How Vision Benefits Automation Can Help Your Practice Level Up

The Case for Automating Vision Claims Processing: Purpose, Implementation, and Proven Results

Dealing with vision insurance can sometimes feel like far more trouble than it’s worth. Problems such as coordinating benefits between coverage types or filing claims with outdated manual systems can consume a shocking amount of time. It can leave you and your staff stretched too thin to give critical billing and direct patient care tasks the attention they deserve.

That’s why an increasing number of ophthalmic practices are adopting vision benefits automation via revBot. This software can take over the mind-numbing tasks that deter your skilled employees from the value-added, patient-centered work of vision care. It can also increase your revenue by cutting down on common but costly errors, while reducing frustrations for your patients.

Revival Health has helped dozens of eye care practices streamline some of the most tedious and error-prone parts of revenue cycle management, including:

• Verifying coverage
• Securing prior authorization
• Submitting claims to both medical and vision payers
• Interpreting EOBs
• Coordinating patient records across disconnected systems

In this article, we’ll discuss the many stumbling blocks in the vision coverage workflow and how automation can help. When done correctly, vision claims processing automation with revBot can transform your claims process from a time-consuming mess to a well-oiled machine.

How Does Vision Claims Automation Work?

Our software, which we affectionately call revBot, acts as an extra staff member — one that works 24/7 and can complete billing tasks 3-5 times faster than the average human worker. If a human can do it by typing or clicking on a computer, revBot can do it too, only more quickly, with greater consistency and at a lower cost.

revBot is adaptable to the unique needs of every office. Its capabilities include:

• Robotic process automation (RPA). revBot can follow complex rule-based scripts to carry out repetitive tasks without human input. Common applications include benefit verification, prior authorization, claim filing, payment posting, and data integration between systems.
• Optical character recognition (OCR). No need to key in the data from intake forms, checks, insurance cards, or other documents — just scan an image and revBot will read it.
• Multifunctional interface engine. Fluent in HL7, X12, and other electronic data interchange protocols, revBot can communicate with a vast range of other health-related digital tools.

Flexible serverless infrastructure. Our cloud-based system architecture means that you can customize your experience with revBot and easily scale up to include new capabilities as your business grows.

Why Traditional Vision Benefit Workflows are Inefficient — And How revBot Can Help

Automation eases staffing pressures and saves money by reducing the number of employee hours needed to verify benefits, file claims, and reconcile payments. Automation also reduces human error by letting machines handle the mechanical tasks that boil down to transcribing information between digital databases.

Instead of logging into a managed vision care (MVC) company’s website and filing a claim manually, you can tell revBot to grab the patient details from your practice management system and do it for you. If you’ve ever wished that vision benefits had a system that functioned as smoothly as Waystar, automation with revBot might be right for you.

Additionally, automation helps bridge the gaps between systems. Our system can keep track of patient benefits and charges even when they’re split between vision and medical benefits. revBot will follow claims from the beginning of the revenue cycle to the end and help you reconcile payments to keep your accounting accurate. All of this can reduce lost revenue by cutting down on incorrectly filed claims and making coordination of benefits easier.

Reducing human error in vision claims is easy with revBot by Revival Health. It’s an expert at the kinds of mechanical tasks that humans struggle with, and it’s optimized for working with health and vision care systems. It can learn your vision benefits workflows and carry them out faster and with fewer errors than a person.

Let’s take a look at how revBot can help with some of the challenges vision practices commonly face.

Staffing Limitations

The U.S. is experiencing a skilled staffing shortage across medical fields, but the eye care sector has been among the hardest hit. One study projected that ophthalmology practices will face a 30% personnel shortfall through 2035, forcing employees to wear many hats. revBot can help you do more with fewer employees.

Human Error

The human brain is incredibly powerful, but it’s not perfectly suited for every job. Billing in ophthalmology requires accurately performing detailed and often repetitive tasks, the kinds most susceptible to human error. revBot doesn’t mind repetitive tasks that require sharp attention to detail.

Mismatched Systems

Many vision care practices have to operate with both medical insurance and vision benefits, sometimes known as managed vision care or MVC. These two types of coverage don’t follow the same rules — or even speak the same language — which leads to all kinds of headaches. revBot is fluent in every system’s language.

Coordination of Benefits

Correctly determining which type of insurance to bill for each patient, visit, and procedure can make a big impact on your bottom line. revBot makes sure critical preauthorizations are taken care of, while staff focus on your most valuable asset, your patients.

Tedious Billing Procedures

Automated clearinghouses like Apex and TriZetto were designed primarily to process procedures, not medical devices. That means submitting claims for inventory items like glasses can be time-consuming. revBot is the solution that can communicate seamlessly with these electronic systems.

A/R Challenges

Managing receivables often means keeping track of wildly variable payment schedules and fee structures. Reconciling what your practice bills and what it actually collects can quickly become complicated, and requires constant vigilance. Keeping track of details like these is where revBot excels.

Implementation

revBot is a completely custom solution that is tailored for the needs of each unique practice. If you decide to partner with Revival Health, we will analyze your current workflow to create a fully adaptable, fully personalized version of revBot for your practice.

revBot behaves much like an employee, and training revBot is a lot like onboarding a new team member. You’ll give revBot an onsite workstation, and it will “shadow” your existing employees, learning your systems over time. Revival software engineers and service staff are engaged throughout the training process and beyond, helping to fine-tune its performance as it gradually takes over tasks assigned to it.

With extensive reporting and documentation, you'll know exactly how revBot is performing, and exactly how much time it’s saving you and your staff. The results are backed by Revival’s return on investment (ROI) guarantee.

‍Want to know more about the implementation process? Read our detailed guide here.

Closing Thoughts

Software automation from revBot can eliminate many of the characteristic headaches of vision claims processing.

Not only can you speed up your workflow while cutting down on errors, but you can also redirect your workforce to better serve your patients. In many cases, automation can also give you greater insight into your revenue cycle so that you can make better strategic decisions for your business.

If you’re wondering whether automation may be right for you, contact Revival Health for a consultation. Our team will go over your business needs and revBot’s capabilities to create a customized plan for automating your vision claims processes. We’ll help you figure out the right blend of software services and human expertise to make sure your workforce is using its time to maximize the patient experience.

Vision Claims Automation: Frequently Asked Questions

What are the most common use cases for automation in vision claims?

Claims automation software is employed in many different ways by eye care practices. Some of the most common uses are:

• Entering claims into clearinghouses or payor websites directly from a practice management system
• Identifying and confirming each patient’s full list of potential payors
• Determining eligibility for vision coverage
• Pulling prior authorizations for vision care procedures
• Automatically posting payments into the PM system and matching them with outstanding claims

What is RPA in vision insurance?

RPA stands for robotic process automation. It’s a type of software technology used to build programs that can interact with digital systems, replicating actions normally performed by human users. revBot is built around RPA processes that let it interface with PM systems, claims, and payment systems, carrying out insurance-related workflows according to complex rulesets.

Why can’t vision coverage providers accept claims through medical clearinghouses?

Medical insurance systems are designed around a very different business model than vision benefits. They grew out of a risk-management approach that assumes customers only need payouts rarely, when things go wrong, as opposed to “maintenance” care like regular vision exams. They’re also built to work with claims for procedures and services rather than inventory items like eyeglasses and contacts.  

As a result, the electronic data interchange (EDI) standards used by most medical clearinghouses lack codes for eyewear. While some of them can code for optometry procedures like exams, most have no way to account for physical inventory. Vision coverage providers have had to develop a separate system for materials like lenses and frames.