TSO Internal Insurance Review

At the TSO Member’s request and approval, TSO will review invoices, write-offs, and reconciliations for insurance (Vision Plans and Medical Insurance) patients to ensure correct reimbursements and payments on claims.

In order to accurately perform this review, TSO will need to remotely access your Practice Management System and computers to randomly select 25 patient files to review. The program that TSO uses to remotely access your computers is GoToAssist. TSO Network Office will call your office and have someone go to their support website and enter in the session number. If you need to download the program, it will prompt you to do so and it is very safe.

Once they have access and are logged into your computer, they will need someone’s log in and password with administrative access to run reports and look at insurance billing in your Practice Management System or you can create them a new login and password with this access. They will not be making any changes to your system. They will simply run a report, first, of the insurance checks and patients that you have received and check to make sure the payments are correct. This will involve looking at fee slips, ledgers, demographic information, insurance benefits etc.

They will need access to the EOP (Explanation of Payments) for the patients, if they are not already scanned into the patients’ files, and access to all of your insurance and vision plan logins and passwords to pull any EOPs that are not available on your computers. They will also need access to your reimbursement fee schedules to reconcile your payments to ensure correct payment amounts for plans that were not negotiated by TSO Network.

Once this is completed, your Regional Market Manager will meet with you to report the results and plan to target any issues that were discovered. If you are interested or approve of this review sampling of Insurance Receivables to help ensure you are receiving the maximum amount of reimbursement and payment possible for the prosperity and growth of your practice, please contact your Regional Market Manager.