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When you are in network with dental insurance plans, you want to be able to generate the most accurate estimates for your patients. Contrary to what you might hear in Facebook chat groups, you CAN get accurate estimates using the fee schedule method or the allowed amount method in your Dentrix software.
In today’s episode Dayna will go through the differences between the two methods so you can make a decision on what will be best for your practice. Either method will help Dentrix calculate more accurately.
If you want to deep dive into managing dental insurance in your Dentrix software, go to Novonee.com and click on the green Join Today button in the upper right corner.
If you want to take advantage of Teresa Duncan’s insurance course offer, click here and use coupon code NOVONEE75
Full transcript below was provided by Riverside AI, please disregard any grammar or punctuation errors.
Dayna (00:02.73)
Hey there. So I was thinking about you today because my good friend, Teresa Duncan, who’s my insurance go-to expert, in fact, she will be on our podcast as a guest in a couple of weeks. So make sure that you keep your eyes open for that interview that I’m doing with Teresa coming up, probably about the first week of December. But the reason why I am talking about her today is she linked up
to a recent ADA guide that came out recently on terminating your dental network agreement. So if you are in network with a dental plan, this guide gives you some guidelines to terminating your contracts, because that’s been the talk of the town for the last few years, especially with higher.
overhead expenses, higher wages, dental practices are trying to get out of network so they can increase their profitability. And so it’s been a lot of questions on your mind about how do I really terminate that contract? So this ADA guide, what it does, and I’ll put a link to it in the show notes today, so you’ll have an easy way to download it or read it if you want to. But some of the things that you’ll see in the video, I’m going to go through, but some of the things that you’ll see in the video, I’m going to go through, but some of the things
Questions that it will be answering for you is you know like how much time is needed? for me to end my contract with a Insurance plan you know so how much lead time do I need in order to break that agreement? It’ll answer questions like where do I send the termination letter? So if you have questions about like where do I even start this might be a really good guide for you?
And then maybe just some pointers, some tips as to when I am now out of network, then what happens? So this ADA guide will help to answer some of those common questions. And so I’ll put a link to it in the show notes. So I just wanted to give a shout out to my good friend Theresa Duncan that posted that up today, and I shared it on LinkedIn. And I think I shared it on…
Dayna (02:20.206)
on Instagram as well. So you could find it out there as well. But it made me think about all the, if you are still in network, because a lot of practices, you’re either in a lot of networks, so you’re a pretty heavy PPO practice, or maybe you’re kind of stuck in that Delta Dental in network PPO plan, or maybe you’re Delta Dental Premier and that’s the only one you’re in.
It just made me think about how I wanted to be able to give you some guidelines as to, you know, what are your options inside of Dentrix in order to make your estimates as accurately as possible, as accurate as possible. Because what I was talking about to you over the last couple of podcasts is improving the communication in your practice between the front and the back.
And one of the things I talked about was putting the patient copay or the patients out of pocket for today in that appointment note so that everybody is on board, everybody’s on the same page with what are we collecting from the patient for their appointment today. So I think it’s kind of timely that this guide came out. And then I can just expand on that a little bit more as to, if you are in network,
and you want to be able to have the most accurate estimates in your Dentrix software, there’s two methods that you can use, okay? I’m going to go over those two methods today and just give you a really good understanding of what the differences is between the two, the two methods, and so you can make an educated decision as to what is the best option for you.
Now, if you need some added information, if you need some more guidance as to what might be the best option for your practice, I mean, reach out to me. I would love to help you navigate that world of being in network and making sure that your estimates are as accurate as possible because I want you to know that no matter what you hear in a Facebook chat room or whatever you hear from
Dayna (04:45.57)
Dentric support or you hear from your study group, you know, if you’re in an office manager study group or if you hear from your neighbor at a conference, you can get accurate insurance estimates out of your Dentric software, okay? I know it, I’ve seen it, I’ve done it, it can be done. It’s just that the setup has to be accurate. The setup has to be done right.
And so what I want to go through with you is the two methods that you have available to you in Dentrix if you are in network. Okay? So you have fee schedule method. So the fee schedule method is a way that you are going to input your Dentrix in network or your contracted fees into Dentrix. So you’re going to take your contracted fees and add them into Dentrix as a fee schedule.
Then what you’re going to do is you’re going to link the fee schedule to each insurance plan. Now what that’s going to do, so here’s what the fee schedule method does. Number one is it’s going to post your contracted fee to the treatment plan and to your patient ledger. Okay, so what does that do exactly? Well, what it does is it will give you accurate
insurance estimates, so your patients will have an accurate out-of-pocket for their treatment plan and their ledger will have an accurate out-of-pocket estimate because you’re posting your contracted fee to the ledger and the treatment plan. So what does that do exactly? Well, what you will see on the appointment book and on your production reports will be in net production.
Okay, because there’s no PPO adjustments. You don’t have to wait for the EOB to come back to make an adjustment. The fee, the discount is already built into the ledger or the treatment plan. And so you will see net production on all of your production reports. You’ll see net production on your appointment book. So if you are using the DENTRIX appointment book for tracking production goals and…
Dayna (07:07.062)
watching to see are we at goal if you’re looking at that daily huddle report every day to see am I at goal or Maybe you’re using that little calendar in the upper left corner of your appointment book to track your scheduled production versus your Your production goals, then you will be tracking Collectible dollars you will be tracking your net production. Okay
So that’s probably the biggest thing that using the fee schedule method does for you is you will see all your production numbers and net production. The other thing that the fee schedule method does is it will allow you to send full fee to the insurance company. So even though you’re posting the contracted fee on the ledger, you will be able to send, which is what I recommend that you send.
full fee to the insurance company so that the insurance companies still see the total office fee for that procedure code. And because whenever an insurance company is going to be looking at maybe increasing the fee schedule, they are going to look at the average fees in your geographical area when they go to do a fee update.
And so it’s really important that you are sending full fee to the insurance company. So you want to make sure that you’re using that. One of the F claim forms, the most up-to-date current one right now that I would recommend is the DX2019 with the F at the end. So that’s the most accurate up-to-date claim form that you’d want to be using because it will send full fee on the ledger. So I mean, full fee on the insurance claim. So it ignores the ledger.
It sends both beyond the insurance claim. Now, a couple other things that you will be able to do if you use the fee schedule method is you can still see on a couple different reports in Dentrix, what would my write-off have been? So on the day sheet, you’ll be able to see what did we post in production today, which is net production, and then it will also show you the difference. It will compare it.
Dayna (09:25.57)
to your full office fee, what it would have been. So you can see what your adjustments, your PPO adjustments would have been. Now, maybe you don’t wanna see that, but I know a lot of doctors like to be able to see what that write-off would have been. So you can always see that on a day sheet. There’s also a report called the Utilization for Dental Insurance Report.
I don’t recommend that you would print that report because it can sometimes be really long. But it might be nice just to maybe jump to the last page. If you’re looking at a pretty broad date range, you can jump to the last page and see what would have been my PPO adjustments in this date range because it shows you all the patients that came in and it shows you the difference between what was charged to the ledger and what your full fee would have been. So.
Kind of a cool report to see the differences.
Dayna (10:37.354)
Now the next option that you have available to you to get your accurate insurance estimates for your treatment plans and on your patient ledger is the allowed amount method. So the allowed amount method is going to still use your fee schedules. So you still wanna add your contracted fees into Dentrix because you’re still going to use your fee schedules
But you’re just not going to link them up to the plan. And it’s not going to post the contracted fee to the ledger and the treatment plan. Still going to post your full office fee to the ledger and the treatment plan. But it will calculate based on the allowed amount, which is really awesome. So this may be a relatively new feature for you if you are still on an older version of Dentrix. I think the.
allowed amount came about like in 22.9 or something or 20, I don’t know, sometime in 2022. And I’ll have to confirm that but I’ll put maybe put it in the show notes. But the allowed amount, you what you want to do with the allowed amount is you’re not going to link up a fee schedule in the insurance data. But what you are going to do is you’re going to copy your fee schedule.
into the allowed amount, which is inside of the payment table. So you go to the insurance benefits section in Dentrix, you’ll see you have your coverage table. Of course, you have your coverage table. You have your deductibles and maximums. And then you have your payment table and allowed amount. So what you’re going to do is you’re going to copy your fee schedule into the allowed amount column.
And then what Dentrix is going to do is it will calculate based on the coverage table, it’ll calculate based on your allowed amount fee, okay? So it will post full fee to the ledger, full fee to the treatment plan, but it’ll calculate based on the allowed amount. So biggest difference between using the fee schedule method which I talked about just a couple minutes ago.
Dayna (12:59.746)
The biggest difference between the fee schedule method and the allowed amount method is one, the fee schedule’s going to post contracted fees to the ledger and the treatment plan. All your production reports will be in net production. The allowed amount method is going to post full fee to the ledger and the treatment plan. So all your production reports are gonna be in gross production, and then you will do an adjustment.
a PPO adjustment when you get the EOB back from the insurance company. Okay, so those are the two methods that you have available to you when you are in network with an insurance plan so that you can get the most accurate treatment plan estimate possible for your patients before they schedule their appointment. Okay, so you’ve heard me talk about this before, that patients don’t get on the schedule
unless they have a financial arrangement, okay? And you know, I hear from so many offices that it’s like, well, I can’t really get a treatment plan, accurate treatment plan estimate because dentrics can’t calculate accurately. And that’s so not true. You could probably estimate, I would say 98% accurate if you’re using the fee schedule method or the allowed amount method.
with your treatment plan estimate.
Dayna (14:33.954)
Oh, excuse me. My throat got all dry there for a second. Because I hear a lot when I’m working with teams one on one, one of the highest priorities that I hear from most of you is treatment plan estimates. We just can’t get accurate estimates. Or our insurance isn’t set up right. What should we be doing? Why?
Why can’t it not calculate accurately? And so we start going through like the hierarchy of the estimating process and are you in network or out of network? Do you want to post full fee? Do you want to post contracted fee? You know, we go through all those questions trying to identify what’s going to be best for you because it’s not a one size fit all. You know, you can choose now between the allowed amount method and the fee schedule method.
So I hope this has been helpful for you. I thought that I should bring that to light and just give you a little bit of information about how you can get the most accurate estimates for your patients. And now I do want to let you know that we have completely re-recorded our dental insurance 101 course that’s in our membership.
Because of all the changes, I don’t know, you’ve probably been noticing all the changes in the insurance module over the past couple of years that Dendrix has been doing with all of these updates. And so finally, we had to re-record our entire Dental Insurance 101 course. And so it’s completed now. And I was really waiting until I felt like it was completed with all of their changes and development.
There’s probably still a couple more things that you’re going to find that will be updated in the next year or so. And I will make little tweaks to the course as that happens. But if you’re not a member yet, then you can go straight over to the Navoni website. And there’s a Join Today button in the upper right corner. You could check out our membership, because that course has been probably the most popular.
Dayna (16:55.79)
course that’s in our membership is that dental insurance 101 because you know insurance is one of the most challenging pieces in your dental practice. It takes the most time. It’s the most challenging to navigate and we go through all the details with you. So I hope this episode has been helpful for you. Make sure you check the show notes for that ADA guide navigating the termination of your dental insurance contracts.
And then stay tuned for in a couple weeks, Teresa Duncan will be on the podcast as one of my guests. And I’m super excited about that. She always has such great information to talk about. So if this episode resonated with you, if you found that it was really helpful and full of great tips that you could implement into your practice today, please rate it, review it, share it to your
your colleagues, share it to your study group, share it on your Facebook chat. You know, if you don’t feel like you’re getting really good information on your chat groups, share our podcast with them. We would love that. Especially if you’re listening to this on iTunes, please give us a review so we can try and get bumped up into the new and noteworthy section of the iTunes podcast. We’d really, really appreciate a review from you. So
We really thank for you to be on with us today. I hope that you were able to find 15 minutes of juicy content that you can implement into your practice right away. So I look forward to watching your journey of becoming a Dentrix superuser.
