Setting Up Doctor Pay Rules

A doctor pay rule specifies the following:

  • Criteria a doctor must meet to receive the payment associated with the rule
  • The default payment associated with the rule

All doctor pay rules require that an exam is sold, and all exams and products specified in a rule must be included on the same order for the doctor to qualify for the rule payment.

You can create a pay rule based on a combination of the following criteria:

  • Patient’s insurance applied to the exam
  • Contact lens type
  • Exam type
  • Exam selling price
  • Purchase of an additional product
For multitenant environments, the following setup can be performed only by administrators of the parent company and is required only for the parent company. The parent company setup applies to all companies.

To set up doctor pay rules

  1. In AcuityLogic Admin, click Doctor Pay Management and select Doctor Pay Rule.
  2. Do one of the following:
    • To set up a new rule, click Add Doctor Pay Rule.
    • To modify an existing rule, click Edit in the rule's row.
  3. Type a description of the rule in the Description field.
  4. Select one of the following methods from the Method drop-down list. The method is the basic trigger for the pay rule.
    • Insurance: The exam is billed to an insurance carrier.
    • Non Insurance: The exam is not billed to an insurance carrier.
  5. If you selected Insurance in step 4, select an insurance carrier from the Insurance Carrier drop-down list. This carrier must be applied to a patient’s order for the doctor to qualify for the payment. To indicate that the rule is applicable when any insurance carrier is applied, select All.
    If a patient order meets the criteria for multiple pay rules assigned to a doctor, AcuityLogic applies the more specific rule. For example, if the patient uses a VSP insurance plan and meets the criteria for both a VSP-specific rule and a nonspecific insurance rule, the VSP-specific rule is applied.
  6. If you are setting up a rule for an exam, type the exact selling price of an eligible exam (the price after applying all discounts) in the Priced Amount field.

    If you leave this field blank, the exam does not need a specific price point for the doctor to receive a payment for the exam.

    If you want a different default payment for each selling price of an exam, you can set up a different pay rule for each price point. For example, if you sell an exam at various prices due to discounts and you want the doctor payment to decrease as the selling price decreases, you can set up a pay rule for each exam price and corresponding default payment.
  7. In the Default Pay field, enter the default pay that the doctor is contracted to receive when the rule criteria are met.
    If you save a rule and then later change its Default Pay, you must update the doctor pay for all doctors to which the rule is assigned. For more information, go to step 11.
  8. If the rule requires that a patient purchase a product not specified in the rule, select the With Purchase check box.
  9. Click Insert to add a rule or Update to modify a rule.
  10. To add additional criteria to the doctor pay rule:
    1. Click Items.
    2. From the Item Type drop-down list, select Contact Lens or Exam.
    3. From the Item Values drop-down list, select the item to add to the rule. For example, if the item type is Contact Lens, select a contact lens type.
      All items that you select must be on the same order for a doctor to qualify for the pay rule.
    4. Click Add.
    5. To update an item, click Edit, select the new item to add to the rule from the Item Values drop-down list, and click Update.
    6. To remove an item from the rule, click Remove, and then click OK in the confirmation message.
    7. Click Return.
  11. To modify the pay of doctors assigned to the rule:
    1. In the rule's row, click Update Doctor Pay.
    2. Perform one of the following actions:
      • To update the pay of an individual doctor, click Edit in the row of the doctor’s name, enter the new pay amount in the Doctor Pay field, click Update, and click Return. The doctor’s pay changes to the specified amount.
        You can also edit a doctor’s pay from the Doctor Pay Schedule module. See Assigning Doctor Pay Rules.
      • To apply the default pay to all eligible doctors, click Update at the top of the table, click OK, and click Return.

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