Insurance Overpaid Report is 5 pages long...

[hjoesaar]

Yup, I found a new report today and ran it. I've got a five page Insurance Overpaid Report. It is 99% false of course, but what's the problem? I've narrowed it down to the "check the box for Claim shows UCR fees, not billed fees." If it was checked, OD shows that we got overpaid by the insurance company and the insurance company gets a credit balance. We're a PPO practice and for years we've checked the box - because we're supposed to, right? We're supposed to submit our standard fee schedule so that the insurance companies know what we're charging. I don't know - should the box be checked or not?

[hjoesaar]

I unchecked the box in the Setup Module, sub Family Module, that says, "Insurance Plan Default to show UCR fees on claims" so that my front desk doesn't have to remember when entering insurance information. I did an experiment of checking the box and unchecking the box and creating two seperate claims - they were both exactly the same. Jordan, I know you have discussed this on this forum but the user manual doesn't address this in the Setup Module.

Now, what do I do about the 5 page report? I'll let you know....

[hjoesaar]

When we submit to a PPO, we submit a $75 prophy (UCR) but plan on getting $57 from the insurance complany. If the insurance company pays us $58 we have a dollar overpayment on the Insurance Overpaid report. Why? What are we doing wrong?

[jordansparks]

Yes, it's good to use an example. $58 is still less than the $75 charge, so what's the writeoff for that proc? Is the writeoff pushing it over the $75? The writeoff should be $17. That's assuming you are even using writeoffs. Is the plan set up as a standard plan with no writeoffs or as a PPO plan with writeoffs? This might be best done over the phone with our support staff.

[hjoesaar]

If OD estimates $57 for a prophy and the insurance pays $58 dollars there is a $1.00 credit placed into the patient's account unless we manually increase the estimate to the payments. Is that correct? When I do that in 2010 accounts it doesn't change the Overpaid Report. is there a global update I could do? Most of these issues were before 2010 but our accounts are locked. How can I fix this?

[jordansparks]

1. What is the writeoff for that proc?
2. Is the plan set up as a standard plan with no writeoffs or as a PPO plan with writeoffs?

[hjoesaar]

Jordan,
You hit the nail on the head! YES, some of those patients had PPO plans that were not set-up as PPOs. They were classified as Category Percentage. Since everything is locked I am going to manually add up the overpayments and add them as an adjustment under a new category for tracking purposes. btw, that employee is gone.