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!

Dayna Johnson, Certified Dentrix Trainer

Dayna loves her work. She has over 25 years of experience in the dental industry, and she’s passionate about building efficient, consistent, and secure practice management systems. Dayna knows that your entire day revolves around your practice management software—the better you learn to use it, the more productive and stress-free your office will be. In 2016, Dayna founded Novonee ™, The Premier Dentrix Community, to help cultivate Dentrix super-users all over the country. Learn more from Dayna at www.novonee.com and contact Dayna at dayna@novonee.com.