The VSP Remittance, the Lab Job Log and Tomorrow's Eligibility All Ran Overnight. Here's the 8:10am That Follows

You tried this in 2024. Somebody sold the practice a billing assistant, it posted three payments to the wrong patient ledgers, your office manager spent a week unpicking it, and nothing has been near the accounts since. Keep that reaction. What changed in 2026 is not that the software got more confident — it is that it stopped needing to finish the job.

What arrived this year is unattended running time. An agent can work for hours on its own — ChatGPT Work shipped on 9 July 2026 doing exactly that, and Claude Cowork has done it since January — which makes the seven hours between the doors locking and the doors opening usable. Not to do your billing. To do the reading, sorting, matching and chasing, and leave a short list of decisions on the office manager's screen.

An overnight queue is not software doing your billing; it is a night's worth of clerical work already done and sorted, handed over in the morning as a short list of things only a person can decide.

6:05pm — what is actually unfinished when the doors lock

Take an ordinary single-doctor practice on an ordinary Tuesday. At close of business the following is sitting there, and it is the same list in every practice in the country.

Remittances from VSP and EyeMed sitting unposted. An aging report where the 60-day column has quietly grown for five weeks. Eight to fifteen denials from the last fortnight — a CO-97 saying the refraction was bundled, a CO-16 for a missing modifier, a handful of PR-204s where the refraction is not covered and needs billing to the patient. Six lab jobs past their promised date on VisionWeb that nobody chased. Four contact lens orders that were meant to ship direct from the distributor and did not. Nine patients on tomorrow's schedule whose eligibility is unchecked. Two annual supply rebates whose window closes this week. And the recall list, untouched since March.

None of that is hard. All of it is reading, matching and chasing. It is roughly two to three hours of clerical work a day, and in most practices it gets done in the gaps between phone calls, which means it does not get done.

11:20pm — the remittances post and the odd ones get set aside

The overnight run starts once the last chart is closed. The first job is the money that came in: match each line on the electronic remittance to the claim it belongs to, post the expected ones, and stop on the rest.

"Stop on the rest" is the whole trick, and it is what the 2024 version got wrong. A payment that matches the contracted fee schedule for a 92014 with the expected patient copay is not a decision; it is arithmetic, and it can be posted and reconciled against the deposit total. A payment that comes in $38 short of the contracted rate, or a line where the refraction was denied as bundled, or a remittance whose total does not tie to the bank deposit — those are decisions. They go in a pile with the claim, the remittance line, the reason code and a plain-English note about what looks wrong.

The same rule runs across everything else. Anything routine and checkable gets finished. Anything requiring judgment gets prepared and left alone.

flowchart TD
  A["Doors lock at 6:05pm"] --> B["Overnight run starts"]
  B --> C["Post VSP and EyeMed remittances"]
  B --> D["Work the 60 and 90 day aging list"]
  B --> E["Check tomorrow's 24 patients for eligibility"]
  B --> F["Chase lab jobs past promised date on VisionWeb"]
  C --> G["Morning queue, exceptions flagged"]
  D --> G
  E --> G
  F --> G
  G --> H{"Office manager approves, edits or sends back"}

2:40am — tomorrow's schedule, patient by patient

This is the part that changes the front desk's day most. For each of tomorrow's twenty-four patients: is the vision plan benefit available or already used this year, when was the last exam, is the authorization pulled, has the Medicare Part B deductible been met, is the contact lens prescription still in date under your state's expiry rule, is there an outstanding balance, and is the visit likely to bill medical or routine.

That last one is the expensive one. The patient booked as a routine exam who is actually coming in about floaters and a diabetic follow-up should be billed to the medical carrier, not the vision plan, and finding that out at 9:15am while the patient is in the chair is how practices end up eating a $180 visit. Finding it out at 2:40am means the front desk has a note at 8am: "Mrs Alvarez, 10:20 — diabetic follow-up in the history, bill medical, deductible not met, quote her the estimate at check-in."

The same run drafts the calls: the four lab jobs to chase with the lab reference and the promised date, the two rebate submissions closing Friday, the eleven patients on the recall list whose benefit resets in six weeks.

8:10am — what the office manager opens

Not an inbox. A queue, ordered by money and by deadline. Something like: nineteen remittance lines posted and reconciled to the deposit, no action needed. Six exceptions, each with the claim, the reason code and a suggested next step. Four denials with an appeal already drafted and the clinical documentation attached, waiting for a yes. Nine eligibility notes on today's schedule, two of them flagged as likely medical rather than routine. Six lab jobs with a chase email drafted. Two rebate deadlines. One patient with a $610 balance at 94 days and a drafted, polite message that nobody has sent.

She works that queue with coffee, before the phone starts. It takes thirty-five minutes. The same work used to take two and a half hours and mostly happened on Thursday, if at all.

The arithmetic: days in accounts receivable and one missed rebate window

Illustration with stated assumptions. Substitute your own figures before you act on any of it.

The cash-release number is the one to be careful with. It is a one-time improvement, not annual income — you get the eight days back once, and then you have to hold them. The $15,576 is the recurring figure, and it is recurring only if somebody actually approves the drafted appeals. A drafted appeal nobody sends is worth exactly nothing.

Cost is no longer the objection it was. Capable models are roughly ten times cheaper than they were in 2025, so a nightly run across a few hundred claims and a day's schedule costs less than the practice spends on coffee filters.

The four things that must not run unattended

Writing off a balance. Ever. A write-off is a decision about money and it needs a person's name against it.

Refunds and anything touching a patient's card. Prepare it, queue it, have a human release it.

Changing codes. If the drafted work suggests the visit should have been coded differently, that is a note to the doctor, not an edit. Coding follows documentation, documentation follows the exam, and the optometrist owns both. This matters more than it sounds: the difference between a routine and a medical visit is a clinical judgment, not a billing preference.

Sending anything to a patient about money without review. A statement to a patient who already paid, or a collection note to a bereaved family, undoes ten years of goodwill in one envelope.

Two more guardrails worth writing into your process. Everything runs inside systems you already have a business associate agreement for, under HIPAA's minimum-necessary rule — do not export patient data to something because it is convenient. And reconcile posted payments to the actual bank deposit every morning; if the totals do not tie, nothing else in the queue gets touched until they do.

Frequently asked questions

What happens if it posts a payment to the wrong ledger?

Two protections. First, it only posts lines that match the claim and the contracted rate exactly; anything ambiguous goes to the exception pile rather than being guessed at. Second, the morning reconciliation to the bank deposit catches a mis-post within one business day instead of at month-end. Run it in read-only mode for the first month — let it produce the queue without posting anything — and compare its answers to your office manager's. If it disagrees with her often, do not turn on posting.

Is this HIPAA-compliant?

It can be, and it is on you to make it so. Ask any vendor for a business associate agreement in writing, confirm where patient data is stored and whether it is used for anything else, and limit what the overnight job can see to the minimum it needs. Your practice management vendor — RevolutionEHR, Eyefinity, Compulink, Crystal PM — is the first place to ask, because the safest version of this runs inside the system that already holds the data.

Does it change the chart?

No. Nothing in this touches clinical documentation, and you should refuse any setup that does. The overnight work sits on the billing, scheduling and ordering side. Charts are signed by an optometrist and edited by an optometrist.

We are a two-doctor practice with 1,400 claims a month. Is that too small?

The opposite. Large groups already have a billing department that works this list during the day. A practice with one and a half administrative people is exactly where the overnight queue matters, because the work currently loses every competition against the phone ringing.

Start Monday with one narrow slice: tomorrow's schedule, eligibility checked overnight, on the front desk's screen at 8am. It is the lowest-risk piece — nothing is posted, nothing is sent — and it is the one your staff will notice within three days.

The overnight queue fixes the work that piles up after hours. It does not answer the phone that rings at 7:15pm while it is running. CallSphere builds AI voice and chat agents that pick up the practice line and the website chat outside office hours, answer the plan and hours questions, book exams into your calendar, and leave the message where your front desk will see it — so the evening enquiries land in the same morning queue as everything else, rather than in a voicemail box nobody clears until Thursday.