How to Handle Partial Insurance Payments

Insurance companies are becoming more and more particular about the type of attachments and documentation they require to process a claim. For example, I was in an office recently that had submitted a claim for a crown with a periapical film. Typically, this type of x-ray would be adequate, but the insurance company sent an explanation of benefits back to the office stating that to process a claim for a crown, the office must submit both a periapical film and a bitewing x-ray.

These types of situation happen daily. Sometimes, when you send an insurance claim for a crown and a crown build-up, the insurance company may pay for the crown build-up, but not the actual crown until additional information has been received. If the insurance company is paying for one procedure now and waiting on additional information before it pays for the second procedure, you should post the payment for the crown build-up when it’s received and not hold the payment until all the procedures have been considered.

When this happens, you want to keep the crown procedure as an outstanding claim to the insurance for two reasons: 1) you can continue to track the outstanding insurance claim for the crown using the Insurance Aging Report in the Dentrix Office Manager, and 2) if you were to post the payment for the build-up and post a $0 payment to the crown, the patient’s ledger would reflect a larger patient portion of the balance than is actually due.

Dentrix has a solution for these types of situations. When you receive a partial payment for an insurance claim, split the primary claim to post payment to the paid procedures and leave the procedure that requires more information as an outstanding claim.

There are a couple of advantages to splitting the claim:

1. If you were to post the payment for the build-up procedure, but post to a $0 payment for the crown, the entire claim would then be closed. It will no longer appear on the Insurance Aging Report, so you lose the ability to track it and it could easily slip through the cracks. By splitting the claim, you are still able to track it.
2. Splitting the claim keeps the original narrative in the remarks for unusual services. You may need to refer to the narrative on the original claim if you have to appeal the claim, and by having a record of the original narrative you’ll know what you wrote and what information you may need to add if further action is required by the office. 
3. The original sent date will be accurate, and any claim status notes you made on the claim will remain with the claim. I wrote a blog post in August about the value of using insurance claim status notes. Once you’ve spent time tracking insurance claims and making notes, you would want to ensure those notes are saved.

To split a primary claim, open the patient’s Ledger. Click once on the claim you want to split so it is highlighted. Then select Insurance > Split Primary Claim.  Select the procedure(s) to be moved to the new claim, then click the down arrow to move it to a second claim.

Once the procedures are split into individual claims, you can post payments to the claims as you normally would.

The ability to split insurance claims is a feature that I find particularly useful that many offices aren’t aware of. Splitting claims helps to keep accurate claim tracking during times when insurance companies request additional information.  If you have questions on this or another topic, please e-mail me at vectordentalconsulting@gmail.com.

Charlotte Skaggs, Certified Dentrix Trainer

Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for almost 20 years and is a certified Dentrix trainer. Contact Charlotte at vectordentalconsulting@gmail.com.

Give Your Hygienists Tools for Success

Hygienists play an important role in a practice. They can be an asset as producers for the office. As office managers, if we can give the hygienists tools to be more efficient with the software, they could have more time to spend on patient care, explaining treatment, and ultimately creating more production for the practice.

During the patient’s appointment, there are certain tasks we expect a hygienist to perform. One important task is to chart the patient’s existing restorations and treatment plan procedures. Having a hygienist chart and treatment plan effectively can help the front office create a treatment plan to present to the patient. I think it can be helpful for the hygienist to chart and enter treatment in the operatory, that way the front office team has an opportunity to review the patient’s treatment plan before the patient comes up front.

Here are a couple of ways to help your hygienist chart and treatment plan more effectively.

1. Procedure Buttons
   Procedure buttons can save the team so much time when they’re charting. Think of these buttons as short-cuts. Instead of having to scroll through procedure categories to search for a specific procedure code while they have a patient in the chair, it’s much faster to select an icon from the procedure buttons list.
   
   
   As an office manager, you may be very familiar with the ADA codes and where to find them, but typically hygienists are not. Procedure buttons can help hygienists to select the correct code for the procedure. I’ve seen offices chart a crown code for the wrong type of material because the hygienist wasn’t familiar with the ADA codes. Creating procedure buttons can help to decrease these types of errors.
   
   In Dentrix you can create a customized set of procedure buttons that works for your office. Once you’ve created the customized buttons your office uses the most, they are accessible from any workstation in Dentrix, meaning the team can chart existing restorations or treatment plan procedures quickly.


2. Auto-State Button
   
   
   
   
   The Auto-State button in the Patient Chart provides a fast and convenient way to chart procedures. The hygienist can chart multiple procedures that will have the same status (treatment plan, existing, existing other) using less mouse clicks.
   
   To use the Auto-State button, choose the light switch icon in the Patient Chart and then choose the procedure status, for example, EO (existing other). Dentrix puts a box around the selected status. Once activated, all the procedures you chart will be assigned this status.
   Think of the Auto-State button like the Caps Lock button on your keyboard. Once you turn it on, all the letters you type are capitalized. Similarly, once the Auto-State button is turned on, all the procedures you chart will be assigned to the selected status.
   
   During Dentrix training I suggest to hygienists they use the Auto-State button. It’s especially beneficial for new patients. They can use the Auto-State to chart all the patient’s existing restorations, then switch to the treatment plan status when the doctor comes in to do the exam.


3. Probing Shortcuts
   Accurate probe depths are an important part of the patient’s record. Regular probing is important to catch signs of periodontal disease. Many offices have their hygienist probe patients once a year. Here are a couple of tips to share with your hygienist that can make the process of probing quicker.
• Many hygienists use the number pad on their keyboard to chart probe depths. They can also use the keyboard to chart, bleeding, suppuration, and bone loss. When the cursor is on the tooth and surface they want to chart bleeding for, they simply need to press B on the keyboard (and S for suppuration and L for bone loss). Using the keyboard saves the hygienist from having to switch from the keyboard to mouse, which saves time when periodontal charting.


4. Clinical Note Templates
   Using clinical note templates when writing notes is a huge time-saver. My favorite part about using templates is that they are completely customizable. They can be as detailed (or not) as you want them to be. Using clinical note templates ensures that all the clinical notes for a procedure are consistent throughout the office. That way you can be sure the clinical notes your doctor wants are included.
   
   For more information read this Dentrix Tip Tuesday post: Adding Clinical Notes using Templates and Prompts.

Hygienists are producers for the office. If we can give them ways to use Dentrix more efficiently and save them time, they can spend more time on patient care discussing procedures that can profitable for the office. If you have questions on this topic or others, please e-mail me at vectordentalconsulting@gmail.com.


Charlotte Skaggs, Certified Dentrix Trainer

Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for almost 20 years and is a certified Dentrix trainer. Contact Charlotte at vectordentalconsulting@gmail.com.

Questions To Ask When Scheduling an Emergency Appointment

Dental emergencies are always going to happen. How we handle scheduling those patients can dictate the entire day for the office.

For example, I visited an office recently where the doctor had four patients scheduled back to back for an emergency exam and X-ray. He only had 30 minutes scheduled for each of these emergency patients. One patient needed an extraction and two others needed a root canal. He didn’t have enough time to treat the patients within the 30-minute appointment and they had to be scheduled for another day. It was a stressful situation for the doctor, frustrating for the patients, and unproductive for the office.

I’ve found that if you ask certain questions when scheduling an emergency appointment, you can schedule an appropriate appointment length.

For example, if a patient has a broken crown, chances are they’ll need a new one. If you schedule enough time to do the new crown that day, the patient doesn’t have to come back for a separate appointment, and the office increases production.

Here are some of the questions you can ask a patient on the phone to better plan for their emergency visit. While I would never suggest trying to diagnose a patient over the phone, you can ask certain questions to give your clinical team more information and be better prepared.

1. What type of symptoms are they experiencing and are they in pain?
   I would always schedule a patient who’s in pain the day they called. But often when they call, they aren’t in pain, for example they may have chipped a tooth. If they’re not in pain, it’s not a true dental emergency. I may try to schedule the patient the next day or at a time that is more convenient for the office.


2. Is the pain constant? And is there sensitivity to hot or cold?
   These questions can help you determine if it may be an endodontic situation. If you refer out for root canals, it may be a good idea to find out what availability the endodontist has.


3. How long has the tooth been bothering them? Where is tooth located?These questions give the clinical team an opportunity to look at the patient’s chart and X-rays ahead of time to be better prepared.


4. If a crown came off, do they have the crown? Is the crown broken or intact?
   This helps to determine if it will be a re-cement or new crown and can help you gauge the amount of time to schedule.


5. How old is the crown?
   This gives the administrative team an opportunity to research the patient’s insurance replacement periods.


6. Did the tooth have a root canal?
   If an endodontically treated tooth is broken it may not be restorable. This may result in the patient needing to have the tooth extracted, so you can schedule the appointment length accordingly.

Asking these types of questions up front when the patient calls can be a little more time consuming, but it saves time and stress when the patient is in the office. I think it’s important to be as prepared as possible when treating patients. Getting more information from the patient helps the front office team and the clinical team provide the best treatment possible to the patient. Document the information you gather during the phone call in the Office Journal so that each member of your team can access the information when they need it. 

If you have questions about this or other topics, please email me at vectordentalconsulting@gmail.com.


Charlotte Skaggs, Certified Dentrix Trainer

Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for almost 20 years and is a certified Dentrix trainer. Contact Charlotte at vectordentalconsulting@gmail.com.

Scheduling Patients with Outstanding Treatment - Beat the End of Year Rush

Now that we’re headed into fall, it gets me thinking about all the things that need to be done at the office before towards the end of the year. There’s always a push at the end of the year for those patients who want to get treatment done that the doctor diagnosed months ago, and patients who want to use their outstanding insurance benefits before they renew in January.

This can be a very productive time for the office, but also a stressful one. You must find appointment times for all these patients. I recommend that you start scheduling those patients now. That way you can control the flow of your schedule. You can spread the patients out over the next few months, instead of trying to jam them all in December. December tends to be a shorter work month with the holidays and many patients will be out of town. It’s more beneficial for your practice to start scheduling these patients now, in the fall.

You can find all the patients with outstanding treatment in the Dentrix Treatment Manager. The Treatment Manager is available from both the Appointment Book and the Patient Chart.

The Treatment Manager allows you to generate a list of patients that have outstanding treatment plans through filter options.

I like to generate a list of patients that is filtered by procedure code range. This allows me to search for a specific procedure codes like a crown or bridge and get an idea of how many patients have those procedures treatment planned, but not scheduled. Another reason I would search for a crown or bridge is because those procedures take two appointments two weeks apart. Many insurance companies pay based on the seat date so it’s important to get both appointments completed before the insurance renews.

Another useful filter is a minimum treatment plan dollar amount which can help you find high production cases. High production cases will result in higher revenue for the practice, so I like to contact those patients first.

You could also use filters to view only patients whose insurance renews in January. These patients are going to be motivated to schedule an appointment before their insurance renews on January 1st.

Once you have set your filters and generated a list of patients, you can display the insurance benefits each patient has remaining, letting you know which patients might be more likely to schedule. 

The Show Columns option allow you to choose which type of information is displayed for each patient. For example, if you wanted to contact patients with treatment plans and outstanding insurance benefits, I would recommend viewing columns for: 

• Patient Name
• Last Treatment Plan Date - shows you the last date treatment was diagnosed.
• TP Total Amount - allows you to see the total amount, so you can contact the higher production treatments plans first.
• TP Dental Ins Estimate - shows you the estimated insurance portion of the treatment plan. You can use this to educate your patients. For example, I could explain to a patient that the estimated insurance portion for the treatment plan is $1000. If the patient doesn’t use that benefit before January 1st, they will lose these benefits.
• TP Patient Estimate - gives the patient portion of the treatment plan.
• Pri Dental Ins Benefits Rem - shows the amount of primary insurance maximum remaining.
• And if your office accepts secondary insurance benefits, you could also view Sec Dental Ins Benefits Rem as one of your columns.

Once you have the list of patients that fit the filtering criteria you’ve set, it’s nice to have all this information in front of you so you can answer any questions they have regarding their treatment plan when you contact the patient. The Treatment Manager also allows you to select a patient’s name on the list and go directly to other Dentrix modules like the Patient Chart, so you have easy access to their clinical notes if the patient asks you a clinical question. 

By starting this process now, using the Treatment Manager to filter patients who have outstanding treatment plans and whose insurance renews in January, you can contact patients and explain to them the advantages of using their insurance benefits before it renews.  By starting early, you have more control of your schedule, and can spread the production out over the next few months instead of trying to squeeze all the patients in December. If you have questions about the Treatment Manager please email me at vectordentalconsulting@gmail.com.


Charlotte Skaggs, Certified Dentrix Trainer

Charlotte Skaggs is the founder of Vector Dental Consulting LLC, a practice management firm focused on taking offices to the next level. Charlotte co-owned and managed a successful dental practice with her husband for 17 years. She has a unique approach to consulting based on the perspective of a practice owner. Charlotte has been using Dentrix for almost 20 years and is a certified Dentrix trainer. Contact Charlotte at vectordentalconsulting@gmail.com.