Understanding Reimbursements with VSP

Hello everyone, welcome to Understanding Reimbursements with VSP. At this point we have discussed chair cost and we have analyzed the VSP Practice Report. So let’s do a quick review.

If we look back at our chair cost of $120 and review the examples we showed you earlier in the program, you may remember we barely made our chair cost when totaling our exam reimbursement, frame reimbursement and the standard progressive. You may also remember that when the exam reimbursement was less, you then ended up short of the $120 chair cost by $15.

Then, as we reviewed our VSP practice report, we were able to identify that our practice was selling a higher amount of lower quality progressive lenses. This is where opportunity lies, not only to enhance and give our patient’s the best visual performance through higher quality eyewear, but to also increase our reimbursement and maximize our potential profit with managed care payors.

So let’s take a look at VSP to help you better understand reimbursements with VSP and with the VSP changes in reimbursement for preferred and non-preferred products.

To understand what our reimbursement is for VSP, we must review our lens enhancement sheets. These can be found on Eyefinity within VSP Online. On these documents, we see the following terms Chargeback, Service Fee, and Patient Copay.

Let’s define:

Chargeback – A chargeback is the amount that the lab is paid for the product.

Service Fee – A service fee is the amount that the provider is paid for the product. We refer to this as our “reimbursement” for the product.

Patient Copay – Of course, our patient copay is the amount the patient pays.

To calculate the service fee, VSP takes the patient copay and subtracts the chargeback or lab fee. This gives us our reimbursement.