Are all your insurance claims being sent out?

A couple of weeks ago, I gave some recommendations on your Daily, Weekly, and Monthly management routines and today’s article definitely should have been put into the Weekly routine. Do you ever wonder if all your insurance claims are being sent out in a timely manner … or even being sent out at all? This tool in Dentrix will screen all your charges and make sure they are batched up to send out just in case you got distracted and missed a couple. Most dental offices I work with batch up the claims on the ledger as the patient is checking out and this is why I think this feature is so important.

From the Office Manager, there is an icon at the top of the toolbar with a big INS on it. If you hover over it, it says “Create Batch Primary Dental Insurance Claims.” When you click on this icon, it will open a new window where you can select a date range, provider, and select whether or not you want to send out claims with procedures with a $0 amount. As soon as you click OK, it will search for all procedures that have been posted and not sent to insurance. It will give you a total and send them all to the Batch Processor.

Now you might have several claims that get created (I was in an office recently that had 109 for a three-month period). What I would recommend is that you run this on a weekly basis so hopefully you only have a few to sort through. Sometimes there is a reason why the claim is not being sent to insurance.

If you already use this feature in Dentrix . . . great job!

Thinking of implementing electronic forms? This is a must read

Which one are you … “chartless” or “paperless?” It is interesting when I talk with dental practices how they use these two terms interchangeably. Most people don’t see a difference. But put yourself in the patient’s shoes and there is a huge difference. If your office sends the patient paper forms to fill out before their appointment, sends the patient a PDF attachment of your new patient forms, or if you send your patients to your website where they have to download a PDF form, your office is ”chartless” not “paperless.”

Put yourself in your patients’ shoes and think about how much more convenient it would be if they could click on a link, fill out your forms, and be done with it. Wouldn’t it be even more convenient if the office team could direct an elderly patient’s caregiver or family member to assist in the paperwork? Implementing this type of technology creates a paperless environment and is simple and cost-effective.

When you are ready to go “paperless” and implement electronic forms, there are three things that often get overlooked.

1. Give your patients options for filling out the forms. My number one option is directing the patient or caregiver to your website. This not only drives traffic to your website so they can see all your services, meet your team, and get directions, but they can fill out the forms from the comfort of their home or work computer. However, there will be circumstances where the patient does not have access to a computer or they forget, so make sure to have plan B available. Plan B is not “give the patient the forms on paper and scan them in.” This is not acceptable. Set up a consult room, check-in station or have a tablet available for the patient to fill out your electronic forms. If the patient does not know how to use a computer, it does not take that long to interview them and fill in the form for them.
2. Layout your treatment rooms in a way so you have at least one monitor that the patient can view and can be pulled within reading view. Having a monitor within reading distance allows your clinical team to easily review the forms with the patient. Also, this allows you to have your patient read over your consent forms as well.
3. Don’t forget the electronic signature devices. Since there is no paper, you will need to capture the signature via a signature device, similar to making purchases at a store on a credit card machine. My recommendation is start small with one signature device for every four treatment rooms and one or two at the front desk. Most signature devices are USB so they can be easily moved from room to room similar to a sensor.

Whenever you are implementing a new technology like electronic forms where the patient will be doing the work, make sure your team does a practice run so they can understand the patient experience. The technology needs to be user-friendly. If any of your team members have trouble with the technology, more than likely your patients will too.

What fee should I bill on the claim?

The topic of full fee vs. PPO fee and how to bill it all to the insurance companies has been a heated point of discussion during the three years I have been writing the blog. Insurance companies are constantly setting their own rules about the claim format and dental offices are trying to keep up with all of the changes in the claim formats.

In Dentrix version G5.2, the development team made some significant feature improvements to help you alter the claim format for individual insurance companies if needed. This new feature enhancement can also give you more flexibility when billing out fees for a specialist or for a provider who is not contracted with a PPO plan.

If you go to the Office Manager > Maintenance > Reference > Insurance Maintenance then open up the Insurance Data box, you will find a radio button to the right of the Claim Format. Click on the Claim Format button to open the options available. You will notice many choices … but the one I am most excited about is the drop down menu under Provider and Fee Options. If you click on the drop down menu under fee schedule, then you can choose for this insurance plan if you want bill out the Default fee schedule, Billing Provider fee schedule, or Insurance fee schedule. Here are the definitions:

• Default – This will bill out whatever fees are posted to the patient’s ledger.
• Billing Provider – Whichever provider is used as the Billing Provider on the claim will have his or her fee schedule pulled. This is similar to using the “F” claim forms. However, many of you may be under the impression that it pulls the patient’s PROV1. If you go to the provider setup, each provider has a fee schedule attached to his or her profile. This feature could be extremely helpful if you have a specialist who comes into your office and you want to bill out a higher fee than the office’s regular fees. For example, if you have an endodontist come in once a week and you bill out a molar root canal for a patient, you could open up the insurance claim and change the billing provider to the endodontist so that his or her fee goes out on the insurance claim.
• Insurance Plan – This will bill out the insurance plan fee schedule if you have one attached to the insurance plan info screen. If you have used any of the “I” claim forms in the past, this feature will perform similar to that.

These new Claim Format features are available with G5.2 and the DX2007 and DX2012 claim forms. Check out the other features within the Claim Format button and see if any of these will pertain to your insurance plans.

Best Practices for Your Team . . . monthly

You have been managing your daily and weekly systems according to plan and now you want to see how the month ended and how much your efforts paid off.  If you are following a guideline, carving out time in your schedule to work the reports, and documenting your communication, you are on the right track for success.  Like I mentioned in my last article, get into preventative mode and out of reaction mode.  This is what we preach to our patients and you can treat the business side of dentistry exactly the same way.

This final article in my Practice Management “best practices” series is what to do on a monthly basis. The goal for your end of the month is to celebrate your success, review with your team, and report to the powers at be.  Numbers tell a story and help you create, change or eliminate systems.  Here is my recommendations for monthly reports and who on the team needs to review them.

·        All Team Members:  In my last article, I gave some recommendations on which team member in the practice should work which reports, but the overall health of the practice falls on everyone.  Of course there are team members who are accountable for different areas of the practice. However, every team member contributes to the success and demise of the practice.

o   Practice Advisor Report:  This report is my favorite report for your team meeting.  It brings together multiple areas of the practice on one report and is laid out in a way that is easy to read and gives recommendations on how to improve the numbers if they are below your benchmarks.  For more information on this report, CLICKHERE.

·        Doctor/Practice Owner/CPA:  There are certain reports that need to be forwarded to the office bookkeeper, CPA or banker.  Also, there is one report that is reserved for the practice owner’s eyes only.

o   Audit Trail: The Audit Trail report is a back end report that can be password-protected so the practice owner can see accounting edits, prescription deletions and login history.  CLICK HERE for more information on this report.

o   Analysis Summary:  This has been a popular report to give to practice owners who have a business loan.  I have been asked “What is the best report to show production, collection, adjustments, new patients and A/R?”  Here it is.

o   Adjustment Summary: There are many summary reports you can generate as part of your month end protocol. However, I think this one in particular is important because it will break down the write-offs into categories.  For example, if your office is using fee schedules in Dentrix because you are contracted with PPO dental plans, your practice would not have very many adjustments in the PPO adjustment category.  If there was a lot of write-offs in this category, I would be a little concerned.

·        Office Manager:  In addition to the Practice Advisor Report, I would go through a couple of other reports in the marketing and customer service side of the practice.

o   New Patient List:  This report can help you identify that all your new patients have a referral source attached to them and a thank you/welcome letter was sent out.  Remember that the new patients on this list are counted by first visit date not comp exam.

o   Referred By Doctor/Other/Patient:  These reports help you decide where your marketing efforts are paying off and gives you an opportunity to thank those patients or other business owners who are referring to your practice.  You can read more about these reports by CLICKING HERE.

o   Referral Analysis:  You may know that you can attach a referral source to each patient, but did you know you can track gratuities?  If you are using this feature in Dentrix, there is an analysis list that you can view by going to the Office Manager > Analysis > Referrals Doctor/Other and see the list in different date ranges. For more on this feature, CLICK HERE.

I hope that these last three articles on some “best practices” for your daily, weekly, and monthly systems has stirred up some interest in using Dentrix to completely manage the business and marketing side of your practice.  Continue to read back on past blog posts and use them as a guide to help create better team meetings, morning huddles, and as a constant reminder to keep your finger on the pulse of your practice.

 

Best Practices for Your Team . . . weekly

Last week, we focused on what was important or the “best practice” for your daily protocol.  Today, we want to move to your weekly systems.  I teach my offices about practicing on the business side of dentistry the same things you preach to your patients in the clinical side of dentistry . . .  “prevention will help keep you out of emergency situations.”  Living in a preventative rather than reactive frame of mind will reap tremendous benefits to your practice.

What I mean by that is putting systems in place and carving out time in your busy schedule to work your reports, follow up with patients and communicating with your specialists on a weekly basis. 

·        Treatment Coordinator – Your main focus is case management and following up with patients who have unscheduled treatment.  When patients walk out of the office without scheduling the crown on #30, you can’t expect them to call, you need to follow up.  The treatment coordinator should be working three reports every week.  You will need to carve out at least 2-3 hours a week of uninterrupted time for this.  

o   Treatment Manager Report – This is your chart audit.  I know some of you are still printing the Unscheduled Treatment Report … stop doing it!  The Treatment Manager is your go-to report for managing unscheduled treatment and one of the reports for keeping your schedule full.  For more details on this report, CLICK HERE.

o   Referred TO Report – When your clinical team is treatment planning and attaching the referral to a procedure code, that patient is automatically added to this report.  Anytime your patient must complete a procedure (i.e. implant placement, root canal, perio surgery) before they can return to your office for the restorative treatment, someone must be making a follow-up call to make sure that treatment is getting completed so you can move forward with that patient care. For more information on how to track referrals, CLICK HERE

o   Unscheduled List – This list should be worked by the hygiene coordinator and the treatment manager.  Follow up with these patients and get them rescheduled. Don’t let them sit on this report for more than six weeks.  For more information on this report, CLICK HERE

·        Hygiene Coordinator – Your main focus is following up with patients who are past due for their recare visit.  Yes, you should have some kind of automated system for sending email, text messaging, and postcards. However, you will still need to pick up the phone and make some calls.  Also, you might want to consider having a patient reactivation system for those patients who are severely overdue.   So how do you keep tight reins on your recare patients?

o   Continuing Care List – This is your go-to list for finding patients who are overdue.  To make this task more streamlined, create yourself some custom lists so you can filter down your lists and it is easier to delegate.  CLICK HERE for more information on this report

o   Unscheduled List – Just like the Treatment Manager, you must work this list on a weekly basis and keep it current.  Don’t let your recare patients sit on this list forever. Follow up with them and delete them off the list if they are not returning your call.  For more information on this list, CLICK HERE

·        Financial Coordinator – You have a big job … collecting the money.  Your team depends on you for results.  If you are not collecting 100% on the day of service, then your accounts receivable needs attention.  There are two reports you must manage on a weekly basis.

o   Insurance Aging Report – This unfortunately is the only report in Dentrix that you have to print (keep sending in your Enhancement Requests for an interactive report).  Insurance companies should pay you within 30 days . . . period!  This will require you to follow up on unpaid claims.  For more information on this report, CLICK HERE

o   Collection Manager Report – Contrary to what you might hear, the Aging Report is NOT your best report for managing patient accounts receivable.  The Collection Manager is much more interactive and will give you more up to date results of your true A/R.  For more information on this report, CLICKHERE.

·        Clinical Team – There are definitely things in the clinical area that need attention on a weekly basis, such as ordering of supplies, stocking rooms, maintenance of equipment and managing your in-house lab.  However, you can definitely help with some of the reports I shared above.

o   Continuing Care – The hygienists can assist with calling patients who are past due if you have an opening in your schedule.

o   Referred TO Report – The dental assistants can help follow up on patients who have been referred to specialists, especially if it requires ordering parts or scheduling lab time.

o   Lab Case Manager – If you are using the Lab Case Manager, you could make sure cases are set to come in on time or use it to track lab fees.  For more information on the Lab Case Manager, CLICK HERE.

Read back on last week’s article and put it together with this one and I can almost guarantee your monthly reports will be right on target.  This is how you manage a practice … by having systems in place for your daily and weekly tasks then you can celebrate when you review your monthly reports. 

My next blog will focus on the monthly systems and my favorite reports in Dentrix.