Tuesday, October 31, 2017

Why are you not running Month End?

Why are you not running the month end process? Is it because you might need to edit something on the ledger or change a clinical note? These are not good reasons to hold out on running your month end process. Now I realize some of you might not agree with me. However, I think most accountants and attorneys would agree that this is not best practices.

Running the month end is so important and critical to having accurate numbers and legal documentation. I was recently teaching a class and one of the audience members refuses to run month end because she wants the ability to edit the ledger. If I was a business owner, this would send up huge red flags for me.

The month end process tackles five key things that help your system run better and more secure…
  1. It locks up your patient ledger into history, so you cannot make edits to charges, payments or adjustments. You can still edit an open claim if needed. If you need to delete a claim and resend the charges to a different insurance plan, you can still do that as long as the claim is still open and no payments have been made to it.
  2. It locks up your clinical notes into history, so you cannot edit the note or delete it. If you need to edit a clinical note or it was accidentally posted to the wrong patient, you can make an addendum. This process is the legal and more responsible way to handle your clinical documentation.
  3. The month end process will reset the insurance benefits used back to zero if the insurance plan renews that month. This will help your team give more accurate treatment plan estimates.
  4. During month end, the ending balance from the previous month will be moved into the beginning balance of the new month. This will ensure that your accounts receivable balances are more accurate on reports like the Practice Analysis, Analysis Summary and the Provider A/R report.
  5. Your patient balances are moved from one aging category to the next during the month end process.  If you never run month end, then your account balances will always stay current.

Be responsible and put the month end process at the top of your priority list each month. There are new updates coming with the month end process so keep your eye out for a blog on that coming soon.

Friday, October 27, 2017

Create different fees for the single PA vs. your PA in a series

Insurance companies are really starting to crack down on how they pay for routine diagnostic X-rays and even going as far as launching audits on dental practices that they feel are “over taking” these X-rays, a critical piece to taking care of our patients. One thing I am hearing a lot is the routine series of 4 bitewings and PA’s being downgraded or even denied based on the FMX or Pano fee. What this means is that the insurance company sees the fee you are submitting for the routine series is higher than the fee for the FMX or Pano. Let me give you a tip to help fix this.

If you are using fee schedules in Dentrix and you are posting the normal D0220 and D0230 along with the D0274 codes, your patient ledger might look okay. However, remember if you are, then using the DX2012F claim format to send out full fee on your claim form the total combined fee could exceed your contracted fee and the insurance company will deny it. If you are not using fee schedules, then you might be overriding the fee on the ledger to reduce the fees for the PA’s before you create a claim which is creating a lot more work for you and your team.

What if you just created new procedure codes for your series PA’s instead of using the ADA-issued codes? Yes, it can be done. Back in 2013, I posted up a blog that talked about this same issue when you want to attach a tooth number to the PA and sometimes not. The same concept applies here. You can create two new codes so you can have different fees attached to each one. Then you could even create a multi-code for your routine X-ray series add it to the initial box so you are always pulling the right fees into your hygiene visits.

Go to the Office Manager > Maintenance > Procedure Code Setup > click New, then fill in the blanks:
  • Description – This will show on the insurance claim and the patient billing statement
  • ADA code – My recommendation would be D0220. and D0230. Notice that I put a period at the end of the code because the insurance claim will on take four characters, so it will drop the period off the claim form.
  • Abbv Description – This will show in the appointment
  • Treatment Area – Select Mouth so the code will not ask for a tooth number
  • Fee – Create a fee so your series will not exceed your FMX or Pano fee

Now with the five characters, you will not be able to add this code to your Initial Reason box inside of the appointment. Therefore, you have the option of creating a multi-code for your entire series and adding the multi-code to the Initial Reason box. Remember that all multi-codes need to have at least one time unit so if you add or subtract this multi-code to your appointment, you may need to adjust the time of the appointment.

If you want to re-read my blog from 2013 on this similar topic CLICK HERE to be directed. I hope this tip helps you bill out X-rays more accurately and avoid unnecessary denials to your diagnostic X-ray series.

Tuesday, October 10, 2017

More tips for getting your claims paid faster

Last week, I attended the annual Dentrix Train the Trainer conference. At this conference, I get to be the student and learn about all the new features being release in the next year. Over the next few months, you will be reading about some of the amazing updates coming out with eServices, Dentrix Pay and your Dentrix software.

Today, I want to give you some things I learned about the current eClaims service and how you can increase the success of your claims getting paid faster.
  • Always batch your claims and send out in a group. What I learned at the conference is that if you send claims in real time or what might be called a “one off” claim, there is a greater chance of getting a duplicate claim.
    • You can turn off the option of sending claims in real time so it will stop asking you every time you create a claim on the ledger. Go to the Ledger > File > Direct Processing Options and uncheck the “Display Real Time Payor Notice”. The is very common with Metlife claims.
    • When you batch your claims, you will get one set of eClaims reports instead of a set of reports with every real time claim. This will save on the amount of reports that display on your Batch Processor. This is more of an annoyance than a tip for quicker payment.
  • If you are not sure of the Payor ID, the Payor Search tool on the Dentrix website is more up-to-date than the Payor ID list in the Insurance Info window. Remember that the Payor ID is the electronic address and, if you have the wrong Payor ID listed, it will slow down the payment of your claim. CLICK HERE to be directed to the Payor Search Tool on the Dentrix website.
  • You should NEVER have to resend a claim if you have a DC#. What is a DC#? It is the Document Control Number or the confirmation number that the insurance company has received your claim. With this number, you can always find your claim and hold the insurance company accountable to find it. For more info on this tip, CLICK HERE to read more about the reports and confirmation numbers.

If your office sends a lot of claims every day, I would recommend sending a batch of claims at lunch and then sending a batch of claims at the end of the day. This will break up the process and give you a smaller list of claims to go through each day. My recommendation is that claims get sent out within 24 hours of date of service.