HOW TO SET UP DENTAL INSURANCE PLANS IN DENTRIX FOR TRACKING INDIVIDUAL PLAN PERFORMANCE TO SEE THE WINNERS AND THE LOSERS

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1 HOW TO SET UP DENTAL INSURANCE PLANS IN DENTRIX FOR TRACKING INDIVIDUAL PLAN PERFORMANCE TO SEE THE WINNERS AND THE LOSERS JILL NESBITT PRACTICE ADMINISTRATOR & DENTAL CONSULTANT MISSION 77, LLC

2 How to Set Up Dental Insurance Plans in Dentrix How to Set Up Dental Insurance Plans in Dentrix For tracking individual plan performance to see the winners and losers in your practice By Jill Nesbitt Copyright 2013 Jill Nesbitt Introduction People are now accustomed to choosing a healthcare provider off a list. They choose their hospitals and family physicians based on the list their health insurance plan gives them. And, when the insurance plan their employer selects changes, they change physicians. A common conversation can be heard throughout the country, I really like your doctor, but my insurance changed and so I have to switch. The same is happening in dentistry. This means that more and more patients are being driven into dental practices by insurance plans. Dentists need to understand how to set up their computer systems to not only process insurance properly for claims payment, but also make sure each dental insurance plan is set up so performance can be measured. This is the business side of dentistry where dentists select insurance plans, see patients and then regularly evaluate the performance of each plan. Periodically, based on this evaluation, dentists will drop the biggest loser plans and add new plans. 2

3 That s why I wrote this report. It s no longer good enough for a dentist to be an excellent clinician. Beyond all the continuing education and reading to keep up with clinical care, dentists must set up their dental insurance plans properly and then manage them regularly in order to maintain the patient flow to keep the practice running successfully. In this report, I will provide the step-by-step instructions to help you set up your Dentrix dental practice management software in order to track the performance of each dental insurance plan. These instructions are based on Dentrix version G5 and on my experience as the administrator for a large group dental practice. We always subscribed to the Dentrix technical support program in order to receive upgrades and phone support and if you have specific questions about Dentrix, I recommend you do the same and sign up for their technical support program. So, let s get started. Step 1: Find your top procedures Insurance companies may negotiate fees with the dentist in order to encourage the dentist to join the plan. Dentists have the best opportunity to negotiate fees when there are very few (or zero!) dentists in the zip code that are already members. If you have the opportunity to negotiate, then you need to be ready to ask for the procedures and fees you want. To determine this, run a report to find the procedures you are providing to your patients the most often. The idea being, you want to be paid the most for the services you provide frequently. An extra $5 per dental cleaning adds up quickly compared to a plan paying your full fee on a frenectomy, which you may do only a few times during the year. To find your top fees in Dentrix: 1. Go to the Office manager screen 2. Click on the Practice analysis icon 3. Select Reports 4. Checkmark Production Summary only (do not check the by category, cross coding, etc.) 5. Choose dates for the last year 6. Include all billing types and all providers 7. Uncheck everything else (you don t need the payments, adjustments, etc.) 8. Click Print 3

4 This report lists each procedure code, description, the quantity completed, the total $ amount charged, average $ amount charged and finally, the percent. As you look through this report, you can see there are numerous procedures that you do only a handful of times throughout the year. Looking at the far right column for the percent, look for the procedure codes you provide at least 1% of the time highlight them. You re looking for your top procedures that you provide the most often. These are the fees you will want to negotiate. Once you have identified your top procedures, now it s time to list them in excel so you can easily see your fees compared to the insurance plan fees. I recommend creating an excel spreadsheet named for each insurance plan that looks like this: Code Description Standard Fee PPO Fee % 0120 Periodic exam $41 $33 80% 0150 Comprehensive exam $70 $65 79% 1110 Adult Prophy $76 $64 84% Generally, the dental insurance company will send you their fee schedule use this to find the PPO fee for the codes you are evaluating. To calculate the percentage, simply divide the PPO fee by the Standard fee. Now you can see at a glance which codes are closest to your standard fees and which are the furthest. I also recommend calculating an average of the percentage column. This average allows you to more easily compare the different plans. If you create a spreadsheet like this for each dental insurance plan you are considering joining, then you can more clearly rank each plan based on fee schedule alone. When you find an insurance plan that performs well for you, then you can speed up the process of negotiating with new plans by simply using the plan fee schedule for the plan you prefer perhaps the insurance plan will match it? It s smart to revisit these spreadsheets for each plan every year if you increase your standard fees, then you are taking a larger hit for each dental insurance plan you have joined. In my report, Managing Dental Insurance, I review instructions on how to regularly monitor performance of each dental plan so you can decide which plans are winners and losers for your office. Since that topic is covered, let s move on to how to set up a dental plan in Dentrix once you ve agreed on the fees. 4

5 Step 2: Set the plan for tracking This step is the key for managing dental insurance properly. It is not required for submitting claims and therefore, you won t find this recommendation through technical support. However, when you set up the tracking in Dentrix and train your team to use this every time, you will be able to run reports that reflect this individual plan s performance and you will be able to make better decisions that affect the business of your practice. First, you re going to assign a billing type. Assigning a billing type is important because it will allow you to run reports based on billing type. This allows you to run the same report for each dental plan and to compare their performance using an apples to apples approach. To assign a billing type: 1. Go to the Office manager screen 2. Click on the word Maintenance in the top taskbar 3. Select Practice Setup in the menu 4. Select Definitions 5. Select Billing types 6. Click Add this automatically adds a new billing type 7. Now you can click into the description to edit it for example Delta Dental 8. Click close to close the window Usually your #1 billing type is for your Standard Billing and then you add a billing type for each insurance plan, so you will end up with one billing type for each plan you join. This is also the place you can change names let s say you join Delta Premier and label it Delta Dental, then next year you join the regular Delta plan and realize your billing type labels are confusing. Simply change the definitions to match the plans. Next, you re going to assign the fee schedule definition. This step simply assigns the proper name to the fee schedule you re going to add. To assign a fee schedule name: 1. Go to the Office manager screen 2. Click on the word Maintenance in the top taskbar 5

6 3. Select Practice Setup in the menu 4. Select Definitions 5. Select Fee schedule (click the little arrow beside the Definition type menu to see all the definitions you can change) 6. Click Add this automatically adds a new fee schedule name 7. Or, simply choose the next fee schedule number that doesn t have a label and click Change and enter the name of the plan. 8. Click Close You re on your way! The next step takes a bit more time and focus, so now is the perfect time to take a break and grab a cup of coffee so you can stay focused on the next step until it s completed. The next step is entering the PPO fee schedule. You re going to be looking at a long list of codes and fees and accuracy is important, so you don t want to be interrupted during this step. Step 3: Set up the PPO Fee schedule Once you ve agreed on the fees, you will have a fee schedule from the dental insurance plan and you need to enter this negotiated fee schedule into your Dentrix system. There will be some procedures that you provide that do not have a fee listed. For these, we will use your standard fees. This is a great default to make sure we re submitting the full fee for anything that we haven t discussed. First, print a copy of your standard fees to use as reference: 1. Go to the Office manager screen 2. Click on the word Reports in the top taskbar 3. Select Reference in the menu 4. Select Fee Schedules 5. Now, select your Standard Billing fee schedule and click ok this will send this report to the batch file 6. Select this Fee Schedule report and print 6

7 With your standard fees and the PPO fees in hand, now you re ready to set up this new PPO Fee schedule into Dentrix. To set up the PPO fee schedule: 7. Go to the Office manager screen 8. Click on the word Maintenance in the top taskbar 9. Select Practice Setup in the menu 10. Select Auto Fee Schedule Changes this brings up a new window 11. At the top, select your Standard Billing fee schedule you want to choose the fee schedule that has your regular fees. 12. Leave the default for Selecting procedure code All to All 13. Next, under Select Operation, choose Copy Fee Schedule to 14. Click the double arrow beside this field and scroll down to find the PPO Fee Schedule definition you just created in Step When you click Copy at the bottom of this window it will bring up a list of all the codes in a new window. Now, in this window of Automatic Fee Schedule Change Results you see a list of the procedure codes, your standard fee, the new fee and the difference. Since there are no descriptions included in this window, it s nice to have your standard fee schedule printed so you can make sure you re editing the correct code the last thing you want to do is end up deep in the 5000 codes and mistake a full denture fee for a denture adjustment fee! What you are going to do now is to use the PPO Fee schedule and enter their fees for any procedure code they provide. To change a fee, simply highlight the procedure code and click Edit this will allow you to change the PPO fee and it will show a green checkmark box and a red x box beside this field. Type in the correct number and click the green checkmark box. You did it. If you make a mistake, simply edit it again. To go faster, simply double click on the procedure code line and this will also allow you to change the fee. You can see how this will take time to go down your list, and edit each fee. If you start to get mixed up looking at so many codes, refer to your standard fee schedule printout so you can see the descriptions and have a better sense of how this plan is paying on your procedures. When you finish all the edits, click the Accept button below. Now 7

8 you have set the fee schedule and all the tracking needed for your staff to use when the new patients with this plan come streaming into your doors! Step 4: Set up the Insurance Plan & Employer Often, you end up joining a dental insurance plan because you already have a number of patients with this plan that are coming to you out-of-network. These patients may have been the ones who called you and told you that they really like you and ask if you would join their plan? Your next step is to setup the insurance plan and the employer(s) to match the fee schedule you just set up. The easiest way to do this is by choosing a patient with this insurance so you have all the information in front of you. If you have the insurance card copy from a patient with this plan or you have a patient with this plan as out-of-network, you have everything you need to make the connection with the fee schedule. Since this step follows the Dentrix instructions on adding a new insurance plan, feel free to refer to for their instructions. To add a new plan: 1. Go to the Family file screen for the patient 2. Double click on the Insurance box this should look familiar. This is where you select the insurance plan and employer for this patient. Always checkmark the two Signature on File boxes and fill in the rest of the information. 3. Next, click on the insurance data box this brings up a window where you enter the name, address, phone, group number, ID, etc. for this plan. 4. Enter the month the plan renews (most are on a calendar year, so January is a common entry) 5. Enter the claim format choose DX2012F this is important because this format will submit your full fee to the insurance company, but enter your negotiated fee in the patient s ledger. 6. Enter the Fee schedule that you just set up for this plan. 7. Select the Payor ID that best matches the plan. If you don t find a match, then choose the top option All other payors. 8. Then choose the Source of Payment Commercial insurance company 9. Finally, click okay this brings up a window where you will be asked to Change for all? Or change just for this subscriber? Choose Change for All. 8

9 This is also the area where you can enter the coverage table, maximum and deductible. The payment table box is where you will find the payments made by this plan listed by the procedure codes that you have charged out to patients. You also can add secondary dental insurance or medical insurance in this window as well. Once you have set up this insurance plan and employer you need to let your staff know how it is listed so they will choose this plan for new patients. You do not want them to enter another plan for this employer that is set up differently. To check this, run an Insurance Carrier List (instructions provided in the next step) and look at all the insurance plans by employer. If you end up with more than one, then you can switch the patients over to the proper plan and delete the wrong one. Step 5: Train your staff Now that you have everything set up, your next step is to train your staff to enter a new patient properly. Personally, I m a big fan of the New Patient Welcome form this is a checklist that your office manager can grab as soon as they pick up the phone and hear Are you accepting new patients? This is a great way for the dentist to clearly communicate to the front desk team exactly how they want new patients to be handled. You can put notes about how you want new patient adults, teens and children to be scheduled, you can provide specific information you want the team to share, etc. And, since most dentists have joined several dental insurance plans, you can create a checklist at the bottom to remind the team which billing type & fee schedule match each plan. For example: Delta Dental Fee Schedule 9, Billing type 12 Aetna Fee schedule 10, Billing type 13 Since you set up the definitions, your team can always scroll through and find the match, but I believe having a form in front of you is a great reminder (and it s a great training tool for new hires!). For each new patient, you ll double click in the top box of the family file and select the fee schedule that matches their plan. Then in the payment arrangement box also in the family file, you ll double click and select the billing type that matches as well. A note here when you set up the Insurance plan data and select the fee schedule, this is another way to make sure that the PPO fees will be entered into the patients ledger. Technically, you could skip entering the fee schedule for the patient in their 9

10 family file because it will already be attached. Either way works. Personally, I like the consistency of matching fee schedules and billing types to the insurance company you set up I think that s a great way to see the setup. However, if you want to save a step and you re confident in the setup of your insurance data, you could leave the Provider Default for the fee schedule in the family file. Repetition is a wonderful teacher. Since you need to go ahead and change all your existing patients with this plan and employer to these new settings, next you will run a report to find the names of patients that need changed. You can give this report to your staff with the instructions to edit the fee schedule and billing type for each one. To find patients with this plan: 1. Go to the Office manager screen 2. Click on the word Reports in the top taskbar 3. Select Reference in the menu 4. Select Insurance Carrier List this brings up a new window 5. Leave the default Dental type report 6. Select the plan and employer use the double arrows to scroll through this list 7. Checkmark Standard List and checkmark Include Subscribers 8. Click Ok This will automatically put this report into the batch file of the Office Manager. Select and print this report. You will see how it provides all the insurance plan information and then lists the subscribers. These are the patients that need their fee schedule and billing type set properly. Conclusion You ve done it. You evaluated the PPO fees against your standard fees. You negotiated on the fees that you charge out most frequently. You made an intelligent decision about joining the plan. Then, you created definitions for the new PPO plan fee schedule and assigned a billing type to match. You entered the fee schedule. You ve trained your staff and edited existing patients with this plan. Congratulations! Now, repeat these same instructions for each plan you join. As you add new plans, you may want to create a folder in your computer system for dental insurance and create a separate folder for each insurance plan as well. In the insurance plan folder you can save a copy of the signed contract, the fee schedule you 10

11 negotiated, your spreadsheet of fee evaluations, etc. You will appreciate having all this information in the same place as you add your 6th plan, 7 th, etc. this is a lot of information to keep track of! Okay, enough dental insurance work go see some patients! Well, maybe one more idea for you. Promote your new membership. Update your website list the insurance plans you ve joined and provide a link to the Find a dentist section of their site for people to confirm you re on their plan. If you have a blog write an article about joining this plan and specifically identify each employer that offers this insurance plan (people know who they work for, but often their dental insurance changes.) Post an announcement on Facebook. Update your practice brochure and then, bring this to your next full staff meeting and let everyone know all the plans you have joined. Ask your staff to refer new patients and ask them to share this news with every patient in their chair for the next few weeks in particular. You want the word to get out! Best wishes to you as you evaluate new dental insurance plans and join the best ones. As dental insurance continues to drive patient choice of dentists, you are taking steps to stay in control of the business side of your practice. You understand how to set up a new plan so that you can track it s performance and drop the losers in the future. You will also be able to run patient lists based on this insurance plan so you can customize communication with these patients. I hope you are feeling more confident about managing your dental practice and making solid decisions about dental insurance. If you would like some one-on-one support, feel free to contact me at jill@dentalpracticecoaching.com. As an experienced group practice administrator, I understand what you re facing and would be happy to help you. 11