Lens Fee Schedules and Practice Management Software

All optometric practices have a fee schedule. But does your practice have a “Practice Management (PM) Software-friendly” fee-schedule?

Lenses Options

Your practice may base your usual and customary solely on the cost of your lab fees and because you may use several different ophthalmic labs, different lens combinations may result in different prices.

To make it more PM software friendly, I have consulted with many doctors to restructure their pricing to an “add-on” type of system. For example, with a Varilux Physio S in Plastic Hi Index 1.67 with Transitions and Crizal Avance UV, has 6 components:
  1. Bifocal (for almost all insurances, if you bill for a progressive they almost always require that you split it up to a Bifocal and Progressive materials code)
  2. Progressive Add-on
  3. Plastic Hi-Index Add-on
  4. Transitions, Add-on
  5. Crizal Avance
  6. Backside UV

Different PM software will approach lens pricing differently. Some will combine the bifocal v-code with the progressive v-code or others will combine Crizal Avance with Backside UV (when VSP recognizes it as two separate codes). So instead of 6 components, you end up with 4.
Officemate's User Guide explains approach on page 71

It all depends on the approach of the software and more importantly, the understanding and approach of the person setting up the software. This is something to consider, when deciding on purchasing/switching to a new PM software or further utilizing your current PM's capabilities.

Creating your fee schedule

Whatever direction you go with, I always suggest a flexible format when creating a fee schedule to accommodate for changes in the software, needs of the doctors, and the needs of the opticians. Almost all doctors will have their fee schedule on some sort of spreadsheet. I recommend making a spreadsheet with multiple sheets with different calculations for different purposes like:
  • re-pricing lenses options
  • lens "package" pricing
  • optician reference
  • combining with the VSP Options List
  • doctor reference

When in the process of repricing lenses, VSP Option Prices aren't needed.  When a doctor is recommending a progressive, he or she does not need to know the VSP Responsibilty. Yet you still have that information available if you need it in another, customizable sheet.  When it comes time to reprice lenses in your PM software, you can use the Options List, or create a new sheet that flows with the lens data entry.

 
This is a sample fee schedule where the "Options (Edit Me)" sheet prices the other three sheets: "Printable", "VSP Sig", & "VSP Choice".  This is a very simple fee schedule where lenses and options are only priced on the first sheet and then populates all other sheets into whatever format you need.  Feel free to copy it and use it.
Summary
Every office needs a Practice Management Friendly Fee Schedule.  In order to complete your own fee schedule, find out how your software structures your lenses, options, and attributes.  Take a look at how your office flows and what information (prices, availability, CPT codes, VSP copays) is preferred by the doctors and staff.  Design your flexible fee schedule with all those factors in mind.



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