I'm currently doing research about insurance estimation and I've put together a survey with questions related to it. It takes about 5-10 minutes to complete and it would greatly help us validate and potentially produce new insights about insurance estimation.
If you work with collecting insurance coverage and benefits (or are knowledgeable about the process) and have some time to participate, please take our insurance estimation survey!
Thanks and have a happy Friday!
Also, I forgot to add that a "range of estimation" could wreak havoc on estimation and tx planning. Unless I could see what you were referencing too, I would think this is a NO GO. Softdent has the ability to be CORRECT on downgrades, 4910's etc.,,, You simply need to give it the information it needs.
I agree....when I got to that question I just about threw a fit.
I strive for perfection in my "estimates" - don't always get it but the closer we are, the better it is for my practice and my patients.
Love it! We currently do most of our estimates by paper as many of our patients have medical and dental policies that both cover things like impacted teeth.... and we are out of network for many insurance companies so rates go off R+C, after we write up a worksheet with figures we calculate by hand as we don't have anything like Bluebooks that might take fees and calculate at the click of a button. We've been exploring options to minimize time spent on an estimate but have only gotten so far as (suggested by our office manager) putting a template in the EMR notes so Names, Ins company, DOB, ID number is filled in automatically but this didn't work out at all in practice as we often have so many patients to check per day, almost all of them brand-new to the office... it was basically a word document so no way to calculate unless you pull out some paper and a pen! Sorry if this rant wasn't specific enough to SoftDent but I haven't come across a thread like this in OMS.
I agree, range of estimation is out of the question! We have our own financial worksheet we have our patients sign. Would be wonderful to have a management software that actually calculated (accurately) patients copay.
Thanks a bunch to y'all that went ahead and filled out the survey! I also wanted to assure everyone that we are definitely not making any alterations to the way insurance estimation currently works especially in regards to the last question in the survey that has stirred quite the conversation.
I did want to disclose in the survey that my research goals involved validating reasons why insurance estimation is important as well as making an attempt to measure how important its accuracy is in relation to the amount of time practices are willing to spend to ensure the data is correct for more accuracy. Even when there are measures that are taken to ease the collection of such data (e.g. usage of third-party services), it becomes even more frustrating when estimations end up still being wrong. And yes, even though final payment changes due to insurance checks not matching what was estimated, because it's your practice's name on the collections bill (or on the phone), blame from the patient, unfortunately, will still likely fall on you, the messenger, even when fault was on the insurance's end.
With that said and without turning into a novel, there are some ideas that are being generated, floated around, and validated through your feedback that is looking to help facilitate the moving parts involved in insurance estimation.
Once I compile and crunch the numbers and responses of this survey, I'll share the results on this forum.
1.) Create Modifier codes for the following procedures, Posterior Composites, All porcelain crowns, All porcelain Implant crowns, All porcelain Pontics and Retainers, this will help your practices formulate the correct adjustments for those procedures.
If softdent created the modifier codes for the user it would create the option of avoiding mathematical errors. (Most ins plans downgrade for these procedures) These Modifier codes would need to read EXAMPLE: 2391- Molar 1 Surface Posterior Composite
2391.2 Premolar 1 Surface Posterior Composite Etc, etc for all Posterior Composite Codes
Equally, all All Porcelain Restorations should be given Modifier codes by their LOCATION in the mouth, Anterior, Pre-Molar, and Molar.
2740 Molar All porcelain Crown, 2740.1 Premolar All Porcelain Crown .2740.2 Anterior All Porcelain Crown.,
When the codes are created and added into the Fee schedules at the SAME ALLOWANCE as the original ADA code and then applied to a Bluebook, it allows for the user to update the downgrade in the BLUEBOOK. The user needs to keep the ALLOWED amount the same as they only adjust to what they BILLED for on claim, but the user needs the ability to add in a different payment without altering the allowed amount. As it is right now if the user changes the paid amount in the bluebook the allowed amount changes..... Its such a headache and most offices do not know how to fix it. At this time, I simply change the percentage to reflect an approximate payment that closely resembles the actual downgrade payment by the plan, --this keeps my allowed amount (ie my adjustment on tx plans and ledgers) accurate.
2) Your COB button does NOT work. In theory, its great, but it would never work assigned to a plan itself. WHY? Because of differences in negotiated fee schedules and the COB assignment of benefits,(which is different than COB calculation)
Example: If a child has primary and secondary insurance through his parents, the COB assignment is generally by birthday rule in which Primary Plan for the PATIENT will be determined by the Parents Birthday. Primary will be the parent in which the BD falls earliest in year and Secondary would be the parent with later BD. WHY does this matter? Your COB calculation would need to be assigned PER PATIENT, so that offices could; if they wished calculate to the lowest allowable negotiated. PER THE NCIS COB regulations- the Dr can legally collect up to 100% of his whole fee, as long as the patient receives the benefit of the lower negotiated allowable.
3) Allow our BLUEBOOKS to not change allowed amounts when payments are changed in the payment section.
4.) Easing insurance calculation is extremely important as a larger percentage of practices are PPO practices and a higher percentage of patients carry dual insurance.
I feel the insurance estimates are one of the most important parts of the software. It needs so much improvement, we have been using this software for almost twenty years and almost nothing has changed even though the insurances have changed drastically. Please, Please update this portion of your software! This would eliminate many irate phone calls from patients and save a lot of heads for front office staff. If you ever have any questions, I would love to talk to someone about this.