Doctors & Folder Colors
Every provider is tied to a set of initials and a folder color. Folder colors are layered: the base color identifies the doctor, while MD / OD identifies the provider type.
| Doctor | Initials | Folder color | Type |
|---|---|---|---|
| Dr. Posner | MGP | Orange | MD |
| Dr. Karim | SSK | Maroon | MD |
| Dr. Santamarina | LS | White | Ret. |
| Dr. Goldstein | SMG | Pink | MD |
| Dr. Godfrey | JAG | Purple | OD |
| Dr. Lubowitz | JJL | Red | OD |
| Dr. Tubiello | SDT | Grey | OD |
| Dr. Balasa | ACB | Blue | OD |
| Dr. Bera | RB | Black | OD |
Color Key
MD = Green
OD = Blue
Retina = Purple
Testing = Yellow
What MD & OD Mean
MD = Ophthalmologist. A medical doctor who can perform eye surgery, diagnose and treat eye disease, and prescribe medication.
OD = Optometrist. A doctor of optometry who performs eye exams, prescribes corrective lenses, and manages some eye conditions, but does not perform surgery.
OD & OS on a Chart
A different meaning, used on patient charts rather than after a doctor's name.
OD = Right eye. OS = Left eye. OU = Both eyes.
The Patient Checklist
Emailed to patients ahead of time, or filled out on the iPad in office. Four required sections, in order.
- Patient Intake Form NextGen: name, address, date of birth, phone number, email.
- Emergency Contacts NextGen will automatically populate.
- Consent Forms These push to the patient's chart within NextGen's document management as a PDF. The Privacy Date (the issued and received dates) will auto-populate in the Privacy field.
- Insurance Capture
Patients can add new insurance or update existing insurance, and take photos of their insurance card(s).LUMA has OCR (optical character recognition) to pull the info directly from the card.RTE (real time eligibility) runs in LUMA when the patient selects "Verify Insurance."Insurances must still be reviewed and updated in LUMA & NextGen manually.Card images still need to be copied/pasted or scanned into NextGen.
Used to send messages to a large group of patients. Typically done for patients that have an appointment scheduled or cancelled, but broadcasts can also be created via a CSV upload list.
Lets patients request or schedule appointments online, a convenient way to connect with the office without calling. Patients access it through the "Book an appointment" link on the practice's website.
After the patient signs and agrees to a consent form, they have the option to save their signature by clicking "Save." If they don't save, they'll have to manually sign each consent form. If they did save, they can check the box and hit Sign. They can hit Clear to start over.
Consent Forms
Five consent items patients complete, and how often each one is required.
1 · Authorization for Use & Disclosure of PHI
Also known as HIPAA. The patient authorizes the use and disclosure of PHI, including but not limited to communication via text, email, and phone, and grants permission to disclose PHI to delegated contacts.
Frequency: once a year
2 · Financial Policy
Patient must acknowledge their responsibilities regarding insurance coverage, copayments, deductibles, outstanding balances, and other financial responsibilities. If referrals are needed, they must be obtained before services are rendered. This authorizes us to bill the patient's insurance, if applicable.
Frequency: once a year
3 · Medical Exam, Refraction & Dilation
Patient must acknowledge that refractions may not be covered by insurance and would therefore be at the patient's financial responsibility. This consent does not mean they will be getting a refraction, but that they are aware of the out-of-pocket costs.
Also informs the patient that dilation may be necessary and results in sensitivity to light, along with decreased near vision for a few hours. They may want a driver if the dilation effects are bothersome. This does not mean they will be dilated. It makes them aware of the side effects.
Frequency: every applicable visit
4 · Consent for Treatment
Patient consents to the treatment at our office and has the right to ask questions and/or refuse at any time during their visit. If they refuse, they acknowledge the limitation of the provider to properly diagnose or treat conditions. If additional invasive testing or procedures are needed, informed consents for those will be presented and require patient signature.
Frequency: only once per patient
5 · Notice of Privacy Practices
The patient acknowledges that they have been provided the opportunity to review and receive a copy of our Notice of Privacy Practices. The NOPP should also be posted in every office, and is available in VIP Info Central.
Frequency: only once per patient
6 · Cancellation / No-Show Policy
The patient must acknowledge that a fee may be charged for late cancellations or no-shows. We require cancellation notice at least 24 hours prior to the scheduled time.
Frequency: once a year
LUMA Prep Workflow: Insurance Verification
Reminder: insurance verification starts 3 days prior to appointment, in the "Prior to Appointment" checklist in the LUMA prep workflow.
- Check Insurance Eligibility in LUMA
If eligibility hasn't yet been run, click "Run Insurance Eligibility" in LUMA.
As a reminder, vision plan eligibility cannot be run through LUMA and/or NextGen. Confirm eligibility and obtain vision plan authorizations directly from the appropriate portal(s).A. If insurance is active and fully confirmed, move on to the next step. Make sure to review the Health Benefit Plan Coverage for all Medicare responses.B. If insurance is inactive or rejected, contact the patient to confirm if they have new insurance, a new ID number, or no insurance at all. If new insurance is obtained, start over with this step. Be sure to deactivate any insurance that is no longer valid.
- Apply Copay if Eligibility Returns One If eligibility returns and the patient has a copay, it will auto-populate in the "Copay" section of the Appointment Charge column. Undetermined/unknown copays or other out-of-pocket expenses (such as refractions, contact lens fit fees, etc.) can be manually added to the "Payment Details" section of the expanded Appointment Details panel.
- Close It Out Once completed, update the Staff Review Status if the patient has completed their checklist.
Insurance Types
Government, commercial, private, and workers' comp coverage, and how each one is handled.
Medicare
Federal health insurance for recipients aged 65 and older, or qualified recipients under 65 for certain disabilities and conditions.
Medicaid
Public health insurance for recipients with limited income and resources, for any age. Covered services are provided at little-to-no cost to the recipient. Needs a medical diagnosis to book. We cannot legally charge them anything out of pocket. Eligibility must be run every check-in/chart.
Tricare
Administered by the Department of Defense. Provides healthcare for active-duty service members, National Guard, Reserve, retirees, and family.
CHAMPVA
Unlike Tricare, services are administered by the Department of Veterans Affairs. Provides healthcare for spouses, dependents, and survivors of veterans and other service members who suffered a permanent disability, injury, or death while serving.
Commercial Insurance
Coverage issued and maintained by companies that are usually publicly traded firms. Examples: United Healthcare, Aetna, Humana.
Private Insurance
Coverage issued and maintained by companies that are usually privately owned. Examples: Blue Cross/Blue Shield and their associated independent contractors (such as CareFirst, HighMark, Anthem).
Workers' Comp
Insurance from a patient's employer that covers injuries sustained at work. Employees must report an injury to their employer and obtain all filing information from the employer before being seen. See Worker's Comp intake details below.
Worker's Comp: Office Intake
When a patient experiences an injury at work: H52 = non-medical / refractive diagnoses. Patient can pay out of pocket, or we have to be on their provider's panel. Cannot pay with personal insurance only.
Form needs: name of employer, address, insurance carrier, claims address, Claim ID, claims adjuster, date of injury, type of injury.
Plan Types & Cost-Share Terms
HMO
Health Maintenance Organization. Defined network of doctors, hospitals, and providers, typically in a specific geographic area. Patients generally don't receive coverage outside the network. Referrals from a PCP are often required to see specialists.
PPO
Preferred Provider Organization. Defined network that operates over a larger area than an HMO, available nationally. Patients can access in-network and out-of-network benefits, though out-of-network incurs higher costs. Referrals are generally not required.
EPO
Exclusive Provider Organization. Defined network within a specific geographic area. Patients do not receive coverage for services outside the EPO network. Referrals are generally not required to see a specialist.
Subscriber vs. Guarantor
Subscriber
The person who is the policyholder of a particular insurance.
Guarantor
The person who is responsible for payment of out-of-pocket expenses.
A patient can have one person as the subscriber of the insurance and another person as the guarantor of the patient's account. Both the subscriber and the guarantor must be attached to the patient's chart as "relationships." A patient can also have the same person as both.
Example: patient's father is the subscriber of the child's insurance, but the patient's mother receives any statements.
Example: patient's father is the subscriber of the child's insurance and is also the guarantor who receives statements.
Vision Insurance
Most Common Plans
EyeMed, USP, VBA, Spectera, Davis Vision.
Davis Vision, GVS, NVA, VSP, and VBA all require an authorization to be obtained for all services.
Benefits Must Be Confirmed First
Benefits must be obtained for all vision insurance prior to the patient being seen. This determines what's available and what the patient can expect to pay out-of-pocket. Authorization must also be obtained at this time for plans that require one.
Vision insurance covers routine eye exams and materials. Some Medicaid plans may also cover routine eye exams themselves.
Vision plans generally limit routine exam benefits to once a year or once every other year. Confirm the patient's specific benefits and exam availability before they're seen.
Routine eye exam: a preventative exam to check for basic vision problems and refractive errors, determine the need for corrective lenses or an adjustment to a prescription, monitor overall eye health, and for early detection (but not treatment) of ocular disease such as cataracts and glaucoma. Typically covered by vision insurance, not medical, though some medical plans carve out routine vision services.
Medical eye exam: focused on diagnosing and treating eye diseases or medical conditions, not necessarily associated with correction. Common reasons: eye pain, sudden loss of vision, diagnosing and treating conditions such as glaucoma, macular degeneration, and cataracts. Billed to medical insurance, not vision, even if a refraction was performed. Visual fields, OCTs, and fundus photos may also be performed.
Reading an Insurance Card
Elements of an Insurance Card
- Insurance provider's name & logo
- Policyholder's name
- Dependent name
- Group number
- Member ID number
- Plan type
- Coverage details
- Copay / coinsurance / deductible information
- Claims filing information
- Customer service information
Cards & Policy Numbers
Some plans issue separate cards and policy numbers if more than one person is covered under a particular policy.
For Medicare, Medicare Advantage, and Medicaid plans, only an individual can be a subscriber; family members can never be covered under these plans.
Visit Codes
Phones & the Answering Machine
Dial 165, *, then password 165 165, # to hear messages.
Example Calls
- Patient wanting to fill a prescription
- Patient wanting to reschedule
- New patient calling to schedule
- Patient wants us to send a message to the doctor about something discussed at one of their appointments
- Patient would like to fill out a records release and switch practices (to us, or a different facility)
- Patients being transferred to us for sooner appointments
- Emergencies
Extensions
Post-Op & Invasive Appointments
We do not collect any money for post-op or invasive appointment checkups. If you don't know whether it's a post-op or a follow-up, there's a list at the front desk.
Any appointment within 90 days after an invasive procedure is free and put down as Post Op.
Post Op 1 or 3 (if testing done) pulls insurance. All appointments are otherwise out-of-pocket unless there's a medical diagnosis.
Contact Lens Appointments
- COE: Full Exam Leave with trials.
- CL Fitting Find contacts that fit the eyes.
- CL Teach For patients who've never had contacts, learning how to put them on.
- CL Post-Fit Check Try on prescription after it's arrived.
- CL Check Every year, new prescription.
Check-In Process
- Ask for Birth Date then mark the patient as arrived in LUMA.
- Fill Out Forms check notes for payment.
- Mark as Ready go to NextGen, right-click the encounter, check insurance, appointment type "General," auto flow, pay.
Clinical Terms to Know
VIP Intranet
VIP Intranet (SharePoint)
Designed to provide all employees with seamless access to essential documents, resources, and content. Acts as a centralized hub, enabling team members to collaborate effectively, stay informed about organizational news & announcements, and access things like the Notice of Privacy Practices.
By utilizing SharePoint, employees can boost productivity and streamline workflows, ensuring critical information is always at their fingertips.
Customer Service Skills
The soft skills that make phone calls, check-ins, and tough conversations go well: patience, positivity, communicating with purpose, and phone etiquette.
Patience
Having a little patience will help you deliver better care, but it also helps you understand and anticipate future challenges with your other patients.
Adjust Your Attitude
When your patience is wearing thin, remind yourself that the current situation is merely uncomfortable, not intolerable.
Use Positive Self-Talk
Put a positive spin on a stressful situation and talk yourself through it, like saying, "Yes, this is tough, but I'm going to stay calm and solve the problem."
Recognize Your Triggers
Impatience arises when things don't go our way. Acknowledging what triggers you and adjusting your expectations accordingly can help you avoid reacting emotionally in a tough situation.
Positivity
Words have more power than you may realize. The human brain has an unconscious bias toward negativity, meaning your choice of words can lead patients to jump to negative conclusions, even when you weren't intending to sound discouraging.
Strong Communication Skills
Communication is the foundation upon which patient relationships are built. When you communicate with a patient, you're representing your brand and setting the tone for their whole experience.
Break Things Down
When a patient isn't understanding what you're saying, maintain your patience and try restating it in bullet points. This forces you to break down your words and streamline the information.
Focus the Message
It doesn't matter what you say. It only matters what the other person hears. As a patient advocate, take responsibility for the message being heard the way you intend it. Reflect on your words. Use a tone and phrasing that are respectful and kind.
Communicate With Purpose
Communication is information delivered with a purpose. When reflecting on the purpose, ask yourself: what outcome am I going for?
Solving a problem? Try concluding with, "Has this information been helpful?" Need more information from the patient? Try, "I'll be happy to address this for you. Could you provide me with some more information?"
Close the Loop
Closing the loop with a patient means circling back to confirm they're satisfied with the outcome of the conversation. This is your chance to assess how they're feeling and wrap up on a positive note.
Growth Mindset
If you stop to think about it, providing great patient service is a bit of an adventure. There's always a new cast of characters, with new stories and new dilemmas.
You'll find it a lot easier to embrace new challenges and your own professional development when you adopt a growth mindset: being open to continuously learning, building your skills, and working hard to develop them.
Phone Etiquette
- When Transferring a Call Share the name of the team member with the caller, if possible.
- When Ending a Call Always say, "Thank you for calling [company]!"
- When Leaving a Message Make sure to provide your name, department, a return phone number, and a concise message.
When a Patient Calls With a Question
Never give advice beyond your competence level or training. Document the information discussed on the call.
Answering the Phone
Speak clearly and project a positive attitude, let them "hear your smile." Have your resources ready (notepad, pen, computer) and always identify yourself when answering.
"Thank you for calling [company], this is [your name]. How may I help you?"
Placing a Caller on Hold
Never converse with others while on a call. If necessary, place the caller on a brief hold using the hold button. Don't lay the phone on the desk. Always ask permission first.
"May I place you on a brief hold?"
Never leave a caller on hold too long without checking back. Check in frequently (within 30–45 seconds), thank them for their patience, and offer to call back if the hold will run long. This keeps the experience positive and avoids frustration.
Step-by-Step Walkthroughs
Click a guide to open it as a pop-up with steps and screenshots.
All Notes, Condensed
Every section on this site, boiled down to the facts worth memorizing. This is the source material the flashcards and quiz below are built from.
Doctors & Colors
- Posner MGP · Karim SSK · Santamarina LS (Ret.) · Goldstein SMG · Godfrey JAG · Lubowitz JJL · Tubiello SDT · Balasa ACB · Bera RB
- Folder color key: MD = green, OD = blue, Retina = purple, Testing = yellow
- MD = Ophthalmologist (surgery, diagnose/treat disease, prescribe meds). OD = Optometrist (exams, corrective lenses, no surgery)
- On a chart: OD = right eye, OS = left eye, OU = both eyes
Checklist, Consent & LUMA
- Patient Checklist order: Intake Form → Emergency Contacts → Consent Forms → Insurance Capture
- 6 consent forms: PHI/HIPAA (yearly), Financial Policy (yearly), Medical Exam/Refraction/Dilation (every visit), Consent for Treatment (once), Notice of Privacy Practices (once), Cancellation/No-Show Policy (yearly)
- Cancellation notice required at least 24 hours prior
- LUMA has OCR to read insurance cards; RTE runs when patient clicks "Verify Insurance"; card images still need to be copied/scanned into NextGen manually
- Staff can never hit Sign for a patient, only the patient can
Insurance Verification Workflow
- Verification starts 3 days before the appointment
- Step 1: check/run eligibility in LUMA. Vision plan eligibility cannot run through LUMA/NextGen, must confirm directly with the portal
- Active & confirmed → move on. Inactive/rejected → contact patient for new insurance/ID, deactivate anything no longer valid
- Copay auto-populates if returned; unknown out-of-pocket costs get added manually to Payment Details
Insurance Types
- Medicare = 65+, or under 65 with qualifying disability. Medicaid = limited income, any age, needs a medical diagnosis to book (cannot charge out of pocket)
- Tricare = Dept. of Defense, active duty/Guard/Reserve/retirees/family. CHAMPVA = Dept. of Veterans Affairs, spouses/dependents/survivors
- Commercial (publicly traded: United, Aetna, Humana) vs. Private (privately owned: BCBS, CareFirst, HighMark, Anthem)
- Workers' Comp: H52 = non-medical/refractive diagnoses; must be on the provider's panel or patient pays out of pocket; always ask if the injury is work-related
Plans & Cost-Share Terms
- HMO = defined local network, referrals usually required. PPO = bigger network, in/out-of-network both covered, no referral needed. EPO = defined network, no out-of-network coverage, no referral needed
- Coinsurance = percentage cost-share (e.g. Medicare 80/20). Deductible = fixed amount paid before insurance contributes (resets yearly, Jan 1 for Medicare)
- Copay = fixed fee per visit type. Prior Authorization = insurer approval required before certain services, doesn't guarantee payment
Subscriber, Guarantor & Vision Plans
- Subscriber = policyholder. Guarantor = responsible for out-of-pocket payment. Can be the same person or different people, both attach as chart "relationships"
- Common vision plans: EyeMed, USP, VBA, Spectera, Davis Vision. Davis Vision, GVS, NVA, VSP, VBA all require authorization for services
- Vision insurance covers routine exams/materials; usually limited to once a year or once every other year
- Routine exam → vision insurance. Medical exam (diagnosing/treating disease) → medical insurance, even if a refraction was done
Codes, Phones & Post-Op
- Visit codes: COVAP = no charge, NKSN = came in/not seen, 92310REV = contact lens check fee, RYZUYUI = dilation fee, MEDRF = medical records
- Voicemail: dial 165, *, password 165165, #. Extensions: Renee 174, Joanna 175, Tammi 173, Retina 191, Surgery 167/168
- No money collected for post-op/invasive checkups; anything within 90 days of an invasive procedure is Post Op and free (Post Op 1 or 3 pulls insurance if testing was done)
Contact Lenses & Check-In
- CL order: COE Full Exam → CL Fitting → CL Teach (first-timers) → CL Post-Fit Check → CL Check (yearly, new script)
- Check-in: birth date → mark arrived in LUMA → fill out forms → mark ready → NextGen right-click encounter → check insurance → appt type "General" → auto flow → pay
Clinical Terms
- IOP = intraocular pressure. A-scan = biometry. B-scan = retina ultrasound. CT = corneal topography
- Goldman IOP = glaucoma pressure check. Lacrifill = gel for tear production. Punctal plug = rubber plug in tear ducts
Customer Service
- Patience: adjust your attitude ("merely uncomfortable, not intolerable"), use positive self-talk, recognize your triggers
- Communication: break things down into bullet points, focus the message on what's heard (not just said), communicate with purpose, close the loop
- Phone: share the team member's name when transferring, always thank the caller when ending a call, never leave someone on hold without checking back every 30-45 seconds
Flashcards & Quiz
Study the material above two ways: flip through flashcards, or test yourself with a multiple-choice quiz.
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