So,we are taking the plunge and going into some PPO networks. It's an umbrella network with 3 plans all on the same fee schedule. My questions are as follows:
1. Do we put in the PPO fee schedule somewhere in practice works?
2. What do we need to do in order to track how much we are writing off with patients on these plans?
This is going to be very new for our office and we just got the paperwork that we go "in network" as of October 10th. I want to be prepared
I'm glad to hear you're setting this up. Once complete it makes a world of difference!
2. You'll want to create unique Adjustment codes for each of the companies you're participating with. For instance if you just signed up with Cigna and MetLife, you would create production adjustments and use the appropriate adjustment when writing off amounts in excess of the UCR.
Best of luck!
I've attached our documentation on Estimating/insurance set up so that you may look over it as well, but i'll cover a few basics here.
1. Yes, you would need to create, if you haven't already, the insurance company profile under List > Insurance companies. This will be used to connect to all the plans underneath that Insurance company.
You'd then need to create, in this case, Three separate Employer/plan profiles under List > Employer/plans. Under these plans, you'll attach them to the Insurance company on the last section of it's profile. To set up the estimating, you'd click on the estimating button. This will bring up your estimating set up table/window. You will add information such as max benefits, when the benefits reset (most are 01-01 [Jan first]). For PPO type plans where you're in network, you're going to want to add in their fees using the "Code specific estimating" button on the bottom right. This will bring up a table of all the codes, and here is where you'll put in their Fee (UCR), how the insurance will pay (percent or fixed amount), and then how the patient will pay. usually with in-network insurance you'll have write offs, so most the time you'll choose option 2 under patient payment method.
2) This leads into question two. once you have the code's estimating set up, it will calculate the write offs automatically for you. you'd just need to also make sure you select the default write off code for that insurance company. You'd select it back on the main estimating window/table underneath where you set the benefits amounts. You may need to create an adjustment code that will be used for the write off.
to track how much you're writing off over all, there is a report under File > Print > insurance called "Insurance Company ledger details" This will print out per insurance company how much the insurance company has paid, vs patient pay, and totals the amount written off for you.
If you'd like to go over this live with one of our representative, please feel free to give us a call. our Support number is located here.
You are welcome to ask for me directly if need be.