If you read my blogs or know me personally, you know that I am a huge fan of using Fee Schedules when an office is a contracted provider with a PPO dental plan. For the full article I wrote on Fee Schedules vs. Write Offs, you can read my blog by clicking here or you can read my article in the Spring 2012 issue of the Dentrix quarterly magazine.
The question I am asked most often is, “What reports can I run that will show me what I am writing off if I am no longer using adjustments for the PPO write offs?”
During the Business of Dentistry Conference, I was able to sit with one of the senior software developers and work through how the office can get a report that will show the write off amount for PPO insurance. We looked at a couple of different scenarios and found a couple of ways to locate the answer. I will explain both.
1. You can see the difference between the billed charges (actual charges on the patient ledger) compared to the office fee schedule (what is listed in the office fee schedule for each procedure code) on the day sheet. When you run your day sheet everyday, there is a “Compare to Fee Schedule” check box. This is where you would select your full office fee schedule to compare the actual charges to your office fee schedule. When you run your day sheet, there will be two new line items that appear right under the charges: “COMPARED TO OFFICE” and “NET DIFFERENCE.” The only thing to be cautious of with this number is that it looks at all accounts (even those with no insurance), so this number wouldn’t necessarily be what your PPO adjustment would have been. For example, let’s say you have a cash patient for whom you are making a nightguard and your full office fee is $500. However, the doctor only wants to charge the patient $250. There would be a NET DIFFERENCE of $250, but this would not have been a PPO adjustment. Make sense?
2. The next report is the Utilization Report for Dental Insurance. This report is more accurate to show what the PPO adjustment would have been. I said “would have been” because we will not be able to reproduce an Insurance Category Report for PPO if there are no adjustments being made. All we can do is try and accurately see the difference between the full office fee schedule and the PPO fee schedule. The difference between the office fee and the PPO fee is the adjustment.
Do you want to know more about the Utilization Report? If you log into the Resource Center on the Dentrix website, go to the Knowledge Base, and open Article # 21709, you will get the same information found below.
The Utilization Report for Dental Insurance will look at actual charges billed to the ledger compared to the office full fee schedule. This report can be printed for a specific time frame, group of insurance carriers, billing types, and providers. If you are only looking for a total dollar number, I would suggest doing a print preview and looking at the total on the last page. The grand total (Fee – Co-Pay) would have been your PPO adjustment. This is the difference between your office full fee schedule and the amount billed on the ledger only for patients with insurance. Please know that I am not saying that this report will be a completely 100% accurate replica of your PPO adjustment report. Why? For example, let’s say you have a patient with Metlife (non-PPO) insurance and you choose to charge the patient less than your full office fee on a procedure, this would also show as a difference on this report. There are two ways to get the information to be more accurate. First, if you choose to lower the fee for a patient with insurance, my suggestion would be to still charge the same fee as your full office fee and then make an adjustment. Second, you could also run the report by specific insurance carriers and exclude your non-PPO insurance plans from the report. I would make sure all your PPO plans are spelled the same way so that you can easily do a “TO” and “FROM” list without skipping any. For example, make sure all your Washington Dental Service plans are spelled the same.
I hope this lengthy description helps you understand the reporting capabilities within Dentrix to give you the numbers you are looking for when using the Fee Schedule method with PPO dental plans.