Tuesday, April 29, 2014

It's only an estimate, so make it as accurate as possible


Are you looking for a more accurate way to accommodate the difference that the insurance company calculates for posterior composites? What about the fact that perio maintenance is in the perio category but is usually paid at 100%? Would you like to be able to give your patients a more accurate out-of-pocket estimate? If so, then using the Payment Table will make you very happy. 

The Payment Table overrides the Coverage Table so it is perfect for those procedure codes that fall outside of the default coverage table. Here are some examples:
  • Posterior Composite Downgrades – most insurance companies do not pay for composite fillings placed in molars, but they will pay for the equivalent of an amalgam filling. For example, you would take the fee for the D2140 (1 surface posterior amalgam code) and multiply this fee by the coverage %. Then in the Payment Table you would enter the D2391 (1 surface posterior composite code) and enter the fee you just calculated. This amount will override the coverage % and give your patient a more accurate estimate. I have seen some offices create a little “cheat sheet” in Microsoft Word for all the downgrade coverage and save it to the desktop for easy access.
  • Nightguards (D9940) – they are located in the Adjunctive category, which is typically covered at 80%. However, in my experience with nightguards, they are usually paid at 50% or 0%. 
  • Perio Maintenance (D4910) – this code is in the periodontal category which is typically covered at 80%. However, the D4910 Perio Maintenance is usually covered at 100% like a prophy.
  • Crown Lengthening (D4249) – this code is also in the periodontal category. However, in my experience, it is covered at the same percentage as a crown (50%).
  • Onlays – In the Dentrix default categories in the Coverage Table, they have onlays grouped in with the Basic Restorative at 80%. However, onlays are covered just like a crown at 50%. Instead of moving around your coverage table groupings, you can just add onlays to the Payment Table.

The Payment Table can be updated manually by going to the patient’s family file or the Office Manager > Maintenance > Reference > Insurance Maintenance and clicking on the Payment Table, or you can update the Payment Table while entering in insurance payments. If you are using the Fee Schedule Method and attaching fee schedules to the insurance plans, do not use the update payment table during insurance payment entry for your contracted plans unless it is one of the exceptions listed above. Only update the payment table during insurance payments for insurance companies with which you are not contracted. 

If you are unsure if you are using the Fee Schedule Method or you want more information on fee schedules, click below to read more on fee schedules.

2 comments:

  1. I have entered in the calculated amount under the payment table for insurances that downgrade. This also has been overriding the deductible. What am I doing incorrectly?

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  2. Hello Alicia,

    The Payment Table does not affect the deductible.
    Dayna

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