Any way to give specific teeth numbers to codes that 'downgrade/alternate benefit' on treatment plans? Some dental plans only give the alternate benefit on 'molars only'.
Good morning Jenny
Sonya is right that is one of the methods that can be used to 'downgrade' a code in the estimating.
Here are the three ways that we currently work around doing downgraded codes
1. The office can calculate the Patient Portion, select the #3 option under "Patient payment method," and enter that fixed amount.
. . . Or . . .
2. The office can create a duplicate 02391 Tx Code, enter the downgraded UCR fee for the duplicate, select the #2 option under "Patient payment method," and enter the percentage. (For the duplicate code to be considered a separate entity in the software, it must be given an abbreviation; otherwise the software will still pull the office fee and estimating from the original code.)
3. The office can calculate the percentage the insurance company will actually pay and enter that figure in PracticeWorks.To do this take the insurance payment amount and divide that figure by the approved amount multiply by 100 to get the percentage.Example;- Insurance allowed amount is $219.- The insurance pays 90% of $148 or $133.20 and the patient pays $85.80.- To set this up the UCR will be $219 and the insurance % will be 61. The patient payment method needs to be 2.Formula used was 133.20 / 219 *100, this will give the insurance percentage to be entered.
I assume you are referring to composite restorations? We just added a "duplicate" code. One is for molars, one is for bicuspids. The blue book is updated accordingly, which will reflect on your tx plan. You could do the same for PFM or ceramic crowns, but we haven't taken it that far.
thanks.. I'll try to do this!
thanks. I've just been estimating everything as downgraded, stating the treatment plan is estimated, and then collecting the correct payment amount when the patient actually comes in for treatment. Usually a pleasant surprise to have it be less expensive than originally quoted.
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