Frequently Asked Questions

Lumata Health’s certified ophthalmic technicians and assistants provide between-visit care coordination, counseling, and general assistance for patients with chronic eye conditions like glaucoma, diabetic retinopathy, and macular degeneration. With an average of 12 years of in-clinic experience and specialized training in social work and case management, our care coordinators are experts at helping patients that need it the most. While our primary goals are improving outcomes, patient satisfaction, and quality of life, we also optimize the operational efficiency of your clinic by reducing inbound phone calls and time spent on non-clinical tasks, reducing no shows and cancellations, and improving patient experience and retention. On average, our program reduces patient no-shows by 30-50%. In addition to care “coaching” to promote adherence, we regularly help patients with things like financial assistance programs, prescriptions and refills, insurance issues, transportation to visits, access to social services, understanding their disease and care plan, and coordinating care with other providers. Our services qualify for reimbursement through Medicare’s Principal Care Management codes. As a result, practices that partner with Lumata Health typically generate meaningful additional revenue with no startup cost or cumbersome EMR integration required.

Our Care Coaches are dedicated to enhancing patient well-being by ensuring adherence to care plans and minimizing the risk of acute exacerbations or functional decline. While prioritizing medication and visit compliance, we also assist patients in navigating financial assistance programs, managing prescriptions and refills, addressing insurance concerns, arranging transportation to visits, understanding of their disease and care plan, and coordinating care with other providers when necessary.

For non-emergent and non-clinical issues, the primary method of communication is through the EMR or an in-office communication channel such as Teams, following the process that in-clinic technicians use to communicate about patient care. If emergent issues arise, the Care Coach will transfer the patient directly to the phone number provided by the practice for medical issues, facilitating a “warm” hand-off to clinic staff to quickly brief them on the patient and the issue.

Lumata Health almost exclusively employs Certified Ophthalmic Technicians or Assistants with prior in-clinic experience. Your assigned Care Coach will have the identical certification and training as your current staff. All of our Care Coaches have worked in an ophthalmology clinic for at least 3 years, though some have decades of experience. We also employ Registered Nurses for special cases, particularly for those patients with diabetic retinopathy who struggle with diabetes control or patients dealing with numerous complex conditions. All clinical staff members maintain certification requirements.

Our goal is to develop trust and rapport with the patient in our Continuous Care Program. That’s why each patient has a single Care Coach responsible for helping them through their care journey.

No. We operate just like in-clinic staff and are restricted to the same scope of practice as all COTs and COAs. Our focus is on solving non-clinical problems that prevent patients from adhering to their doctor’s recommendations, such as financial issues, transportation, prescription refills, insurance issues, and general health coaching to promote compliance. We do provide the patient with information related to their doctor’s instructions, such as reminders about which medications they should be taking and when. This information is based on the patient’s medical chart in the practice’s EMR. We are happy to share our policies and procedures for dealing with medical issues over the phone. These policies mirror typical in-house clinical staff guidance and are based on JCAHPO training modules.
Lumata adheres to the highest standards of data privacy and security for all of our customers, from large insurance providers to individual practices. We are HIPAA compliant, but also operate in HI-TRUST certified environments when appropriate. Our data privacy and security processes and protocols have been rigorously vetted and approved by each of our customers, including Health Care Service Corporation – the largest customer-owned health insurance company in the United States.

No, Lumata Health does not charge any startup costs. There are no penalty fees and the practice is free to cancel at any time, making Lumata’s services completely risk-free.

These services qualify for reimbursement through Principal Care Management codes, which were added by Medicare in 2020 due to the success of the Chronic Care Management codes introduced in 2015. These codes, which saw a reimbursement increase of over 50% in 2022, are billed separately from office visits on the date that all criteria for billing have been satisfied. Our service ensures meaningful revenue for practices without any startup fees or complicated EMR integration.
We almost exclusively enroll patients for whom the service is fully covered through a secondary, supplement, or Medicare Advantage plan; 99% of patients have no out of pocket costs. Alternatively, some patients are willing to pay the cost share in the months we help them, though this is rare. All patients are made aware of their responsibility prior to enrollment, and we work hard to make sure that patients are never surprised by a bill.

Our expectation is that the practice will generate modest revenue through reimbursement from Medicare, Medicare Advantage plans, and some commercial plans for this service. The profit will be the difference between the reimbursement amount and our fee for this service.  We also anticipate that practice revenue will increase in other ways, through improved patient retention, higher patient satisfaction (and positive online reviews), fewer cancellations, fewer no-shows, and reduced loss to follow up.

For most practices, managing care in-house poses financial challenges due to staffing, technology, and operational complexities.

Try Lumata risk free

100% paid for by Medicare. No integration required. Just minutes of admin time monthly.