would love to hear from others how they keep track of all of this. Has everybody bought into dedicated optical software that keeps good track of this? Have people developed informal systems that help? Cheat sheets on every plan? Any help appreciated.

[Blunder Woman]

We use OfficeMate and it still does not do perfectly keep track of things like chargebacks. If you call customer service, they will tell you that the software does not have a great way to handle this. We take Davis, Eyemed, and VSP. What a mess.

The sub plans are incredibly complicated. Especially all of the medicare carve out plans. We constantly debate if we should list them independently, or as a plan listed under their medical coverage. I wish I had something helpful to add, but we are in the same boat. Looking forward to what others have to say (besides "don't take inurance")

[Jubilee]

Here is what I do..

I *love* to have my fee schedules in my EHR. This makes things so much easier when I am trying to assess our true receivables. For the vision plans, the big ones (VSP AND EYEMED) have some basic templates to their plan. You know what Signature is going to pay. You should know what Choice will pay. If its covered, usually (thought not 100%) the service fee you would typically get (Copay-chargeback) is given to you. Though not always true, especially with kids.

Eyemed, All the "Access plans" have a set template to them, versus the Blue View Vision, compared to Insight, etc. The plan letter gives you additional information about how the patient copays will play out ($0 for the exam copay versus $20 copays...)

So I will have an Insurance company called Eyemed, under that plan I will have subplans. Each major plan we see frequently, I have listed on its own. Then I also have Access plan by itself, along with a Blue View Vision, etc.. these are also labled NOS.. Not otherwise specified. I will have the most common fee schedule in place for them. The idea is to know that we will get X for the exam, the only question is that patient paying the $20 copay or a lesser amount.

For Davis we did something similar, we put in our most common plans, and have a NOS plan for those that don't line up. SO its mostly accurate.

I have about 15 listings for all the medicaid, HIP, exchange plans that all go through the same core set of payers. I put each one under its own payer so I know if I have an issue with Opticare versus MDWise for any outstanding Medicaid receivables.

It can seem like a headache at first, and takes time to get it in place. However the headaches clear up greatly in a few weeks when you don't have to restart your insurance reconciliation 15 times because of not all the invoices were showing up under the same payer.

[adoc]

Thanks Jubilee, that's great advice. If I understand correctly you are saying that you put in all of your information into a regular EHR? My office manager is indicating that this is difficult to do because regular EHR's have no mechanism for chargebacks. She claims that when she receives a check from a vision plan that has chargebacks she needs to do special manipulations such as applying the chargebacks on one patient to monies received on another patient (to make sure it balances correctly). Furthermore, there is the issue of what to do on patients who are being seen for medical exams using medical insurance but are also applying vision plan benefits at the same time? Do you encounter such issues?

[fjpod]

I throw a dart.

[Jubilee]

Depends upon the EHR. I have always used an optometry specific one. My Vision Express, Officemate and now Crystal. Each one has had the ability to do a chargeback, though some of them require a bit of finesse.

Many in its simplest form, require you to do a bit of math. If you charge the patient $90 for a PAL, but only get to keep $30, then you record a negative $60 payment. Some insurances will give you a column to help you do the math. So it will show the amount you have outstanding, a column to put in payment received from insurance, then another column for the chargeback, producing the amount that is being written off due to contractual agreements.

The issue for many is when you end up with a negative remittance advice. All your patients paid you more than your total reimbursement, and thus the insurance company wants their cut to pay the lab bill. Some of these will allow you to post negative payments. Then you either not balance check wise at the end of the day, or you transfer the balance to a fake patient named the insurance company and write it off there. Some recommend you DO NOT POST the negative EOB until you get a positive balance and do all of them at once. However, on some vision plans, waiting for the day they pay you, instead of you paying them may never come. Or you might receive a demand letter asking you to pay your quarterly balance off..

I know Officemate would not let you post a negative payment, they were the ones that insisted you let it ride. It makes sense because that is how things are most accurate. Every penny is being accounted for properly. However at times it just wasn't possible. So we would post a check for a penny and allocate as best as we could, then if/when a payment came that was reduced due to the previous negative EOBs (that have already been "reconciled" ) then you end up placing an equal chargeback as the reduced amount on a patient file. Ultimately in the end, it usually ended up almost being a wash if you are comparing your insurance profitability, but it certainly wasn't perfect.