We have an insurance that we are contracted with that pays a set fee, but we also have to write off the difference in the contracted prices. When I am setting up my table, Patient payment method is #2, Insurance payment method is fixed price, but it will not let me put in UCR max fee considered. I need this to still write off the difference in the fee schedule pricing. Any thoughts? So for instance, the total fee is $25.00, the insurance pays $8.00, the contracted fee is $21.00. I need the update to show the part the patient owes of $13.00. Right now it updates that the patient owes $17.00. Is there a way around this or no? Maybe I could do something different?
Set up code under #3 PPM (Patient Payment Method) with the amount the patient will pay; set up IPM (Insurance payment method) with what the amount insurance will pay. ( see below)
Treatment plan breakdown
Check out Ledger break down
Yes that works, but with 100 dental codes thats alot to go through and have to figure what the patient will pay, when we should just be able to put in the max fee considered and the computer automatically figure it. maybe something to consider for the future.
PracticeWorks Code specific estimating does do the math at the precentage rate with the Insurance UCR entered. If you are dealing with downgraded fees then you will need to do the math to figure what is the precentage actually being paid for the procedure.
Some fees are downgraded only on specific teeth. For example code 2740 may be downgraded on a molar but not on a premolar or an anterior tooth. How can I enter that info so the estimating is correct?
You can enter the a duplicate ADA code. Use a unique abbreviation when creating it. It wll be the same code, same fee, different abbreviation.
To create a duplicate code go to the Transaction code list and create.
My oringal code
My duplicate- I put in the same abbreviation with a D for downgrade
Then go to the Bluebook and enter in downgrade info.
In summary when checking out a patient or creating a treatment plan for the specific tooth always select your second code.
One more thought---
Creating duplicate codes means that in the charting they will get a prompt to choose a code. It is normally in order of creation. So the orignal ADA will be the first option and duplicate will be second.
A prompt when entering a treatment plan-