Any advice on how to tackle cleaning up the fee schedules and insurance plans? I am attempting to help my husband at his office since someone retired, and I am discovering that the OD program is not being used to its potential AND there are areas that were not set up properly (insurance).
In short, we've discovered that fee schedules were incorrectly attached to plans and patient insurances. When there was doubt about what type of plan/fee schedule to attach, an educated guess was made (disaster).
I realize that this is not entirely an OD question (and a very basic office management question), but I am looking for any guidance on the most efficient way to tackle clean up via the OD program. My knee-jerk response is to delete all fee schedules and plans (there are so many duplicates) and start completely from scratch, but I realize that this is not ideal and there has to be a faster and more common sense way around this problem! Any feedback is appreciated i.e., would it make sense to first go in and correct fee schedules and then go through plans and link them up (delete duplicates, combine when appropriate) and then verify accuracy with each patient check in? Thanks in advance, Anne
Fee Schedule/Insurance Plan Clean Up
Re: Fee Schedule/Insurance Plan Clean Up
Hi Annesa,
You totally slipped by me yesterday. Sorry for that.
Sounds like you have quite the project on your hands. Depending on how you want to tackle it, our conversions department may be able to assist with some mass changes.
Before you begin, you may want to consider making a backup of your database. Some of the merges below cannot be reversed.
1. The first thing I would do is merge identical insurance carriers. Go to Lists > Insurance Carriers
2. Merge identical plans. This will be time consuming. You should check each plan is indeed identical (benefits and all). Group Number is a solid way of identifying identical plans, although you are kinda trusting the previous data entry person.
3. Consider working with our conversions department to disassociate fee schedules from all insurance plans. We can also mark the plans as 'Pending'. Once you have reviewed the plan, you can remove that flag and trust the information.
4. You actually won't be able to delete plans or fee schedules. Those plans are associated with claims and you'll need them for historical claims purposes. We may be able to clean up some of the fee schedules, though.
If you want some help, we'd be happy to help. Give us a call and we can go over this together.
Good luck!
You totally slipped by me yesterday. Sorry for that.
Sounds like you have quite the project on your hands. Depending on how you want to tackle it, our conversions department may be able to assist with some mass changes.
Before you begin, you may want to consider making a backup of your database. Some of the merges below cannot be reversed.
1. The first thing I would do is merge identical insurance carriers. Go to Lists > Insurance Carriers
2. Merge identical plans. This will be time consuming. You should check each plan is indeed identical (benefits and all). Group Number is a solid way of identifying identical plans, although you are kinda trusting the previous data entry person.
3. Consider working with our conversions department to disassociate fee schedules from all insurance plans. We can also mark the plans as 'Pending'. Once you have reviewed the plan, you can remove that flag and trust the information.
4. You actually won't be able to delete plans or fee schedules. Those plans are associated with claims and you'll need them for historical claims purposes. We may be able to clean up some of the fee schedules, though.
If you want some help, we'd be happy to help. Give us a call and we can go over this together.
Good luck!
Entropy isn't what it used to be...
Arna Meyer
Arna Meyer
Re: Fee Schedule/Insurance Plan Clean Up
Thank you very much! This information is very helpful and much appreciated!
Re: Fee Schedule/Insurance Plan Clean Up
We had the same problem. The previous person pretty much just made up the insurance information.
This is how we have been doing it:
1. Got all our contracted fee schedules and updated or added them to OD.
2. Set all insurance plan fee schedules to the basic office fee schedule.
3. Combined any duplicate insurance groups from the list of insurance plans.
4. Printed report of number of active patients in each insurance plan.
5. Spent a weekend entering insurance data starting with group with most patients and working down the list.
6. After that weekend, all new patients have correct insurance data entered before they leave.
7. Keep working your list as time allows.
8. Until all insurance plans are updated for all patients, the front office staff always verifies the accuracy of data before printing a treatment plan. If the plan information is not accurate, then we print plans with just the office fees and no patient portion estimate, telling the patient that we don't have their plan in the computer. When this happens we update their plan before their next visit.
Doing it this way we know a plan has good data if there is a ppo fee schedule attached to it. I also always add plan notes about frequency limitations, waiting periods, etc., so any plan with plan notes had good data. Then when plans are inadvertently duplicated, you can usually tell which of the duplicates to combine in to by looking at how detailed the plan notes are.
This is how we have been doing it:
1. Got all our contracted fee schedules and updated or added them to OD.
2. Set all insurance plan fee schedules to the basic office fee schedule.
3. Combined any duplicate insurance groups from the list of insurance plans.
4. Printed report of number of active patients in each insurance plan.
5. Spent a weekend entering insurance data starting with group with most patients and working down the list.
6. After that weekend, all new patients have correct insurance data entered before they leave.
7. Keep working your list as time allows.
8. Until all insurance plans are updated for all patients, the front office staff always verifies the accuracy of data before printing a treatment plan. If the plan information is not accurate, then we print plans with just the office fees and no patient portion estimate, telling the patient that we don't have their plan in the computer. When this happens we update their plan before their next visit.
Doing it this way we know a plan has good data if there is a ppo fee schedule attached to it. I also always add plan notes about frequency limitations, waiting periods, etc., so any plan with plan notes had good data. Then when plans are inadvertently duplicated, you can usually tell which of the duplicates to combine in to by looking at how detailed the plan notes are.
Re: Fee Schedule/Insurance Plan Clean Up
thank you!