Revenue cycle management

Step-by-Step Breakdown

Detailed explanation of each automated stage in the workflow.

1. 1

   Trigger

   Patient appointment scheduled

   New appointment is created in the practice management system with patient demographics and insurance information. Triggers the automated revenue cycle workflow.

   EyefityPractice Management
2. 2

   Action

   Verify insurance benefits

   Automatically checks patient's insurance coverage, copay amounts, deductible status, and vision benefits through VSP and other carrier networks. Updates patient record with current benefit details.

   VSP Vision CareEyefityPractice Management
3. 3

   Action

   Process exam and services

   Captures completed services from the EHR including eye exam codes, diagnostic tests, and prescribed treatments. Automatically generates appropriate billing codes and service documentation.

   RevolutionEHRCompulink Advantage SMART Practice
4. 4

   Decision

   Route claim submission

   Determines whether to submit insurance claim immediately for covered services or generate patient invoice for non-covered services. Routes based on insurance verification results and service types.

   MaximEyes
5. 5

   Action

   Submit insurance claims

   Electronically submits claims to insurance carriers with proper coding and documentation. Tracks claim status and handles electronic remittance advice processing.

   MaximEyesVSP Vision Care
6. 6

   Action

   Generate patient statements

   Creates and sends patient billing statements for remaining balances, copays, and non-covered services. Includes automated payment portal links and multiple payment options.

   EyefityPractice ManagementWinOMS
7. 7

   Output

   Complete payment reconciliation

   Reconciles all payments received from insurance and patients, updates account balances, and generates accounts receivable reports. Triggers follow-up workflows for outstanding balances.

   WinOMSMaximEyes

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