Two exams can be worth wildly different amounts depending on who's paying. A vision plan like VSP or EyeMed reimburses on a fixed schedule with a materials copay; a medical plan pays differently again; a private-pay patient pays the full fee; Medicaid pays the least. Net reimbursement per exam — the blend of what the plan pays plus what the patient pays — is the number that tells an owner which segments of the schedule actually carry the practice. This dashboard shows the payer mix and the real yield behind it.
What this dashboard answers
The Payer Mix page answers the owner's strategic question: what is our mix, and what does each plan really pay per exam? It shows net collected revenue, the managed-care mix rate, net reimbursement per exam, and exam count, with a donut of exams by payer, a 100% stacked bar of payer mix by location, and net reimbursement per exam ranked by payer. The Yield by Plan page splits each payer's yield into the plan's payment versus the patient's responsibility, isolates private-pay revenue, and gives a per-payer table with exams, net collected, reimbursement per exam, and the patient-responsibility share.
The metrics that matter
Net reimbursement per exam and managed-care mix rate are ratios over exam count, computed as a sum over a sum so they read as true per-exam and mix figures. The split between payer payment and patient payment matters because the same net reimbursement can be mostly plan-funded or mostly patient-funded — and the patient-responsibility share is both a collections risk and a signal of how much front-desk collection discipline the mix demands. Private-pay revenue is isolated onto its own column so the highest-yield segment is a clean total rather than a filtered guess.
Why the data is trapped across the systems
Payer, plan payment, patient responsibility, and the exam itself live in the EHR/PM and its claims module — RevolutionEHR, Eyefinity/OfficeMate, Compulink, Crystal PM, Acuitas (Ocuco). But the practice's economic view of a payer requires netting the plan's remittance against the patient's collected balance, per exam, and then comparing that yield across plans — which the PM reports rarely do in one place. So owners tend to know their volume by payer but not their yield by payer, and the two can rank completely differently: a high-volume vision plan can be a lower-yield segment than a smaller private-pay base.
How to read it
Read net reimbursement per exam by payer first — that ranking, not the exam-count mix, is what tells you which segments fund the practice. Then read the managed-care mix rate and the payer concentration: a schedule dominated by one low-yield plan is both a margin and a risk problem. The payer-vs-patient split tells you how much of your revenue depends on collecting at the desk. The sample uses fully synthetic claim data with no real plan member information, so nothing identifying appears in the report.
Metrics it tracks
| Metric | What it means |
|---|---|
| Net Collected Revenue | Payer payment plus patient payment across all claims and sales. |
| Net Reimbursement per Exam | Total collected divided by exam count (a SUM-over-SUM ratio). |
| Managed-Care Mix Rate | Managed-care exams (vision plans, medical, Medicaid, other) divided by all exams (SUM over SUM). |
| Private-Pay Revenue | Collected revenue on private-pay encounters, isolated onto its own column for a clean total. |
| Patient Responsibility Collected | Copays, deductibles, and balances collected across all encounters. |
| Exams | Count of exam or claim rows in the period. |
Used by: Owner-ODs and billers analyzing payer mix and yield
Frequently asked questions
What is net reimbursement per exam, and why use it?
It's the total collected — the plan's payment plus the patient's responsibility — divided by exam count, by payer. It's the truest measure of what a payer is worth to you per visit, and it often ranks payers differently than raw volume does, which is why it should drive scheduling and contract decisions.
Why separate the payer payment from the patient responsibility?
Because the same net reimbursement can be mostly plan-funded or mostly patient-funded, and that changes how you manage it. A high patient-responsibility share is both a collections risk and a sign your mix demands strong front-desk collection — the split makes that visible per payer.
Can I build this on my own payer data?
Yes. Export your exam and claim data with payer, plan payment, and patient payment from your EHR/PM, and use this as a template — we model it into a Power BI report. The sample uses synthetic data, so there's no real plan member information here.
Build this report on your own data
Clone this Optometry & optical template — describe it and we’ll generate sample data so you can try it free, or upload your own export. You get a fully modeled, branded Power BI project that opens in Power BI Desktop.
Use this as a template →