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Dealing with crazy insurance limitations

Insurance plans are driving us crazy! The benefit coverage creations that some of these plans are coming up with are just ridiculous. Because of that, you have to figure out how to enter it into the computer system so you can give your patients the most accurate treatment plan estimate possible. Some plans will cover only gold crowns on molar teeth while others won’t pay for gold crowns at all. I was in a pediatric office recently and one thing they struggle with on a regular basis is the sealant coverage because it is different and all over the board.

With these tips today, hopefully you can customize your treatment plan estimates for a patient and use your Dentrix software in a more efficient way.

First, let’s look at when an insurance plan will pay for a procedure on one tooth but not another because of plan limitations or patient frequency limitations. There is a way you can override the insurance plan coverage table and payment table directly. When you are in the patient chart or the treatment planner, double click on the procedure code and it will open up the edit window. As a note, this is also where you could put a procedure note or refer it out to a specialist.


In the upper right section of this window, you will see an Override Dental Insurance Benefits. You can put a check mark in the Prim Ins and then the insurance coverage. If they have secondary, you can do the same thing. This technique also works well if you are estimating over two benefit years or if the crown is paid on the seat date or if there is a missing tooth clause.



The next tip is if a procedure is not covered at all on this plan and would apply to any tooth number or any patient on this plan. The best way to handle these types of situations is by using the Payment Table. The Payment Table overrides the Coverage Table and is great for things like posterior composite downgrades, nightguard coverage, grafting, etc.



This type of data would apply to any patient that is on this plan and is not patient specific. Remember that the Payment Table will override the Coverage Table.

For more articles on insurance and estimating, click on the titles below . . .

Insurance Co-Pay Plan setup
Insurance Estimates, make it as accurate as possible


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Don't get caught with outdated treatment plan fees

With today’s ever-changing dental insurance industry, employers are moving benefits from one company to another all the time. As you may know from my previous blog posts, I am a huge fan of using fee schedules in Dentrix to help your team provide accurate treatment plan estimates, collect better at the time of service and send out billing statements in real time. If you are using fee schedules and your practice is contracted with several reduced fee dental plans, you will want to have a plan in place to making sure your patients’ treatment plan fees are as accurate as possible.

We all know that patients sometimes drag their feet about accepting treatment and go out and purchase that Coach handbag instead . . . because they had to have it! So when you are following up on the unscheduled treatment or the patient is coming in again for his or her 6-month recare visit, I would recommend updating the treatment plan fees so that you are always quoting the most up-to-date fees.


It is super simple and worth the two clicks it takes to do it. My new rule of thumb is that if the procedures were not treatment planned today, then update it. The quickest way to do it is from the appointment book (since you probably already have that open anyway). Single click on the patient appointment and click on the Treatment Planner icon or right click on the appointment and select Treatment Planner. Then click on the Update Fees icon and click on Update. That’s it.


Now you can move ahead with printing, signing, presenting, scanning and saving the patient treatment plan as you normally would and knowing you have prepared the most up-to-date treatment plan possible.

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Credit Card option for Insurance payments just added in Dentrix G6.4 release

If you haven’t heard already, Dentrix G6.4 was recently released and there are few new features that are worth bragging about. I upgraded my system a couple of weeks ago and checked out the new features in my demo database. I love how Dentrix is staying relevant to the changing industry and giving the team features that they are asking for.

There have been many improvements to the functionality of the Ledger. When you are dealing with money, insurance and A/R, it is always important to have the most efficient and user-friendly systems as possible. Here are the new highlights to the Ledger . . .
  1. You can now select Credit Card as a payment method for insurance payments. When you are applying an insurance payment to a claim, there is now a credit card option in the drop-down menu for payment type. Now, even though I recommend to all my offices to opt-out of credit card payments from insurance companies because you end up paying a 2.5 – 4% merchant fee which ultimately reduces your collections, Dentrix needed to add this feature to keep up with the ever-changing dental insurance landscape. I applaud them with this new feature. It will definitely help the practice balance the day sheet and keep the accounting straight.  Thank you Brad!
  2. There is a new Payment Agreement Manager and it is located on the Ledger not the Office Manager. For the dental practice that takes a lot of payments and wants a report to only show the payment agreements in the practice, this could be helpful. If your practice is going to allow for payments, you need a way to track them. My favorite report continues to be the Collection Manager Report for managing all accounts receivable, including Payment Agreements, so I will be on the lookout for feedback on how this new report is working in the office.
  3. The Payment Agreement Setup has also been updated so check that out as well. In my practice, we did about 25-30% of our practice production in ortho so we had many patients on Payment Agreements for their monthly ortho payment. This worked well. I created a special instruction sheet specifically on the ortho setup in Dentrix and if you would like a copy of it, please email me directly.


There are also many fixes from previous releases and little tweaks to features that had been released previously. For the complete rundown, there is a Dentrix 6.4 release guide that I can send you or you can find it in the Dentrix Resource Center.

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Welcome to 2017 . . . update fees and keeping your reports accurate

It’s a new year! Welcome to 2017! It’s time to think about new insurance benefits, fee schedule updates and making sure that all your reports are up to date. There is a lot going on at the beginning of the year that we need to plan for and make sure your practice is running like a well-oiled machine.

First, let’s tackle the new insurance benefits. Now, not all insurance benefits renew in January but most still do and it is important to keep your insurance as accurate as possible so you can keep your accounts receivable in check. The insurance benefits used is updated and reset back to zero at the time you run the month end process.

It might be time to do a fee increase in your practice or maybe one of your contracted PPO plans has sent you an updated fee schedule (wishful thinking I know) that you need to update. If this is the case, then go to the Office Manager > Maintenance > Reference > Fee Schedule Maintenance. Now you can select the fee schedule you want to update and choose the appropriate process you want to complete. If you are going to update your office fees by a set percentage, then highlight the fee schedule name and click on auto updates and enter the details. If you have a PPO fee schedule plan that you need to update certain procedure codes, then highlight the fee schedule and click on View/Update. Then edit the procedure codes one at a time.

Now, the last thing I want to really hit home is how important it is to run your December month end so that your management reports are as accurate as possible. The month end routine will move your ending balance from the previous month into the beginning balance of the new month, so if you need to know what your A/R is at the end of December for accounting purposes this is extremely important. The easiest way to check your accounts receivable is to look at the Practice Analysis from the Office Manager > Analysis > Practice and then looking at the YTD ending balance. This ending balance will not be accurate if you have not performed month end.


Looking for an amazing year! Thank you for being a loyal reader of my blog.

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New Associate? Get the setup right from the start

Do you have a new associate in your practice and not quite sure how to make sure the provider settings are correct? Let me help.


There are a couple of settings that you need to make sure are correct to avoid any delayed claims, rejected claims and provider payment allocation. Depending on if your new associate is paid on production or collection will determine how you should setup your default payment allocation. Also, it is important to know how Dentrix looks at the provider with some of the management reports.

  • The first thing you will set up is the provider ID in the Practice Resource Setup. This is where you will enter the NPI, Tax ID, DEA and provider license number. The doctor’s personal (Type I NPI) number will go here and the office tax ID number.
  • After you have the provider setup finished, then double check that the claim is set up the way you want it. The claim setup in located in the Practice Defaults, go to the Office Manager > Maintenance > Practice Setup > Practice Defaults. This is where you want to double check that the Billing/Pay To Provider and the Rendering/Treating Provider is set up the way you want it. The information here makes up the bottom two boxes on your insurance claim form and the insurance companies use this information to know who to send the check to and if the rendering provider is a contracted provider.
  • Depending on how your associate is being paid may prompt you to double check your default payment allocation setup. Go to the Office Manager > Maintenance > Practice Setup > Preferences and look in the upper left corner of this window to see how it is set up now. There are four choices and you can read a blog I wrote recently about these options by CLICKING HERE. If your new associate is being paid on collections, this is going to be extremely important.

The above list are the critical things to makes sure the billing and claim form is set up correctly for your doctors.

You will also need to setup your new provider with the appointment days, hours and a special color for the appointment book.  You can read more about how to set up the appointment for your new doctor by CLICKING HERE.

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Insurance Co-Pay plan setup

I had a question the other day from an office who had a patient with a new type of insurance plan that she did not know how to setup in Dentrix. Over the last year or so, I have been seeing a lot of new and interesting dental plans popping up around the country. The plans I am seeing the most are patient co-pay plans so I wanted to take a moment to help you with the setup. 

Most of us are used to the traditional plans that pay 100% on Preventative, 80% Basic and 50% for major dental treatment. These traditional plans are being replaced with unconventional, harder to manage dental plans. With a co-pay plan, the patient will pay a fixed dollar amount toward certain procedures and then the insurance plan will pick up the difference. Once you get it set up, the computer will take over and calculate the patient’s out of pocket on the ledger and treatment plan estimates. 

From the Insurance window on the patient family file, click on Insurance Data and enter in all the insurance demographic information and attach the correct fee schedule if it applies. If you want more info on using fee schedules, CLICK HERE. Then click into the Coverage Table section and this is where most of the setup will happen. 



First, select a different coverage table so it will show all the procedures instead of the categories. Next, highlight the procedure code where there is a co-pay applied, enter the amount in the co-pay box and click on Add. Do this for every procedure where there is a patient co-pay and also make sure that the coverage percentage is 100% (it will default to 100% but it doesn’t hurt to double check). The final step is to select the co-pay calculation method. In my example, I have selected the (total fee – co-pay) x cov% because this is the most common.

Now, if this co-pay plan has procedures that are not covered, you can either change the coverage % for that procedure code to 0% or enter the procedure in the Payment Table. Remember that the Payment Table overrides the Coverage Table so it would also be good to check to make sure the Payment Table doesn’t have anything in it that might throw off your estimates.


I hope this helps. Let me know if I can assist with any other odd insurance plan setup. I am happy to help.

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Medical Billing or Bust - what you need to know now

I had the pleasure of speaking last week at the annual American Association of Dental Office Managers (AADOM) meeting in Boca Rotan, Fla. My topic, Medical Billing or Bust, is a passion of mine and anytime I have the opportunity to spread the word about how you can change the world and change the lives of your patients is important to me. Keep your eyes open for registration to The Business of Dentistry Conference coming up in August 2017 where I will be teaching the Medical Billing or Bust to Dentrix users.

There are several things I can bring you up to speed now in this article that will help you understand how to set it up in your Dentrix software. Medical billing is not only about trying to maximize your patients’ benefits that they might not have access to, but it is also about providing the necessary coding for other organizations to use for growing awareness about disease patterns. With this being said, you can use medical coding on both the ADA claim form and the HCFA medical claim form.

Here are a few things to know now . . .
  • You will need to upgrade your Dentrix software to G6.1 in order to using medical coding on any claim form and send out a claim. This upgrade was released on October 1, 2015 so it has been out for almost a year.
  • When you upgrade to Dentrix G6.1, the software will include the most common ICD-10 codes for a dental office. This will save you a ton of time with having to input these codes. If there are some codes not included that you need, you can manually enter them into your system.
  • Make sure the HCFA claim form is added into the Definitions because you will need to attach it to the insurance plan information. There are several medical claim forms available. If you need a different format than the HCFA, you can search the Dentrix Knowledge base for the article that lists all the medical claim forms available so you can add the one you need into the Definitions.
  • When you upgrade to Dentrix G6.1 and you have not done any medical billing yet, you will need to add in all your CPT codes, Modifiers, Place or Service codes and Type of Service codes. If you need resources for these codes, please email me directly and I can send you a resource page at dayna@raedentalmanagement.com


For more information on medical billing, please read these past articles . . .

Medical Billing - the new shiny toy
Jump Start Your Medical Billing




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Checking insurance benefits will suck the life out of you unless you change your system

Dental insurance benefits are the thorn in our side every day. Checking benefits, eligibility and maximums for our patients is a great benefit … and it also sucks the life out of us to the point where we don’t have time for other things during
the day. There needs to be a balance between it being a customer service task and a hand-holding task. The insurance benefits belong to the patient. They do not belong to the practice and we need to put the verbal skills in place to help our patients understand this.

One thing I have been doing with my practices is teaching them to transfer that ownership back to the patient in a way that is beneficial to the patient and not too time-consuming for the practice. The easiest, most efficient way I have found is using the eCentral Insurance Eligibility feature inside of your Dentrix software. Have you seen the “E” all over inside of your Dentrix software and wondered what it does? CLICK HERE to learn how eCentral Insurance Manager works.  Let me share with you some of my tips in using this amazing tool.

What has worked really well for many offices is to print a copy of the electronic benefits for the patient and then send a copy to the patient’s Document Center for your reference. Now, how you hand off the information to the patient makes a big impact on how much you will be babysitting in the future. So here are some of my best tips . . .
  • When you print out the eligibility benefits from eCentral for the patient, I would highlight a few key pieces of information (insurance company phone number, maximum and coverage percentages).
  • Hand the patient the printed copy of his or her benefits and say something like, “I took the liberty of checking on your dental benefits for you and here is what we received from your plan. Notice I have highlighted some of the important things about your plan. One thing I want to point out is that if there is a procedure you need that is not on this print out, then we don’t know how much your insurance company will pay so we estimate zero.”
  • Let patients know if they would like more details about their plan, you highlighted the insurance company’s phone number for them.


Using eCentral Insurance Eligibility not only as a tool for your practice efficiency but also using it as a resource for your patient will help you to strengthen your relationships with your patients and they will trust you more. Trust will help build your practice and grow your referrals.

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Do your patients have new insurance benefits for 2016? Help them navigate it and build their trust.


I don’t know about you, but my insurance benefits changed this year … and if I was a patient in your practice, I sure could use a little help figuring it all out. This time of year, many of your patients will be walking in with new benefits. Sometimes they have a card from the insurance company … and sometimes they don’t. Now I am not asking you to take on the role of benefit coordinator for your patients, but many of your patients will need a little guidance. This is one area where you can exceed the level of customer service between your office and the office down the street.

In many cases, I don’t believe your patients want you to manage the benefits for them. They just need a little information so they know the right place to go and who to contact if they have questions. With many of the electronic services available to the dental practice, you can access benefit information much quicker than the patient can and you are much more knowledgeable on what to look for than the average dental patient.

I believe having a conversation with your patients and helping them navigate their plan is a great way to build trust and loyalty with your patients rather than building a wall between you and your patient. When I was working in practice, there were many times the insurance company would say things to our patients that simply weren’t true. If you can provide your patients with information before the insurance agents get to them, you are much better off being pro-active than re-active.

Many patients believe that if your office is “Out of Network,” they cannot be patients at your office. However, in many situations, this is simply not the case. Letting patients know that you can work with their plan (even if it is an out of network plan) might be the difference between them scheduling with you or calling someone else.

I realize that checking benefits can be time-consuming so try and use the online resources available to you. Many insurance carriers have online portals that you can log into and check patient benefits. I would recommend printing a copy of the benefit summary for your patients and letting them know that this is the information you receive from their insurance plan and is what you will use to estimate their out of pocket expenses. Giving the patient a printout of exactly what you see is a great way to not only inform your patients, but also build trust with him or her.

Another way you can check benefits directly from your Dentrix software is to use the Insurance Eligibility through eCentral. This feature is in real time and often provides quicker access to a more comprehensive benefit breakdown. The benefit breakdown you receive from eCentral Insurance Eligibility can also be printed for the patient and also sent to the Dentrix Document Center for future reference. I used this feature in my office and it saved me a ton of time being on the phone and logging into multiple insurance company portals throughout the day. CLICK HERE if you want more information about eCentral Insurance Eligibility.

I am looking forward to an amazing 2016 and I hope you are as well.

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Top 10 features in Dentrix you are not using


In 2003, my dental practice converted from an archaic DOS-based dental software to the impressive and robust Dentrix practice management software. To say the least, I was completely overwhelmed. Two years later, in 2005, I still felt like I hadn’t even scratched the surface of my new powerful software’s potential so I applied to become a Certified Dentrix Trainer in order to learn everything there was to know about the Dentrix program. What better way to learn than to get a certificate?

Now I know that not everyone has the opportunity to become a Dentrix trainer like I did, but with a little self-motivation and some tips from me, you will be well on your way to being a “Dentrix super user.” Since I am working with dental practices every day, I have the unique opportunity to see what features they are using, what features they are not using, and what features they have no idea even exist. My goal today is to give you my top 10 you might not even know exist.
  1. Quick Letters and Letter Merge – Maybe this sounds familiar . . . you have a folder on your desktop with all of your office’s letters you send out to patients, including collection letters, welcome letters, and letters to specialists. When it is time to send a letter, you edit the date, enter the patient’s name, address, and salutation, then sign the letter and scan it into the document center. That process sounds like a lot of work to me. Why not add your custom letters into the Quick Letters or Letter Merge with the proper merge fields and let Dentrix do all the work for you? The best part is it will automatically put a note on the Office Journal and you can “Send to the Dentrix Document Center” without scanning (see #5 on the list).  Here are some more blog posts related to this feature . . .
    1. Send letters that make an impact . . . CLICK HERE
    2. Can you write me an excuse note . . . CLICK HERE
  2. Dentrix Mobile – Have you ever been sitting in the comfort of your home watching the weather forecast and hoping that the power doesn’t go out … then suddenly there’s nothing but darkness. You check the office and the power is also out there … so how are you going to let your patients know not to come in? Has your doctor ever been out of town and received a call from a patient requesting a drug refill but he or she has no way of checking the last prescription or the patient’s last visit unless he or she goes into the office? Both of these two common scenarios can be solved just by registering for Dentrix Mobile. It’s included in your Dentrix customer support plan so there is absolutely no excuse for not using this service.
    1. Three reasons you should be using Dentrix Mobile . . . CLICK HERE
    2. A lifeline to your patient info . . . CLICK HERE
  3. Payment Agreements – I wrote an article called “Get it out of your head and into the computer” back in April 2014. The theme of the article was speaking to office managers who store all their verbal payment agreements in their head. What I am seeing is this is still happening, but I am also seeing new doctors purchasing practices with a significant amount of the accounts receivable over 90 days past due or new office managers taking over a practice where there has been no management of the accounts receivable. Using the Payment Agreement feature in Dentrix will not only help you get organized with patients who are making payments, but also allow the entire team to see on the ledger what the arrangement is with the account.
    1. Two options to help you manage your A/R . . . CLICK HERE
    2. Get the info out of your head and into the computer . . . CLICK HERE
  4. Tracking Gratuities and Referrals - Do you know where your new patients are coming from? Are they hearing about you from friends, Google Search, or the ValPak flyer that cost you $15,000 to send out? Your marketing dollars depend on where patients are being referred from so you should know where to continue spending money and where to stop. When a patient refers a new patient, do you give him or her a thank you gift? Would you like to track if you gave the referral source a Starbucks or Home Depot gift card last time or be able to track a referral source’s gratuity history? Tracking referrals and gratuities in Dentrix is super easy and gives the doctor a lot of good information about where to spend marketing dollars … but I find most offices never use this useful tool.
    1. Building relationships one referral at a time . . . CLICK HERE
    2. Keep tight reins on your referred patients . . . CLICK HERE
  5. Sending to the Dentrix Document Center – This will save your team a ton of time in unnecessary scanning, unnecessary wasted paper, and unnecessary hard drive storage space. When you scan a document into the Document Center, it takes many more steps and the file size of a scanned document is about 100 times larger (just a guess) than that of a file send electronically through the Dentrix Document Center printer driver. Anything you want to print can be virtually printed to the Document Center for file storage. This is such an amazing yet underused feature.
    1. A little known secret . . . CLICK HERE
  6. Perfect Day Scheduling – Close your eyes for a moment and imagine if you could see your patients on time, complete 80% of your production goal before lunch, get out for lunch on time, and finish your day without pulling the roller skates out of the closet. This can be a reality if you create it. Take control of your appointment book with Perfect Day Scheduling. When you use perfect day scheduling, your team knows exactly how to schedule because you have mapped it out for them. There is no room for error.
    1. What if everyday could be a perfect day . . . CLICK HERE
    2. The new patient experience, scheduling the appointment . . . CLICK HERE
  7. Goal Tracking – Every dental practice has production and collection goals they need to meet in order to keep the financial state of the business healthy. I always encourage doctors to share these goals with the team and be transparent with the key performance numbers with the team. There are several places in Dentrix to watch and monitor your practice goals so the team can strategize and work together on exceeding the goals. You can monitor your goals on the monthly calendar, Practice Advisor Report, and the Daily Huddle.
    1. Let's do some goal setting . . . CLICK HERE
    2. Looking ahead to  . . . CLICK HERE
  8. More Information Button – Have you ever been on the phone with a mom and she wants to know when her three kids and husband are scheduled next for all their future appointments … but you’re not sure what’s the most efficient way to find all these appointments for the entire family? Try the More Information button and I can guarantee you will fall in love with this super quick search tool. You can find the More Information feature on all Dentrix modules. When you are selecting a patient anywhere in Dentrix, you will see it at the lower left corner of the window.
  9. Create Batch of Primary Dental Claims – Are you sure you have batched and sent off all your insurance claims from last week? How about last month? Use this second pair of eyes to double check and make sure all your claims have been sent out. Not only will this give you peace of mind, but also keep your accounts receivable out of the 90-day past due column.
    1. Are all your insurance claims going out . . . CLICK HERE
  10. Patient-Friendly Descriptions – Do your patients often ask what a “resin 2surf, post” or a “Crown-porc fused noble metal” is? Or is your practice in an area where English is not the primary language for many of your patients? If you would like to create a treatment plan that your patients would more easily understand and helps them understand what each procedure is, then start using patient-friendly descriptions. With Dentrix G6.1, it is even easier to use because you can edit these descriptions in the procedure code edit.
    1. No speak English, no worries . . . CLICK HERE

Have fun experimenting with these features and working toward increasing your level of efficiency and customer service. Drop me a line at dayna@raedentalmanagement.comif you have other questions. I’m happy to help.

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Unused insurance benefits . . . it's now more than a once a year project


Since I have been writing the Dentrix Office Manager blog, I have posted up an article about this time of year reminding you to reach out to patients who have unscheduled treatment withremaining insurance benefits. This year is no different. However, I think that it might be a project you might want to tackle a couple of times each year depending on when the big employer groups start their benefit year. When I was working in my practice in Washington state, we had several groups that renewed at other times than January. Boeing, for example, renews in July and the school districts renew in October. 

If you decide to generate this lists of patients, you can filter the list by benefit renewal month. To generate the report, go to the Appointment Book > Treatment Manager > select the filters you want, including the benefit renewal month.

 


Since I have written on this topic every year, I am going to point you back to the articles so you don’t have to do a search.

               CLICKHERE to read “Don’t let unused insurance benefits go to waste.”

               CLICKHERE to read “Unscheduled treatment . . . the urgency is now.”

               CLICKHERE to read “Send letters that make an impact”

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How can you prepare for the ICD-10 deadline?


The countdown to October 1, 2015 continues as we all wait to see if the implementation of ICD-10 really happens or not. Many of you have been using the ICD-9 code sets when billing medical insurance for procedures like TMJ, sleep apnea, and trauma. However, we are now seeing the use of diagnostic coding in the adoption of EHR and practices that are billing Medicaid. After October 1, we are going to see many more requirements for diagnostic coding. So how can you prepare?
  • Find out if your practice management software will be ready for ICD-10 by October 1. This is critical if you have already been including diagnostic codes on your claims because the insurance providers will start denying claims without ICD-10 after October 1. I reached out to the Dentrix product manager and Dentrix G6.1 will be ready for ICD-10 … but you will still be responsible for adding the codes into the system.
  • Make sure you are using the ADA 2012 claim form because it has been upgraded to accommodate diagnostic coding. Within Dentrix, you can use the DX2012 or the DX2012F claim form to add diagnostic codes. Email me directly at dayna@raedentalmanagement.comif you would like an instructional PDF from the ADA on how to fill out the claim form.
  • Check your state Medicaid requirements to find out what diagnostic codes will be required. If you are already billing Medicaid, you are already familiar with the ICD-9 coding and hopefully you have already been informed about the looming October 1 deadline. Email me directly if you need more information about Medicaid requirements.
  • Start asking the insurance payers if they will pay for additional services if you are submitting the proper diagnosis codes. Many dental plans are now paying for additional preventative cleanings because of the direct relationship between periodontal disease and diabetes and heart disease.

As I get more information about his topic, I will keep you informed as much as possible. However, you can do your own research by clicking on the links below. Also, email me if you would like any of the information I discussed in this blog.

CLICK HERE for ICD and CDT Coding Examples, you must be an ADA member to use this service.

CLICK HERE for free reference tools on the ICD-10 codes

CLICK HERE for the definition and final release from the CDC

 

 

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Why now is the perfect time to examine your fees


My good friend (and insurance editor for Dental Products Report) Teresa Duncan recently wrote an article about how now is the perfect time to reevaluate your office fees. Teresa says that many practices wait until the end of the year, but if your practice is anything like the norm, the end of the year gets pretty busy. CLICK HERE to read Teresa’s article on fee updates. My blog today wants to piggyback on Teresa’s article and show you how to implement this task in your Dentrix software.

The process of updating your fees is a pretty simple task that can be accomplished with a couple of clicks. Go to the Office Manager > Maintenance > Practice Setup > Fee Schedule Setup (if you are on earlier versions of Dentrix, it might say Auto Fee Schedule Changes). You will get a window that looks like this. If you want to update your fees using a percentage or a dollar amount, click on the Auto Changes button and your fees will automatically be increased by the amount you set, then you will have an opportunity to look at each procedure code individually and then click OK to accept the changes.

If you want to take a more complex approach and change each procedure fee individually or if you want to copy one fee schedule to another, you can click on the View/Edit button and open a window that will allow you to update fees one by one or copy fees from another fee schedule. If you are updating a PPO fee schedule from a list provided to you by the insurance company, this is probably the method of choice for you.

Once you have updated your fee schedule, remember that any existing treatment plans still contain the old fees. With a new feature in Dentrix G5.2, you have a new feature where you can update all your treatment plan fees with the click of a button. Going back to my first image above, you will notice there is a Treatment Plan button. If you click on this, you can update all the fees in the existing treatment plans from here. If you have not upgraded to Dentrix G5.2, you can still update your treatment plan fees by opening the Treatment Planner.

Here are some other articles I have written on this topic if you want to continue reading about fees.
Fee schedules . . . the perfect choice for PPO plans
Fee schedules or write offs . . . . that is the question
 

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Business of Dentistry . . . why it's my favorite conference of the year

It’s that time of year. It’s time to get your doctor and your team registered for the Business of Dentistry Conference. As you have heard me talk about before, I have never missed a conference and I am going to give you 5 reasons you and your team should not miss it either. This year's conference is being held Oct 7th - 10th in sunny Florida.

 
  1. You will be repeating the words “I didn’t know Dentrix could do that! I can’t believe how we are under-utilizing our practice management software.” Even if you have been using Dentrix for over 10 years, I can guarantee you will learn things that you didn’t know existed. Last year, I taught the advanced Billing and Collections class and my class was filled with doctors excited to learn how the software could help their practices meet production goals. It was eye-opening.
  2. There is something to learn for every member of your team. Especially the dentist!  This year the Business of Dentistry is offering more clinical technique and technology courses than ever before.   The Dentrix courses have a skill level from entry level to advanced so the attendees can choose the level that best fits their knowledge of the software. This conference attracts some of the most sought-after consultants and they tailor their presentations to fit into the Dentrix agenda so you not only get amazing practice management educational material but you also get tips on how to implement it into your practice management software.  Check out the course listing by CLICKING HERE.
  3. Don’t miss the Learning Lab. This is my favorite part of the Business of Dentistry Conference. This is where you get to bring your questions and sit down with a knowledgeable support tech and get one-on-one help. If you are having issues with Dentrix, eServices, Easy Dental, or Enterprise, bring it to the Learning Lab. Here’s a tip: Take screen shots and print them out so you can show the team your issue (make sure you black out any patient information).
  4. Learn about third-party software that integrates with your Dentrix software. The vendors pour out into the hallways just waiting to tell you how their product, along with your Dentrix software, can help your practice more profitable, secure, or productive. Since Dentrix G5 opened up the Marketplace, there are many third-party companies that enhance your software in so many ways. I will have a booth at this year's conference so come by say Hi and check out what I have to offer you and your team. 
  5. Finally . . . have some fun and enjoy spending time with your team! This year’s conference is being held at the amazing Gaylord Palms Resort and Convention Center in sunny Kissimmee, Florida.  Henry Schein always brings the fun to this conference. I can remember bowling parties and dance parties that were off the charts. I can’t wait to see what this year has to offer.

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Stop giving the insurance companies so much power


Will whoever gave the insurance companies the power to do whatever they want please stand? Oh yeah … we did. We have given and continue to give them power when we don’t have proper documentation to justify our treatment plan or confirmation showing that our claims have been received. If we don’t manage our systems properly, we have to do what they tell us to do because we can’t prove anything.
The easiest way to have some leverage with your insurance companies when it comes to claims processing is to use Dentrix eClaims. The claims reports and support you get will give you a leg up when you have to follow up on an unpaid claim. When you use Dentrix eClaims, you receive a lot of reports. When I am training out in the field, I ask the team, “What do you do with these reports?” The most common answer is “Nothing” or “I don’t know”. These reports give you the information you need to be in charge of your claims and attachments, but you need to know what to look for.
The two most important eTrans reports for you to look for are the Payer/Clearinghouse Report and the Attachment Status Report.

Payer/Clearinghouse Report – You will receive this report about 24-48 hours after a claim is sent out and it contains some very important information. This report will give you the INSURANCE REFERENCE NUMBER also called a DC#. The DC# you are looking for is one that has the source as the insurance carrier. This is the only number the insurance company will be able to use to track your claim. My recommendation would be to copy this DC# into the claim status note so you have it readily available if you need it, then you can shred the rest of this report.

Attachment Status Report – This report will give you the NEA number assigned to your attachment within 6-24 hours after you send your claim. If the insurance company states they did not receive your X-ray or perio chart, you can use the NEA number to prove the attachment was received and they should be able to track it. As stated above with the DC#, my recommendation would be to copy this NEA number into the Claim Status Notes on the claim so if you need it, you don’t have to track down your reports.

Don’t give the insurance companies the power to manipulate the situation. If they say they do not have the claim and you have the DC#, do not resend another claim. Ask to speak to a supervisor or call the Dentrix eClaims support team and they will help facilitate the situation.

Another great resource for you to use is the Insurance Manager with eCentral and have the reports archived for you.

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Medical Billing . . . the new shiny toy


Medical billing is definitely the new shiny toy that is getting lots of attention lately. Each week, I receive several e-mails from offices asking if they should or shouldn’t use medical billing in their practices. The answer is … well … it depends. It depends on whether you have medical necessity. You can’t just bill medical for an oral appliance because it is covered under a patient’s medical plan. You must have medical necessity and proper documentation.
There are many considerations when deciding to take on medical billing. The office I worked at for 18 years performed a lot of neuromuscular, head, neck, and facial pain treatment and medical billing was an integral part of our billing process. I think medical billing can be a huge value-added service. However, I want you to go into it with eyes wide open.
  • You must have a medical diagnosis – If the patient is being referred to you for an oral appliance from his or her physician for sleep apnea or TMJ, usually the physician can provide you with the diagnosis code and any clinical documentation that will be necessary for the claim. However, if the patient is not being referred, then your doctor will need to provide the diagnosis code for claims processing.
  • Medical is billed on a different claim form – If you are going to process the claims for your patients, you will need to send them electronically on a HCFA1500 claim form. Medical insurance plans will no longer accept paper claims from the practice, but you can give patients a paper HCFA1500 claim form to submit to their insurance if you choose.
  • Be prepared for denial, denial, and more denials – Medical is worse than dental when it comes to stalling payment. You may want to consider having the patient pre-pay for treatment, then reimbursing him or her when the medical insurance pays.

If I haven’t scared you off yet and want to pursue medical billing in your office, check out an article I wrote last year on getting started with the setup in your Dentrix software by CLICKING HERE. E-mail me directly if you want one-on-one training for your team to learn medical billing in Dentrix.

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Put the pen down and put away the white out


What do you do if a patient tells you about his or her secondary coverage after you have already sent out the primary or after you have already received payment from the primary? How do you create a claim to send when you don’t have the “Create Secondary” tab highlighted to generate a secondary claim? I have had several answers.

All of these solutions are very creative and will probably get you paid … but what if you could create the secondary in Dentrix with the click of a button? The solution is simple (as long as the claim is not in history).
  1. Add the secondary insurance on the patient’s Family File.
  2. Go to the patient’s ledger and open up the claim by double clicking on it.
  3. Double click in the top box of the claim where it has the carrier and subscriber information. This will open a new window.
  4. At the bottom of this window, you will have a box to check “Update Secondary Insurance.” Put a check mark here and you will now be able to click on the tab to Create Secondary Claim.

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Someone deleted the entire Batch Processor . . . how do I find all those claims?


Do you ever wonder if all your claims are being sent out? Has the batch been completely deleted and you are worried there were insurance claims on there? Do you want to know what reports to look at to manage your claims? If you answered “yes” to any of these questions . . . read on. 

Recently I wrote about the “Create Batch of Primary Dental Ins Claims,” but there are a couple of other tools at your fingertips to make sure nothing falls through the cracks. If you want to read this article, CLICK HERE to be directed to it.
  • Insurance Claims to Process – This report gives you a list of patient names for claims that still need to be batched, printed or sent electronically. If the claim has a status of “created, eValidated, eWarning or eRejected,” the patient’s name will show up on this report.
  • Procedures Not Attached to Insurance – This report is similar to the “Create Batch of Primary Dental Ins Claims,” but it will only give you a list of patients, the procedures and date of service. You would then need to either go to each patient’s ledger and batch up the claim individually or run the “Create Batch of Primary Dental Ins Claims” to batch them all up at once.
  • Insurance Aging Report – This report should be managed on a weekly basis. However, if you think there are claims that have been batched up and accidently deleted off the batch processor before they got sent out, this is the only way to find them. When you run this report, make sure you click to view status notes. If the claim has only been batched, it has not been sent out and therefore not being paid. For more information on this report, CLICK HERE.

Lately, I have been noticing the insurance accounts receivable on the insurance side going up in a lot of practices. I don’t want this to happen to you. Look at your reports and get your claims out in a timely manner.

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Oops! What to do when the wrong tooth was posted


Have you had a patient in your chair for his or her 6-month checkup and, while you are perio charting, you notice that the wrong tooth is missing. After further investigation, you realize that the patient was in for an extraction three months ago, but the wrong tooth was set complete. You don’t know what to do, but the tooth chart needs to be fixed.

This happens more than you think. Sometimes the mistake is caught before month end is run and the procedures are locked up in history so it can be fixed with just a change of the tooth number. But what do you do when the procedure has been posted, sent to the insurance company, paid, and put in history? Do you leave it? No, that is not the right answer. You must correct it and, if the patient has insurance, you should correct it with the insurance carrier as well.

The correct way to fix this situation after the procedure is to invalidate the procedure in history, post the correct procedure and tooth number, and then adjust the ledger as necessary. There are two steps here . . . invalidate and the adjustment. When you invalidate a procedure, it only takes the procedure off the tooth chart. It does not change the ledger. You can invalidate the procedure from the patient chart or the ledger. From the ledger, double click on the procedure and click on the Invalidate Procedure in the upper left corner of the edit procedure window. From the patient chart, you can highlight the procedure, right click and select invalidate, or highlight the procedure and click on the invalidate icon on the toolbar.

After you have invalidated the procedure, then you can repost it on the ledger and make an adjustment to correct the patient balance. You will also need to fix the history with the patient’s insurance company … but this can be challenging. More than likely, you will need to send in clinical notes to prove the mistake and even send in X-rays.

In the end, having an accurate clinical record for your patient is the recommended option. Your patients’ clinical histories will follow them when they move or change insurance companies so it is best to keep their records as accurate as possible.

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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!

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