Difference between fee scheduals, bluebooks and allowance tables

[usmanato360]

Hi everyone,

We have an established practice and I am supposed to revamp fee schedules for the year 2019. 

We currently do not have any allowance tables setup and we prefer ICM2 calculations (Collecting patient portion at the time of the service). I have a few questions:

1. Can someone please explain to me difference between these:

Fee Schedules

Allowance Tables

Bluebooks

And how all three of these are linked and used in fee calculation and is there something special about fee0 schedule? 

2. I printed a bluebook report and it was about 5000 pages, when I update using system->fee maintenance->bluebook update or fee schedule update, where does the software get these updates from? Softdent servers ?

3. What is the ideal roadmap to reset everything for year 2019 and update all fees properly?

A million thanks in advance 🙂

[JaneeFDA]

Bluebooks are more so based on the different insurance companies. For example, our practice in a in network provider for 2 insurances, however we accept patients with all insurances. As we receive checks from out of network insurance companies, we have the option of "updating the bluebook" according to that insurance companies allowable fees. This alone, as updated, will allow our staff to collect the correct amount from patients using out of network insurances. The bluebook stores the insurance companies fees.

Your fee schedule(s) stores YOUR OFFICE fees. You can attach a different fee schedule to different patients, example, generically, fee schedule 0 is attached to everyone. If you're an office that provides a certain "discount" to patients who have no insurance or senior citizens who receive "special pricing.." In your system, under each ADA code, you can list the discount version of your fees under "1". By attaching 1 in the fee schedule block on the lower right side of each of the patients you want those fees applied to which having to change the fee every single time.

[tallarob1]

The way I understand it is that the Allowance Table is establishedfor a particular Insurance Plan.  You have to manually go in and indicate the fees for all procedures.  When you update the Allowance Table and link that Allowance Table to the Insurance Plan, you will see that it then updates the Bluebook.  Ultimately, everything goes through the BlueBook.  You have to have the Insurance Plan setup as a %PPO and check the box that says "Post Writeoff At Time of Service" checked.

When you post an transaction for a patient who has a PPO Insurance and has the Allowance Table setup, you charge them your usual fee and Softdent will then post a Transaction Writeoff showing the discount they received by having that PPO.  The advantage to doing this is that any other patients who switch or join that same PPO will automatically be charged the correct, adjusted fee.  We used to try and setup indivisual Fee Schedules for each insurance plan but it was difficult to make sure everyone was assigned the correct fee schedule.  Also, if they changed Insurance Plans or dropped their insurance, many times we would forget to change their fee schedule and they would continue to get charged the discounted fee.  Also by doing this, you can get a better grasp on how much you are actually writing off for all these PPO's - very depressing!!  When using Allowance Tables, you set all fee schedules to "0".

[usmanato360]

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@tallarob1 wrote:

The way I understand it is that the Allowance Table is establishedfor a particular Insurance Plan.  You have to manually go in and indicate the fees for all procedures.  When you update the Allowance Table and link that Allowance Table to the Insurance Plan, you will see that it then updates the Bluebook.  Ultimately, everything goes through the BlueBook.  You have to have the Insurance Plan setup as a %PPO and check the box that says "Post Writeoff At Time of Service" checked.

When you post an transaction for a patient who has a PPO Insurance and has the Allowance Table setup, you charge them your usual fee and Softdent will then post a Transaction Writeoff showing the discount they received by having that PPO.  The advantage to doing this is that any other patients who switch or join that same PPO will automatically be charged the correct, adjusted fee.  We used to try and setup indivisual Fee Schedules for each insurance plan but it was difficult to make sure everyone was assigned the correct fee schedule.  Also, if they changed Insurance Plans or dropped their insurance, many times we would forget to change their fee schedule and they would continue to get charged the discounted fee.  Also by doing this, you can get a better grasp on how much you are actually writing off for all these PPO's - very depressing!!  When using Allowance Tables, you set all fee schedules to "0".

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Thanks for sharing this information I really appreciate that.

1. Can you elaborate when we update bluebook/fee schedule from system, where does the system gets these updated values? does these updates come from SoftDent servers?

2. What are the information SoftDent comes with ? (I.E. Payer Lists, BlueBooks etc? Is there a utility to load all of them in a fresh installation?)

3. How do you use Trojan Tables? our installation shows disabled links in front of Trojan Tables.

Thank you so much in advance, you have been a great help already I hope you'll help me with these questions as well.

[tallarob1]

I don't use the Trojan Services so I am not familiar with what they do.  I know, many years ago, I looked into them and I seem to remember that they didn't have anything to offer me in Florida.  I would be curious to hear if anyone else is using them and exactly what they do.

Although you can do it, we generally do not directly update the Bluebook.  For every PPO we accept, we have an Allowance Table setup.  You have to go to List>Allowance Table>Add and from there make a selection.  You then have to manually enter the PPO fee for each procedure.  If you have 10 different PPO's, you have to setup 10 different Allowance Tables.

The trick is to then make sure you connect them properly to the Insurance Plan.  You can go to the patient's Account Screen and click on the down arrow next to the Insurance Plan.  Then select "Edit" to open the plan details.  Under "Plan Information", set the estimation type to %PPO and the Sub Type to PPO.  If will ask you if you want to use defaults.  I don't think it really matters, because you are going to change it, so you can select either yes or no.  In the bottom left hand corner, select "Post Write Off at time of Service".

Next, select the Coverage tab. Towards the bottom it says "Allowance Table".  Select the down arrow and then select the appropriate Allowance Table.  It will then update your Bluebook with the fees you have placed in the Allowance Table and you are good to go.  Do also make sure you have the correct percentages indicated for procedure types as well as whether or not a deductible applies.  

Now when you post a procedure, it will show your regular fee and a corresponding "Transaction Writeoff", which is the difference between your regular fee and the PPO fee.

Hope this helps.  Setting it up correctly is the key.  One thing to remember is that if you add or change anything on your Allowance Table you need to update your Bluebook.  The way you do this is to go to the Allowance Table selection on the Insurance Plan Coverage tab and select a different allowance table.  Then, go back and select the correct Allowance Table.  It will first change the Bluebook to the new table you selected but will then overwrite it with the correct table when you go back and select the correct one.

There may be better ways to do this, but this is how we do it in our office.  If anyone does something differently, I would love to hear it.

[mdunham]

Allowance table entries should immediately update bluebook fees.  Within your Bluebook you can select "refresh", any codes in Allowance table should update.   This can be done without first selecting a different Allowance table and immediately adding the correct one in.     

The problem with deleting and selecting an Allowance table for sake of updating is that all of your plan-code specific notes and details will be removed.  This is a bugger, if you are using your Bluebooks to notify Hygiene department and TX Plan Coordinators of items such as hyg frequency limits on procedure codes.  

All notes on code within a blue book will offer a "pop UP" notification of the entry when viewing an appt card, scheduling an appt etc, and is a wonderful time and overhead cost save for SD practices.  

[doctom4300]

Thanks for the tip on using Refresh within the Bluebook. We just recently started using the notes and details and it would be quite frustrating to have to re-do all of that when fees get updated.

[doctom4300]

We do not apply the insurance discount at the time of service. We apply it when we receive the EOB from the insurance company. SD correctly calculates the amount we need to collect at the time of the appointment, as if the discount as been applied, but the discount is not posted to the account until we receive the EOB.