Monday, October 17, 2011

Fee Schedules . . . The Method of Choice for PPO Plans

As I said in my last post, using Dentrix’s Fee Schedules takes a little bit of management but produces huge benefits!  I am amazed at how many offices don’t know this Dentrix feature exists for setting up and managing fee schedules.   If you are in one of those offices, it’s time to find it and use it – you’ll be so glad you did.  Let’s walk through it together so that you can start seeing those benefits sooner than later. 
First, you will need a copy of your fee schedule from the insurance company.  Next, in Dentrix, find your way to the fee schedule set up screen, by following this path:   go to the Office Manager > Maintenance > Practice Setup > Auto Fee Schedule Changes.  The box that opens up should look like this: 

This is the tool you will use whenever you need to make changes to your fee schedules.  If you want to rename your fee schedules, just go to the Office Manager > Maintenance > Practice Setup > Definitions > click on the drop down menu and select Fee Schedule Names.  Now that your fee schedule is set up, you can now attach it to the Dental Insurance Plan, using the insurance edit screen on the Family File.  If you want to bill out full fees to the insurance companies, you’ll find a box just above the Fee Schedule box called the Claim Format box where you can change it to DX2012F.  See below: 

When you use the DX2012F claim format, remember that you will be billing out full fees to the insurance companies.  When you receive your EOB back from the insurance company it may look like you need to do an adjustment because the submitted amount will be greater than the allowed amount, but remember, the patient’s ledger has the correct PPO fees so no adjustment should be necessary. 
The final step in the setup is making sure the Coverage Table is accurate.  When using fee schedules, do not use the Payment Table unless there is a specific procedure code that falls outside the fee schedule coverage percentage.  A good example of this exception would be the downgrade for posterior composites.
The biggest benefits I see with using fee schedules are in the Treatment Planner and on the Ledger when collecting over the counter. 
If you are just switching over to using fee schedules and your patient has an existing treatment plan, you will need to use the Update Fees feature in the Treatment Planner in order for the treatment plan estimate to reflect the new fee structure.  Once you’ve used the Update Fees feature,  you can print the patient estimate just as you did before, but now it will reflect an accurate estimate without any manual calculations. 
In my experience, using Fee Schedules when you are contracted with an insurance company will give you more accurate accounting of production, help your front office team collect more accurately on the day of service and help give your patients an accurate treatment estimate when accepting treatment.  This is a WIN, WIN for everyone!

108 comments:

  1. Is there a way to use the fee schedules to accurately "estimate" the insurance portion of the payment and the patient portion when the patient is out of network? I am a Delta Premier dentist who treats quite a few PPO patients. I'm not subject to the PPO Fee schedule, but I really would like to give the patient a more accurate number when they check out including any write-off for the MPA.

    ReplyDelete
    Replies
    1. Kristy, Yes you can give accurate estimates with Dentrix by either using Fee Schedules, the Coverage Table or Payment Table. Depending on the insurance plan and the doctors contract status would determinte which one you would use. Contact me directly if you have trouble.
      Thank you for your comment, great question.
      Dayna

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  2. Which fee schedule do we assign the patient in the Family File when using the DX2007F claim format? We use the insurance company fees, right?

    Glynis E.

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    Replies
    1. When you are using Fee Schedules it is important to attach the fee schedule to the insurance plan not the patients Family File. The DX2007F claim format will allow you to post the fee schedule fees to the patients ledger and treatment plan but send full office fees to the insurance company.

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    2. I have a question.... I do not have the option of using that claim format is there any other way to bill full office fees when using a fee schedule?

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    3. You might need to add the DX2007F claim format into your Dentrix definitions. This is the only way to bill full fee to the insurance company and PPO fee to your patients. To add this claim format go to the Office Manager > Maintenance > Practice Setup > Definitions, click on the drop down menu and look for Claim Format and add it in here.

      Hope this helps.
      Dayna

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    4. If I have successfully added the DX2007F claim format, is there a way to edit and choose that format for all insurance plans at once or do I need to do each plan individually? Thank you in advance!

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    5. Most insurance plans are attached to the first insurance claim on the list so if you edit the first one it will change it for all.
      Dayna

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  3. How do you handle situations where the PPO adjustment is less than expected? Let's say the PPO fee for a crown is $800 but our fee is $980 (PPO adj of $180). Insurance denies the claim due to a back dated termination and the patient is not eligible for the PPO adjustment. How do you add the $180 back to the patient's ledger after they have already walked out with a receipt showing our charge was $800? What if the month is already closed? How do you explain this to the patient?

    ReplyDelete
    Replies
    1. Great Question! What I would recommend is an adjustment for this situation. Many offices have an adjustment for "Adjustment to Insurance" or "Add back charge" for this reason. Then depending on the patient you would need to have a one-on-one conversation explaining the need for adjustment.

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  4. How do I properly estimate a patient's copay when insurance downgrades composite fillings on molars?

    ReplyDelete
    Replies
    1. You would want to use the Payment Table in addition to the Coverage Table.

      Hope this helps.
      Dayna

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    2. How would the payment table help?

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    3. The Payment Table overrides the Coverage Table. If you are using the Fee Schedule method then only enter the exceptions into the Payment Table. For example; posterior composite downgrades, perio maintenance when paid at 100%, nightguards, etc.

      Hope this helps

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    4. We use the fee schedule in G6 I want to put my posterior downgrades in the payment table however when I did it still shows in the ledger the fees for them and not the downgrade to amalgam. What am I doing wrong? I put the D2391 2392 etc... in the payment table

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    5. How does the downgrade show? I put it in this am. I put the D2391 2392 2393 in the payment table with the amalgam fee but it did not reflect in our ledger?

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    6. The payment table is not the fee that you charge the patient, the payment table is what the insurance company will pay on that code. The fee schedule is what gets charged to the patient ledger.

      Hope this helps,
      Dayna

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  5. I was wondering if dentrix has a new update for the new 2013 CDT codes that were deleted and the new codes that were added

    ReplyDelete
    Replies
    1. Yes, you can go on the Dentrix website and download it directly. There is a video I posted in my blog in January if you want a visual on how to do it.
      Dayna Johnson

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  6. I was wondering if dentrix has updates that will automactically install new CDT codes for 2013, and delete the old ones?

    Thankyou

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  7. Yes, in fact I just installed it at my own office today. If you right click on the quick launch icon in the lower right task bar and "check for updates" it should find the update. It will load all the new codes but will not delete the old ones, you will need to move them into the NONE catagory if you want them out of the list.

    Thank you,
    Dayna

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  8. how do you go in and put in the fees for the fee sch. We have been using Dentix ledger but the fees are not in right the % are right usually but the fee is not set up. How can I do that to make it faster when we print up out treatment plans and not have to always look up the fee that the insurance fee is? We have our fee printed on the print out but the insurance fee is not on there and we are writing in and then doing the% our self and then adding all up and then go over it with the pt. We are wasting a lot of time.I just started at this office and the other offices that I was at already had that set up. We need help up front....
    Thanks!
    Misty

    ReplyDelete
    Replies
    1. Misty,

      Great question! If you refer to the video blog I did you might get your question answered here.

      http://thedentrixofficemanager.blogspot.com/2012/10/fee-schedules-your-questions-answered.html

      If this does not answer your question you can email me directly at dayna@raedentalmanagement.com

      Thank you,
      Dayna

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  9. I have DX2007. How do you get the DX2007F?

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    Replies
    1. You can add it into the definitions. Go to the Office Manager > Maintenance > Practice setup > definitions > click on the drop down menu and find claim format, then type in DX2007F in the name and DX2007F in the description and click add.
      Hope this helps.
      Dayna Johnson

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    2. Do you know any reason why in the Claim Format section of Definitions it won't let us add the name DX2007F? It acts as if it is too long (too many characters). It only allows DX2007, but it won't put the F in. It works fine under for the description to add the F, but not in the name section. We are using Dentrix G4.

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    3. I have seen that happen, just keep trying it will eventually take it.

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  10. I know you recommend using fee schedules but we would like to see full production recorded in Dentrix for benchmarks and ratio analysis. Is there a recommended process for using full fee and helping the staff accurately estimate the fee and copay? We would like to train the staff to make this process smoother. Any recommendations?

    ReplyDelete
  11. You can still see a comparison between full fee and PPO fee a couple different ways. When you run a day sheet you can click on "compare to" and compare the posted fees to your full fee schedule. Then there is a report on the office manager called Insurance Utilization Report. This will show you the difference between full fee and PPO fee schedule in whatever time period you choose.

    I realize I didn't answer your question, but I would like you to try this first.

    Thank you,
    Dayna Johnson

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  12. When we run the Ins Utilization report to get our write-offs for Delta our numbers are not correct, due to dual Delta insured patients. The write off shows up twice in the report, once for the primary and again on the secondary. How can we get accurate Delta Write-offs? Thank, Julie

    ReplyDelete
    Replies
    1. I will have to do a little research on that question. Let me get back to you.

      Thank you,
      Dayna Johnson

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  13. Thanks so much for your very helpful post. We have been wrestling against this issue for 2 years.

    Our only concern with switching to the DX2007F method is when we have to work denials. We have a 3rd party that manages our billing, and their concern is that if they only see the Insurance Allowed Amount in the ledger. How will they know what fees to talk about with the Insurance Company as they may be inquiring about a claim?

    Do you have any suggestions on this?

    ReplyDelete
    Replies
    1. Lance,

      I think you emailed me directly on this one, but if I was using a 3rd party billing service I would probably use the regualar DX2007 claim format and not worrry about submitting the full UCR fee. Not everyone bills out the full fee to the insurance company, just make sure your fee schedules are up-to-date. Also, make sure any fees not listed on the fee schedule are being billed out at your office fees.

      Hope this helps,
      Dayna Johnson

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  14. As you referenced, we also bill claims with our UCR fees, even if we're contracted with a PPO network. Our ledgers and tx plan that we present to our patient's are with the PPO fees, and we explain that we submit our UCR fees to the insurance. Since then, I received a letter from an Insurance stating that "fees submitted to them (or any other insurance company) must reflect the fees actually charted to the patient". Where do I find information to rebuttle their complaint against us? or are they correct?

    ReplyDelete
    Replies
    1. Is it possible for you to send me a copy of the letter directly to my email? I am trying to find out the legal, factual answer and not based on my opinion.

      Please email me a copy of the letter to:
      dayna@raedentalmanagement.com

      Thank you,
      Dayna Johnson

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    2. I am interested in this answer as well. Have you been able to find the legal answer by chance?

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    3. I would like to research it, but no one has sent me a copy of their letter. I cannot ask anyone without a copy of the letter. If you have one please email me a copy at Dayna@raedentalmanagement.com.

      Thank you,
      Dayna

      Delete
  15. We usually bill the insurance company UCR fees as you stated, but what if for some specific patients we want to bill out to the insurance company the PPO fees? how do i make that change to a specific patients chart only?

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  16. If you want to change it per patient you can attach a different fee schedule to the demographics secion on their Family File. This fee schedule will over ride the fee schedule for the insurace plan. Remember this is only one specific patient so do not attach the fee schedule to all your patients in this way.

    Thank you,
    Dayna

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  17. Hello Dayna,

    Could there be a reason why when I select DX2007F and print claim , the claim has insurance fee schedule instead of office fee schedule?

    Best,

    ReplyDelete
    Replies
    1. Could be a couple reasons; that claim form was not originally attached to the insurance plan at the time the services were charged out, I would delete the claim and re-create it, the fee schedule was not attached to the patients insurance before the charges were posted, try deleting them and re-posting, or those charges are the same in both fee schedules.
      Hope this helps,
      Dayna

      Delete
  18. Hi Dayna, We do not have Dx2007F, we only have DX2007, so our fees are not distributing like we want. i.e. PPO fee to treatment estimate, and ledger, but UCR to insurance. How do we get this claim format?

    ReplyDelete
  19. Actually, the problem is when I go into definitions and add DX2007F in both fields I am not able to ADD it because the ADD button is not highlighted, am not able to click on it. Your advice would be greatly apprecialted. Patti Blakey

    ReplyDelete
    Replies
    1. Hello Patti,

      If the list is already maxed out you can change one that you do not use. You really only need one claim form, two if you bill out medical.
      Dayna

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  20. Hi Dayna,
    Can you educate me about HMO and PPO ?What dental plans are good for a small office HMO or PPO?

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    Replies
    1. I can educate you about the difference but the choice is up to you. An HMO will send the office a check depending on the number of patients you have in a particular HMO. The HMO pays you per patient, not by procedure. The PPO plan is a more common choice for a small dental office. This is where the office is contracted with the dental plan and can only charge the fee agreed upon. The PPO plan pays you based on a fee schedule not per patient.
      Hope this helps.
      Dayna

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  21. This comment has been removed by the author.

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  22. How can you edit your claim format? Our claims are printing with the info blank under "treating dentist and treatment location information". I'm getting denials because box 53 (signature of treating dentist) and box 54 (Provider ID) are blank. I want it to say "signature on fiile" and have our NPI for provider ID but I can't figure out how to edit this information. Please help!

    ReplyDelete
    Replies
    1. The defaults for the insurance claim can be found by going to the Office Manager > Maintenance > Practice Setup > Practice Defaults. To make sure the correct provider ID's are in your system and the Signature on File is checked go to the Office Manager > Maintenance > Practice Setup > Practice Resource Setup and check each one of your treating providers.
      Hope this helps,
      Dayna

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  23. We participate with Delta premier plan but we have a lot of Delta PPO patients and a lot of Delta plans from out of state (PPO as well). Should we be attaching all of these different Delta to their own fee schedules? We haven't done that and it seems like a lot of these Delta plans allow different fees or downgrades to a different procedure code and it messes estimates up because the fees are being updated when Delta checks are posted and we only have one Delta Fee Schedule.

    ReplyDelete
    Replies
    1. Hello Kennedy, you only want to enter the fee schedules that you are actually contracted with. If you are not contracted with the Delta PPO then the patient is responsible for the difference in the fee between Premier and PPO.

      Hope this helps,
      Dayna

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  24. How can I edit our claim format so that the CMS 1500 claim forms are printed on the correct version? We are trying to print medical claims and are only able to print the 08/05 version rather than the updated 02/12 version, which we no longer have claim forms for any longer, and as far as I know, is no longer being accepted by insurance companys. Any help would be greatly appreciated.

    ReplyDelete
    Replies
    1. The HCFA 1500 clam form is still the current claim form for medical insurance. In the definitions you need to add it to the list of claim forms and them make sure you have the medical insurance added to the patients family file and make sure the dental codes are cross coded to medical.

      Hope this helps,
      Dayna

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  25. If I change the format in the OM to the DX2007F form, will that change all the insurances to that claim format or do I have to change each insurance separately? Thank you in advance for your assistance.

    ReplyDelete
    Replies
    1. If you change the first one in the list in the definitions it will change it for all. Also, the most recent claim format now is the DX2012F.

      Hope this helps,
      Dayna

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  26. If you change the first one in the list in the definitions it will change it for all. Also, the most recent claim format now is the DX2012F.

    Hope this helps,
    Dayna

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  27. We are an office that sees primarily Medicaid patients (85% vs. 15% private insurance). Right now we feel we are inefficient...each day the fees are hand calculated to reflect the full fees against the insurance fees. We want to go to an automatic fee schedule in Dentrix but would you still recommend this and would it work the way you've outlined given we primarily receive Medicaid payments? Another aspect is that we bonus our staff off of true production each day, not the inflated estimate. Would changing to an automatic fee schedule effect this?

    ReplyDelete
    Replies
    1. Using fee schedules with Medicaid would work exactly the same way as private insurance. It would give your team the efficiency it needs to present and collect with accurate numbers. Also, with your bonus all your reports will reflect the fee schedule fee which is true production so I think it would make your bonus system easier to calculate.

      If you are going to start using fee schedules check out the report I just launched that is integrated with Dentrix. www.greatminds.com/products it is called The PPO Analyzer.
      Thank you,

      Delete
  28. What does Sched-6 mean. it wont let me print in the office manager

    ReplyDelete
    Replies
    1. You have lost your connection to the printer. Either reboot your computer or call Dentrix support.
      Dayna

      Delete
  29. Can you let us know how to do a variant of this? We have our fee schedules and coverage tables in, for the provider, our PPOs, and for medicaid. What we want to do is charge the full provider fee schedule on insurance claims, and have the full provider fees printed in the ledger, but use the fee schedules and coverage tables to generate the patient's portion due at the time of service.

    ReplyDelete
    Replies
    1. If you are linking the fee schedules to the insurance plans and using the DX2012F claim form it will post fee schedule fees to the ledger, appointment book and treatment plan and bill full office fees to the insurance companies. Currently there is not a way to bill and estimate by switching back and forth, it all or none.

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  30. Is there away to enter DHMO fees in Dentrix?

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  31. Would you please let me know if there is a way to upload the Fee Schedule to Dentrix instead of adding one by one?

    Thank you,
    Farsheed

    ReplyDelete
  32. Hi,
    Is there a way to download the fee schedules and then upload them to Dentrix, instead of adding them one by one?

    ReplyDelete
    Replies
    1. Hello, currently there is no way to do this. Sorry.
      Dayna

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  33. We have several claims that were paid according to our office fee schedule when in the insurance file we had selected the Humana fee schedule. After contacting the insurance we found that we were no longer contracted through Humana due to not renewing our application. My question is what do we do with the credit showing in the patients ledger? For example one patient was seen for a recall with the Humana fee schedule our ledger billed $168.00, however the insurance paid $222.55. The patient's ledger is now -$54.55.

    ReplyDelete
    Replies
    1. You can make an offsetting +adjustment to bring the patient's account to $0. I would have an adjustment type called Insurance allowable fee or Adjustment to Insurance Fee Schedule. The credit belongs to the office not the patient.

      Delete
  34. How can I create an insurance plan that covers all procedures but charges a $25.00 copay per visit?

    ReplyDelete
  35. I thought haven’t read such distinctive material anywhere else on-line.dental implants south bay

    ReplyDelete
  36. We are currently using DX2007 claim format and the state is now requiring the use of J430. If I understand correctly, if I switch to the J430 all claims will be in that format and I cannot designate J430 to just the Medicaid insurance patients. Thank you.

    ReplyDelete
  37. The most up to date ADA claim form is the DX2012, if you are using fee schedules I would recommend using the DX2012F claim format. I am not sure what the J430 claim form is but if Medicaid is requiring it then I would attach that claim form to your Medicaid insurance plans and attach the DX2012F to all your other plans.

    Hope this helps,
    Dayna

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  38. Is it mandatory the UCR fee is higher than a PPO fee? In reviewing the fee schedules, one plan pays $55 for 1206 which was higher than the fee for a cash patient.

    Thank you

    ReplyDelete
    Replies
    1. I would always make your UCR fees higher than your PPO fees. When you are using the DX2012F claim form the insurance will be billed your UCR fee so it is important for your UCR fees to always be higher.
      Dayna

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  39. Our concern is that the patient's walk-out statement will only show the PPO fee instead of our office fee, and if the patient drops their insurance they won't realize they were seeing an adjustment all along and they will be shocked when they have to pay the full fee. Also, we like them to see the adjustment in writing. Is there a way to do that for a walk-out statement?

    ReplyDelete
    Replies
    1. I hear what you are saying, however in my opinion the benefits of using fee schedules far outweigh the patient seeing the write off. The benefits of cash flow, accurate treatment plan estimates and production tracking is much more important to me.

      The patient will get an EOB from the insurance which will show the difference between the full fee and the PPO fee. The EOB the patient receives will show the discount they are receiving.

      Currently there is no way to post PPO fees to the ledger but have the walkout statement show something different.

      Hope this helps
      Dayna

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  40. I have noticed that sometimes our fees go to the insurance companies and sometimes the customized fee schedule fee goes, is there a reason that our fee doesnt go all the time and is their a way to ensure that it does?

    ReplyDelete
    Replies
    1. It depends on which claim format is attached to the plan or if someone has changed the claim format in the Insurance Data window. Any of the claim formats with a "F" at the end will send out fee schedule fees. Also, there is special formatting on the DX2007 and DX2012 if you click on the Claim Setup button in the Insurance Data window.

      Delete
  41. Hello Dayna, I am confused as to the advantages of using the dx#### format. We have been using the ECSForm. As a PPO provider for multiple insurance companies, why would you want to send your office fee schedule to the insurance company if they are just going to adjust the fees back to your PPO fee schedule?

    ReplyDelete
    Replies
    1. The DX2012 and the DX2012F claim forms are the most up to date ADA claim form. The difference between these two forms is that the DX2012 pulls the fees from the ledger and the DX2012F pulls the fees from the Office fee schedule not the ledger. You always want to send your full office fee to the insurance company so that when they are looking to update the fee schedules in your area they are seeing what your full fees are not your PPO fees.

      Hope this helps,
      Dayna

      Delete
  42. When we look at our claims in ledger, we only have billing provider showing. How do we add rendering provider and pay-to provider?

    ReplyDelete
    Replies
    1. It has already been added in your setup. Go to the Office Manager > Maintenance > Practice Setup > Practice Defaults, here you will see who has been selected as the Billing, Rendering and the Pay To providers.
      Hope this helps
      Dayna

      Delete
  43. Hello
    Last year we had all UCR fees in the system and this year (2015) we changed to using fee schedules, our collections is down and alot of people have credits because of the change. could this make our collections go down?

    ReplyDelete
    Replies
    1. Using fee schedules should not make your collections go down. Make sure you are using the DX2012F claim form so you are always billing out full fee to the insurance companies. Never bill out the fee schedule fees to the insurance companies.

      Hope this helps,
      Dayna

      Delete
  44. Hi
    2014 we used a UCR fee schedule for everyone, 2015 we switched to fee schedules, our collections is down and more people have credits. could this by why collections are less?

    ReplyDelete
    Replies
    1. If you are using a UCR fee schedule your production is inflated so you would need to subtract the adjustments from the production total to see your net production. If you are using fee schedules the adjustment is built into the fee so the production totals are already net production. Whether you are using fee schedules or UCR your total collection % should still be 98 - 100% of production. The only way your patients will end up with a credit balances is if you are making unnecessary adjustments or your fee schedules are off.

      Hope this helps,
      Dayna

      Delete
  45. We have updated the claim form to DX2012F and we have the contracted fee schedule attached to the insurance and default fee schedule in the family file but the insurance claim is still generating with contracted fee not the full office fee, any ideas of what else we can try? The ledger and appointment book are both showing contracted fees as well.

    ReplyDelete
  46. We have updated the claim format to DX2012F and we have attached the contracted fee schedule to the insurance and the family file is set to default. The ledger and appointment book are showing contracted fees but claims are still generating with contracted fees instead of full office fee. Any ideas?

    ReplyDelete
    Replies
    1. Are you just double clicking on the claim on the ledger or are you actually printing the claim to check it? Do me a favor and actually print the claim out on paper and I am sure you will see full fees on the insurance claim. Let me know
      Dayna

      Delete
  47. I have a question. We just joined a network and a few of their fees are actually higher (not much higher) than our UCR fees. Even if I were to make a fee schedule for this particular network Dentrix will still recognize our submitted fee as our UCR fee... Is there a way to change the submitted fee for these patients in network....or is the only way to raise our UCR fee?

    ReplyDelete
  48. We just joined a new network and a few of their fees are higher than our UCR fees. Even if I were to make a fee sch for the patients in network Dentrix recognizes the UCR fee as the submitted fee... Is there a way to change the submitted fee to the higher contracted fee?

    ReplyDelete
    Replies
    1. Yes, I would update your UCR fee schedule. If you are using contracted fees on the ledger and using the DX2012F claim form then you want to make sure your full fee schedule is higher on all the procedures. The "F" claim form will ignore the ledger and pull your full fee schedule.
      Hope this helps.

      Delete
  49. An insurance company is changing what few schedule they are in. Is there a way to find all the patients using that specific insurance and mass change their few schedule, instead of having to go into each individual family file.

    ReplyDelete
  50. An insurance company is changing what few schedule they are in. Is there a way to find all the patients using that specific insurance and mass change their few schedule, instead of having to go into each individual family file.

    ReplyDelete
  51. Yes, you can go to the Insurance Maintenance section on the Office Manager. Hope this helps
    Dayna

    ReplyDelete
  52. I have started on with an office who has one provider out of network and one provider in network. The fee schedules were originall assigned in the insurance information rather than individual family file, so the doctor who is not in network seeing a patient with an insurance (delta) that is in network with the associate was getting incorrect fees. My solution was to stop assigning the fees to the insurance which affects everyone across the board on that plan, and instead to their family file individually. Is this the accurate resolution? Both providers also have their own different fee schedules.

    ReplyDelete
    Replies
    1. This is a tough one to manage. With your situation having one doctor with one fee schedule and another doctor with a different fee schedule you will want to make sure the Primary Provider is assigned correctly so it pulls that doctors UCR fee schedule. Now if you have a patient that is assigned to the primary provider with a contracted fee schedule then I would link it to the Family File and not the insurance plan.

      One thing you will need to remember is that if a patient see's a different doctor it will not switch over to that other doctors fees.

      If you still get hung up on this one then we can schedule an online session.

      Hope this helps,
      Dayna

      Delete
  53. We are a "fee for service" one provider office. Doctor is "out of network" regardless of a plan. We release insurance claim to patient after our fee is paid in full. Our Doctor is looking to get an Associate with an option to buy in. The Associate doctor will be joining our practice with his own patient database. He is a PPO in network provider with major insurance plans. He gave me "his fee schedule" which is MUCH lower than our current fees. My next step is to call insurance companies to add our location to his name/license. Getting their fee schedules and adding all info Dentrix. From reading your blog (which was really helpful) I was able to understand that:
    1. It's ok to submit to insurance our current fees (using non-participating provider TIN) as long as treating DDS is in network and is on the claim form as a treating provider.
    2. Using DX2012F set up for insurance and DX2012 set up for patient ledger is LEGAL as long as patient co-payment amount is calculated and billed based on "his fee schedule" and not on our current fee schedule.
    I would appreciate your comment and any other advise you can give us on how to make this transition as smooth as possible. What other issues might occur? Thank you.

    ReplyDelete
    Replies
    1. It sounds like you have a very clear understanding on how the fee schedules work. You could setup your system a couple different ways depending on how you want the ledger to look and if you want to use fee schedules on the ledger or do write offs. Let me know if you want to setup an online meeting to talk about the options. I can help.
      Thank you,
      Dayna

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  54. We have been pretty much Fee for Service and are now adding some PPO Plans for the first time. As you recommended we are now attaching fee schedules to the PPO Plans and hence the associated patients. As you say - it does make the treatment plan presenter reports, patient discussions, and collections at the counter much easier!!! Ya for that, but it appears to have come with one huge downside. Help. We also look at our scheduled production daily and weekly from the appointment book view. However, these "scheduled production" amounts now reflect the PPO discounts since the patients scheduled production is being posted on the appoinment card at the PPO fee. This is a problem. While the discounted amount might truly reflect reality, for the purposes of goal setting we want our scheduled production to reflect PRODUCTION at our office fees not the ppo discounts. For example if our hygiene goal is $1000 per day of collection, the scheduled production amount in the appointment book view for that hygienist may be less than that to reflect the ppo patients being seen that day. again, reality yes, but for managing PRODUCTION goals that is a mess. What can we do, if we are attaching fee schedules to plans/patients, to know what the scheduled "production" (not collections) truly is? help?

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    1. Thank you for your comment. With all due respect, you should be managing production goals in net production not gross production because you will never collect on gross production and your team will be receiving an incentive on unrealistic goals. My recommendation would be for your doctor to re-visit the hygiene production goal and calculate it based on net production and not gross production.

      Hope this helps give you a different perspective.
      Thank you,
      Dayna

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  55. Thanks for the reply. I understand your point on "net production" goals, but would argue gross production goals are necessary for a manageable, equitable, and sustainable 'production' goal monitoring system.

    But the problems with posting PPO fees to the ledger go beyond just making it difficult to monitor gross production. While the benefit is certainly better treatment plan presentation (really a work-around for a poorly designed treatment plan presenter module) and certainly helps with front desk collections, it is fraught with back end issues as voiced here : http://myvoice.dentrix.com/forums/130655-enhancement-requests/suggestions/265220-option-to-calculate-show-discounts-and-write-offs?page=2&per_page=20 (See GCChristophers comments - amen, he understands)

    There seems to be a lot of us thinking Dentrix users that are still looking for a better solution for managing contracted fee schedules on the ledger side that actually works well with the Treatment Plan Presenter side as well. Frankly, the Treatment Plan Presenter module is inadequate when it comes to contracted fee plans and many dentists are figuring this out.

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    1. I agree with the enhancement request that the treatment planner should have more options for calculating a discount and/or reduced fee schedule. Insurance is such a complicated and ever changing process that it is difficult for the software to keep up. We need to do the best we can within the parameters we have.

      There are a few ways you can see your gross production compared to the fee schedule production within Dentrix. You can see it on a daysheet and use the Utilization Report for Dental Insurance. I realize we disagree on the use of gross production or net production, however I would not want one of my teams using gross production for planning goals or managing the production in the appointment book because it gives false information for collections.

      Thank you for your comments,
      Dayna

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  56. How come all the other dental software systems can calculate PPO write offs/adjustments but Dentrix cannot? It's so confusing to me. You would think Dentrix would have fixed this issue a long time ago. Softdent is miles ahead of Dentrix.

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    1. Dentrix can calculate PPO write offs if you are using fee schedules. Attach your contracted fee schedule to the insurance plan, make sure your coverage table is accurate and use the payment table for the exceptions like posterior composite downgrades. It works like a charm.

      Let me know if you have specific questions and I can help.
      Dayna

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  57. Is there a report that give outstanding claims billed to insurance at frequency of say 25+ day or so. Reporting claims that have not been closed??

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    1. You can use the Insurance Aging Report and search for claims that are current, 30 days past due, 60 days past due or 90 days past due.

      Dayna

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  58. Is there a way to get the claim to reflect the allowed fees, when the secondary insurance is Medicaid, and how would we get that to show not the claim?

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