Reminders for different phase of treatments

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khdilger
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Reminders for different phase of treatments

Post by khdilger » Fri Feb 11, 2011 4:22 am

Does open dental have the capability to setup reminders for different phases of treatment with patients? I am looking for a way to remind me and the office staff when patients are ready for different phases of there treatment plan. For example the oral surgeon sends me a letter letting me know when the patient will be released for impression/restoration of implants. I would like to have open dental remind us when that occurs for each patient. I am sure someone is going to say setup a recall type but I am not sure how effective that would be and want to hear thoughts on how to do what I want.

Thanks,
Kenny

khdilger
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Re: Reminders for different phase of treatments

Post by khdilger » Sat Feb 12, 2011 12:08 pm

Should I be using the Planned appointment feature in the Chart module for this? How many people utilize the planned appointment in the chart module and how do you use it / how is it useful?

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Re: Reminders for different phase of treatments

Post by khdilger » Sat Feb 12, 2011 12:59 pm

After diving more into it I think what I am really looking for a a way to track every patient. How are others tracking patients who need treatment. Is it just me or is Open Dental really lacking in the ability to find unfinished treatment? Sure there is the report that gives you patients and their total dollar amount of treatment outstanding but that seems very inefficient...

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Re: Reminders for different phase of treatments

Post by jordansparks » Sat Feb 12, 2011 1:34 pm

We do make the assumption that you're using the Planned Appointment feature. If you're not, then you're missing out on some of the power.
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khdilger
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Re: Reminders for different phase of treatments

Post by khdilger » Sat Feb 12, 2011 2:17 pm

Yes, i do agree and just figured that out. I am reading up on that now.

Yorek
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Re: Reminders for different phase of treatments

Post by Yorek » Sun Feb 13, 2011 10:15 am

Is there a way to distinguish prosthetics that have been started but not complete?
Now status for Crowns/Dentures are either treatment planned or marked completed.
Is it possible to indicate status: "A) Tx Planned B) Started" or C) Finished
then Started crowns/dentures etc would show up in reports of work to be completed.
Occasionally a patient disappears under the radar and this would help.

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Hersheydmd
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Sun Feb 13, 2011 1:19 pm

Yorek wrote:Is there a way to distinguish prosthetics that have been started but not complete?
Now status for Crowns/Dentures are either treatment planned or marked completed.
Is it possible to indicate status: "A) Tx Planned B) Started" or C) Finished
then Started crowns/dentures etc would show up in reports of work to be completed.
Occasionally a patient disappears under the radar and this would help.
Yorek, that is an excellent idea. I'd call the status "Mid-treatment" or "In-treatment".
It would also help because we generally don't mark a Prosthetic tx plan COMPLETE until the day it is delivered, which is also the date we submit to the insurance company, and which can be many weeks or months after it was begun. But that means that the fee doesn't show up in the patient's ledger until the end of a long series of treatments. The patient sees their credits accruing with no corresponding debit. It would be better to have the fee show up as soon as the status changes to "IN TX". Psychologically, the patient would see it as money that is owed and being paid down, rather than credits building up. It should also be simple to create a report of all treatment that was started but not finished, or patients that are in the middle of tx but don't have an appointment set up.
At the end of tx the status would be updated to COMPLETE and the date updated to the date of delivery, and the insurance can be submitted for payment.

I think we need a FEATURE REQUEST for this feature. I just wrote one, #1813.
Robert M Hersh DMD, FAGD
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Re: Reminders for different phase of treatments

Post by jordansparks » Sun Feb 13, 2011 6:01 pm

I think this is better handled by procedure codes. For example, if you want to charge at the first visit, you can either use the real code, or you can use a dummy code. If you use a dummy code, you can zero out that dummy procedure when the D code procedure is set complete many weeks later. If we were to add an indicator to the second procedure, it certainly would not be important enough to be another status like TP or C. At most, it would be a simple flag checkbox, and the procedure would remain as TP. The only reason for such a flag would be for tracking and reporting. The procedure code technique described above would be used for billing.
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Hersheydmd
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Sun Feb 13, 2011 6:56 pm

Jordan,
I respectfully disagree.
I've been doing it your way, and it can get quite confusing.
I have codes for crown prep, impression, try-in, deliver, cement, and similar breakdowns for denture visits.
If we attach a fee to the first visit dummy code, it has to be voided out when the procedure is completed because the fee is also attached to the D-code on the last visit, otherwise you end up with duplicate charges. That is a pretty cumbersome way to handle it.
If we mark the procedure completed on the first visit so that it shows up on the patient's statements, we have to remember to change the date on the last visit otherwise the insurance claim is submitted with the wrong date on it (which has happened many times). It's just not intuitive and it is too dependent on having to remember to change entries.
It makes so much more sense to start out with a TX PLAN status. When work commences, the status should change to reflect that. When work is delivered, status should be changed to COMPLETED. ONE PROCEDCURE CODE, ONE FEE, only the status is changing over time, which determines whether the fee is charged to the patient's account or not. You can still have your dummy visit codes to show what you are doing each visit, but they should have nothing to do with the accounting. Temporarily assigning fees to dummy codes with the intention of deleting them, just mucks things up. K.I.S.S.
Robert M Hersh DMD, FAGD
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Re: Reminders for different phase of treatments

Post by jordansparks » Mon Feb 14, 2011 4:37 am

You are right that the current workarounds are too cumbersome, but I still haven't heard an elegant enough solution to the problem. The best way to KISS is to bill everyone at the first visit. That absolutely guarantees that nobody falls through the cracks. But if you insist on waiting, it's going to get complicated. For example, you want to show the fee on the patient's bill right away, but how would you do that without sending it to insurance? We would have to come up with yet more exceptions in our math. That makes every financial report more complicated. Additional statuses and exceptions to rules are a great way to introduce bugs into our math. One option would be to mark the procedure complete and create a claim that was very similar to a sent claim. We could add a new status for claims, something like "InProgress". That way, none of our insurance math would have to change. A claim with an "InProgress" status would be on hold until the work was done, and then it would be sent with a newer date of service than what showed in the account.
Jordan Sparks, DMD
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Re: Reminders for different phase of treatments

Post by Yorek » Mon Feb 14, 2011 4:50 pm

This is something that's been on our minds for a while.
I agree with Jordan that the fee must be charged when the prosthetic is started
Maybe this will help with the rest..

My old, old software, which holds no candles to OD, did it like this..
When any prosthetic TX was selected there were separate buttons to select
'Proposed'__ 'Started'__ 'Complete'__
An additional_ "Date box" auto filled when status was changed to 'Complete'
Very nice, simple and intuitive.

A report could be run for "INCOMPLETE TREATMENT" of obvious value finding pt's not returned to complete tx
it had start date. I don't remember if it was in columns like an aging report 30 60 90 etc.

I'm not sure where the math has to change..
The fee is still charged when treatment is started and posted to the patient's statement as it should.
We can send it to the insurance whenever it's appropriate, impression stage or seating.

Insurance and patient payments are still deducted from the Total Balance.
Insurance payments are deducted from the Est'd insur pending.
===================================================================================
For those of us that 'Accept and Wait for insurance CoPays'..
My old program had these modifications on the patients' statements
which I've seen on billings from my own personal physicians.

------------------------------------------------------------
Change Balance to => Total Balance
Then Add these 2 lines under it
With a 'universal billing message' something like shown here.

So the top of the Patient Statement looks something like in this example..
--------------------------------------------
Total balance: $2000.00
Est'd Insur Pending : $ 975.00
________________________________
Amount Due Now: $1025.00

"Note, insurance pending is only an estimate of what your insurance might pay.
This can change due to many factors not in our control.
Patients' final balance will be calculated after all insurance payments have been received and may differ from this estimate."

(This mssg can be changed as desired).

We already have this information in our account module
So can we just add it to the patients' statements.
==================================================================================
Simple and easy to understand it allows for billing anytime during the treatment phases.

There was also a manual overide for both 'Due Now' and 'Insurance Est' (just in case).
So if the dentist and patient negotiated only to pay for eg $150.00 this month..that could be entered into the Due Now box. These changes do not affect Total Balance.

It explains clearly to pt's that we may accept your insurance but it's only an estimate and they are responsible for the total balance in the end. The Mssg reduces confusion if the insurance falls short.

Lastly. General Billing could be filtered NOT to print Due NOW if = 0.00

I'm sure not everyone will like or understand this option,
SO,, IT COULD BE TURNED OFF in preferences. 8)


Admittedly, I do not know how much programing would be necessary for this and am humbled by the progress OD has made is such short time. I know Jordan really tries to prioritize and give us his best ideas.

Continued Success OD!
Last edited by Yorek on Mon Feb 14, 2011 5:01 pm, edited 1 time in total.

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Hersheydmd
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Mon Feb 14, 2011 4:59 pm

Hi Jordan.
I've been waiting all day to be able to post a reply.
We tried Completing procdures at the first visit. It's not so simple. It can be darn right confusing especially with complicated, involved tx plans that spread out over many months (and occasionally years).
You can't tell if the procedure has been finished or not. You are marking something complete that isn't complete. You have to literally read through your progress notes to figure out if a particular procedure has been completed or not. And if you forget and create an insurance claim at the end of treatment without changing the date, you will inadvertantly file with incorrect dates, which could result in claims being rejected and having to be refiled with letters of explanation [Yuch].
Example: You are doing several extractions, bone grafts, sinus lift, implants, abutments, crowns. You give the patient a tx plan and begin treatment. Ideally, I would like to charge all the charges to the patient's account up front, so the patient and I and my staff can see at a glance at any point in time, what the patient's balance is toward the tx plan. The only way to do that currently is to mark all the procedures complete up front, which is an oxymoron, contradiction, paradox. You are saying they are complete when they are not.
All the other work arounds you suggested are equally cumbersome. Creating dummy codes with charges, and deleting them at the end is susceptible to different errors and confusions.
Keeping the procedures in "Tx Plan" status and only marking them "Complete" when they are actually complete, makes it very difficult to look at the patient's Account or statement and figure out where they stand financially.
A status of "InTreat" would solve all these problems, though I can imagine, as you say, it might present other problems.
Couldn't "InTreat" be considered identical to "Complete" for all financial transactions and math. Changing the status from "TxPlan" to "InTreat" would be like going to "Complete" financially. Changing the status from "InTreat" to "Complete" should have no effect on the math. The only difference between "InTreat" and "Complete" would be to prevent it from showing up as an "Unsent" insurance procedure that needs to be sent. The "InTreat" procedure status should have a corresponding "InTreat" claims status which can't be sent to an insurance company. Once the procedure status changes to "Complete", the claim status should change to "Unsent" so a claim can be generated.
I'm not a programmer, and I don't know how difficult this would be, but it seems so logical. I am sure the incredibly talented programmers at OD could make this work. OD is and should continue to be the best PMS out there.
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
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Re: Reminders for different phase of treatments

Post by Yorek » Tue Feb 15, 2011 4:22 am

Hersh,
We all seem to be on the same page but have slightly diff requirements.

It's obviously important to be able to distinguish between Proposed.. Started.. Complete Treatment.

Variables:
1) When to charge a patient's account..
More important in especially large complex restorative cases,
not small ones like single Cr's or dentures.

2) When to 'be able' to send to insurance..
Usually A) impress date or B) seat date.
Varies by insurance plans.


So we need some flex ability built into whatever system is done.
Perhaps something like..
For Simple Cases:
Start = Charge patient = Mark insur 'unsent' and can send anytime.. not too much confusion

For Large Cases:
1-Tx Plan= not charged to pt, cannot send insur claim.
2- Start procedure = charge patient account
Then we need an extra button for 'Insur Status Option':
A) 'mark ready to send' = (unsent) or
B) 'mark Hold till complete'..
When marked 'Complete' this automatically changes status to 'Unsent'
Both situations will now show up in any of our reports.

Another thing I've been thinking that to reduce confusion even more, especially on large cases
would be to.. Modify Account module. like this..
1) make the text of unsent treatment BOLD BLACK.."
unsent" just seems to get lost in with the other text, just see the difference this line and above.
2) have an options to "Show only unsent Tx" some sort of check box at the top.

"Due Now" modifications to patient billing are even more beneficial with large cases.
You can decide how much is DUE NOW at any time during treatment without affecting total charges.
Maybe even set up recurring charges at a fixed amount each billing cycle.. lots of options.

Any of these modifications will be appreciated.

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Re: Reminders for different phase of treatments

Post by jordansparks » Tue Feb 15, 2011 3:19 pm

1813 has been approved.
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Hersheydmd
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Tue Feb 15, 2011 5:45 pm

Yorek,
Good points. I agree that the most beneficial point would be to have a new procedure status that would allow the pt's account to be charged the same as a "completed" procedure.
When to file insurance varies by the case and the ins. plan, but OD shouldn't have to figure out if it is a simple or complicated case. Simply changing the status to complete (on the impression date or the seat date, whichever), would allow a claim to be created.

You know, currently if you click on procdures in the Account Module that have already been filed, and you try to create a new claim, you get a warning pop-up that says "Not allowed to send a procedure to the same inurance company twice."Same if you click on a procedure that is marked "(NoBillIns), you get a pop-up that says "Not allowed to send procdures to insurance that are marked 'Do not bill to ins'."
The same thing should occur with procedures that are started but incomplete. Instead of "Unsent" displayed next to the procedure, it should say "Intreat" and you should get a pop-up that says "Not allowed to send incomplete procedures to insurance."
That is really the jist of it. It doesn't have to be any more complicated than that. You want to send the claim in at the impression date, just change the status to complete on that day. It shouldn't have any effect on OD math. All it should do is unlock the ability to send to insurance. It can be very simple and automatic and shouldn't require you to mark or unmark any other checkboxes.

With regard to setting up different due dates for different phases of treatment, what I do is create different treatment plans for the different phases of treatment, and I tell the patient x% is due at the beginning, middle, or end of each phase. It is totally customizable. You can also set up payment plans, within OD, if you want.

Time to go check out 1813 and vote on it. Unfortunately, all I have left is about 13 votes.

Regards,

Rob
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
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Re: Reminders for different phase of treatments

Post by jordansparks » Wed Feb 16, 2011 8:46 am

For the math to work, the claim has to be created immediately after the procedure is added to the Account. The claim will have a special "In Treatment" status to keep it from being sent.
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Hersheydmd
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Thu Feb 17, 2011 1:52 pm

jordansparks wrote:For the math to work, the claim has to be created immediately after the procedure is added to the Account. The claim will have a special "In Treatment" status to keep it from being sent.
Jordan,
Couldn't the "InTreat" procedure status mimic the "Completed" status in that the claim would be created, but with the special "in Treatment" status, as you said. Changing the status later on to "Completed" would just change the claim status from "in Treatment" to "Unsent" and not create a new claim. Then the math wouldn't be affected.
Am I reaching for the stars?
Rob
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
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Re: Reminders for different phase of treatments

Post by jordansparks » Fri Feb 18, 2011 5:48 pm

There isn't going to be an "InTreat" status. The status will be Complete. There will be an additional flag that shows that it's still "InTreat". We can't add another status without messing up the math.

Right, you wouldn't create another claim. You would just send the claim that was created earlier.
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Hersheydmd
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Fri Feb 18, 2011 7:58 pm

Got it.

Final Questions.
1) While the procedure is flagged, will it show up next to the procedure description in the Account Module (in the same way that "Unsent" and "NoBillIns" shows)?
2) It is easy to tell when there are procedures that need to have their status updated from TxPlan to Complete - they are red in the Chart Module and they show up in the Tx Plan module and they show in the Appointment Edit window. Would there be any obvious reminder, or way to tell that there are flagged procedures that need to be unflagged? So they aren't forgotten, out of sight way up at the top of the Account window?
3) When you open a procedure edit window to unflag the procedure, can there be a command button (like Set Complete) to update the date to the current date? If the flagged procedures would continue to show in the Appointment Edit window, it would be easy to link the procedure to the seat or impression date appointment, when that time finally arrives.
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
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Re: Reminders for different phase of treatments

Post by mfdental » Thu Jun 07, 2012 10:43 pm

This thread is over a year old, but I would like to go into further details:
My main issue is very similar to Hersheydmd...
My patients pay their full co-pay on the day of crown prep, and I do not want the account module to show the crown co-pay as a credit on their account.
So I set the crown to complete on the day of the crown prep, and start a new claim without submitting it. Then when the patient pays their copay, it shows their balance as zero so everyone is happy.
This is a work-around, but its much better than having the patient have a $500 credit, and then their wife comes in, does $500 worth of fillings, and the receptionist tells them they have no co-pay since they have the credit.
Its also better than creating a dummy code, because you'd have to delete the dummy code every time you complete the procedure, or you end up double charging the patient.

(BTW, request #1813 is totally unnecessary. I know another way to prevent you from accidentally sending the claim before crown delivery. When you go to the procedure info section, there is a "Prothesis Replacement" box. If you leave it checked as No, then open dental will give you a warning if you try to send the claim: "Cannot send claim until missing data is fixed: PFM Prosthesis". When I cement the crown, I go back to the "Prosthesis Replacement" box and check either initial or replacement with the original date.)

So here is my current issue with setting the procedures complete on the day of crown prep... it SCREWS with your reports.
I have to do monthly reports to BoA practice finance, with production, collection, etc, and this method artificially inflates your production numbers. I'm going to use mock numbers to show why:

Crown treatment planned for $1000, with 50% insurance coverage
5/25/12 - crown prep, marked crown as complete, and start new claim without sending claim. Make patient pay $500 copay. Patient balance = 0. Insurance balance = 500.
5/31/12 - run production report for May. Production is 10,000 + $1000 crown = $11,000 total production on the report.
6/10/12 - crown delivery. I print the claim from 5/25/12, and whoops. The procedure's date is 5/25/12. I cannot send the existing claim, because it states that crown was delivered on 5/25/12. Therefore, I delete the claim, and then change the date of the completed crown code from 5/25/12 to 6/10/12. Then I create a new claim, and now it shows 6/10/12 on the claim, so I can submit the claim now.
6/31/12 - run production report for June. Production is 15,000 + $1000 crown = $16,000 total production on the report.
run production report for May again. Production is now ONLY $10,000, because I changed the date of that $1000 crown to June.
So the problem is that I already submitted the report to the bank in May as a $11,000 production, but in reality the production in May was $10,000.

Is there a way around this issue?

Thanks,
Jason

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Re: Reminders for different phase of treatments

Post by jordansparks » Fri Jun 08, 2012 9:00 am

Where did it say on your claim that the crown was delivered on 5/25/12? The procedure date was 5/25/12 because the treatment was substantially completed on that date. It's perfectly fine to send the claim on 5/25 with a proc date of 5/25. I would say that the majority of dentists bill and send the claim on prep date. That's what we recommend in our manual.
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Re: Reminders for different phase of treatments

Post by mfdental » Fri Jun 08, 2012 9:52 am

Oh really? I never knew that. I had always assumed that you had to send claims for crowns on delivery date. If its legal to send it on prep date, then I'm fine doing it that way, and not changing the dates on the procedure.
Thanks for the tip Jordan!

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Re: Reminders for different phase of treatments

Post by jordansparks » Fri Jun 08, 2012 10:11 am

Jordan Sparks, DMD
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Hersheydmd
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Fri Jun 08, 2012 4:56 pm

mfdental wrote:Oh really? I never knew that. I had always assumed that you had to send claims for crowns on delivery date. If its legal to send it on prep date, then I'm fine doing it that way, and not changing the dates on the procedure.
Thanks for the tip Jordan!
I don't think that is true. At least around here, most of the plans I deal with want the crown in the patient's mouth before they will pay. A few allow you to submit on the impression date. Very few on the prep date.
Robert M Hersh DMD, FAGD
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Re: Reminders for different phase of treatments

Post by jordansparks » Fri Jun 08, 2012 6:15 pm

So if you submit a claim for a crown, how do they know whether the date is prep or seat? Do you state so in the notes?
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irfan
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Re: Reminders for different phase of treatments

Post by irfan » Mon Jun 11, 2012 10:49 am

you can send the claim however you want the insco will likely never know, however if they audit you and find out you were submitting on prep date not seat date, and this affected end of year benefits for patients, you can be in hot water. an "in progress" status that creates a claim , but doesnt allow it to be sent until completed, would take care of this. configurable so you can send on prepdate if you want, based on insco rules, would take care of that problem too- it would be an option you set in their plan, much like if composites get downgraded.

regarding BoA practice connection, they arent auditing, it doesnt matter if your previous months reports were off a bit due to a crown prep.

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Re: Reminders for different phase of treatments

Post by mfdental » Tue Jun 12, 2012 5:49 am

Alright, I figured that was so... So how do you guys bill for crowns on open dental then? The only way I know how is the way I just showed you guys... After delivering the crown, I have to delete the pending claim which was linked to the prep date, change the date of the procedure to the delivery date, and then resubmit the claim... This is starting to get annoying, especially since I'm getting busier and doing more crowns now.

I think it would be simpler to just enable us to change the actual dates on the submitted claim without changing the date of the procedure. That way the date of completion stays on the prep date, but the claim shows the date for the delivery date. Is it possible to do this Jordan? I tried changing the dates on the claim, but it was locked out...

Regardings BoA, that's only part of the issue... I track my numbers constantly, and its annoying to see my monthly production constantly change, even though the month is over already.... With my method, I cant accurrately track the current month production accurately... I have to wait a few months afterwards and make sure all the crowns/bridges/dentures that were started that month had been delivered and had their dates changed to the delivery date....

Also, this is impossible to track bonuses... since it will give the staff an artificial production number for that month, since it will eventually be lower after I change the dates over...

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Re: Reminders for different phase of treatments

Post by mfdental » Tue Jun 12, 2012 5:56 am

jordansparks wrote:So if you submit a claim for a crown, how do they know whether the date is prep or seat? Do you state so in the notes?
Jordan, I think it is understood from the insurance point of view that the date is on seat. I was always under the assumption that claim has to be sent on delivery date from all the doctors I've worked with in Massachusetts...

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Re: Reminders for different phase of treatments

Post by jordansparks » Tue Jun 12, 2012 8:49 am

I think date of service for the claim as a whole needs to match date of service for the individual procedures.
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Re: Reminders for different phase of treatments

Post by Pruce Dental » Tue Jun 12, 2012 9:55 am

Hersheydmd wrote:
mfdental wrote:Oh really? I never knew that. I had always assumed that you had to send claims for crowns on delivery date. If its legal to send it on prep date, then I'm fine doing it that way, and not changing the dates on the procedure.
Thanks for the tip Jordan!
I don't think that is true. At least around here, most of the plans I deal with want the crown in the patient's mouth before they will pay. A few allow you to submit on the impression date. Very few on the prep date.

read line item 53 on the American Dental Association claim form...
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Re: Reminders for different phase of treatments

Post by jordansparks » Tue Jun 12, 2012 11:01 am

It says, "...This is the dentist who performed, or is in the process of performing, procedures, indicated by date... ...Dentists should be aware that they have an ethical and legal obligation to refund fees for services that are paid in advance but are not completed."
I interpret this as saying it's OK to submit for crowns or dentures once you reach the point where you've sent impressions to the lab for final fabrication. All that's left is the delivery appointment. Nearly all costs have already been incurred and treatment is substantially complete. I'm not an attorney, but I've heard anecdotal stories of successful judgements against patients for prostheses that were fabricated but never delivered.
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Sun Feb 03, 2013 2:24 pm

mfdental wrote:So how do you guys bill for crowns on open dental then? The only way I know how is the way I just showed you guys... After delivering the crown, I have to delete the pending claim which was linked to the prep date, change the date of the procedure to the delivery date, and then resubmit the claim... This is starting to get annoying, especially since I'm getting busier and doing more crowns now.
I hear your pain, because we used to do something similar.
We called several insurance companies and local union plans and the majority want the date the prosthesis was delivered to the patient. Since it is too much trouble to remember the few that will allow submission on prep or impression date, we submit all claims on the delivery date.
Here is how we do it:
We set up additional codes with fees for Prep(N9990), Impression(N9991), and Delivery(N9992)
When we tx plan a crown/denture/bridge, we also tx plan a Prep, an Impression, and a Delivery procedure.
The fee attached to the crown/denture/bridge is the full fee. It is not marked complete until the delivery date.
The fee for the prep visit is 1/3 of the total fee. It is marked complete on the prep date, the patient owes that amount, and I also use that procedure box to enter my clinical note for that visit.
Same thing for the Impression. 1/3 of the total fee is added to the ledger. (If you prep & impress on the same visit make it 1/2 or 2/3, however you like).
The fee for the delivery visit is entered as a negative number, i.e. minus the sum of the 2/3 that was previously posted. (Yes you can set up procedures with negative numbers, it keeps everything clean & simple and is better than entering Adjustments)
On the delivery visit both the Delivery (minus 2/3) and the actual procedure (full fee) are marked complete. The ledger will reflect that the patient owes the final 1/3 of the fee.
The Prep, Impression, and Delivery codes are setup as "Do Not Bill to Ins", so the insurance company never sees them.
The actual procedure, with the full fee, is set complete on the delivery date and that is what is filed with the insurance company.

Since we started doing it this way my front desk is much less confused. They know how much the patient owes to date. That makes it easier for them to keep the patients' accounts current. Our accounts receivable number is a much better reflection of what is actually outstanding, rather than including money that is not due yet.
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Re: Reminders for different phase of treatments

Post by boboffice » Tue Feb 05, 2013 8:28 pm

Pruce Dental wrote:
Hersheydmd wrote:
mfdental wrote:Oh really? I never knew that. I had always assumed that you had to send claims for crowns on delivery date. If its legal to send it on prep date, then I'm fine doing it that way, and not changing the dates on the procedure.
Thanks for the tip Jordan!
I don't think that is true. At least around here, most of the plans I deal with want the crown in the patient's mouth before they will pay. A few allow you to submit on the impression date. Very few on the prep date.

read line item 53 on the American Dental Association claim form...
CEREC solves all that!
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Tue Feb 05, 2013 9:51 pm

boboffice wrote: read line item 53 on the American Dental Association claim form...
That doesn't prove anything. All that line means is that your signature is valid whether the work is in progress or completed. It doesn't mean the insurance company will agree to pay for work that is still in progress.

Example:
1)Delta Dental Utilization Review Guidelines 1/1/13 specifically states:
Page 19 Regarding crowns: "Benefits are payable when the treatment is complete. For crowns, this is on the insertion/cementation date of the permanent crown, not the date of preparation."
Page 38 Regarding dentures: "Benefits are payable on the date the denture is delivered."
https://www.deltadentalrionline.com/Pub ... elines.pdf

"Interestingly enough, some dental teams we talk to assume all carriers pay on the prep date and others assume all carriers pay on the seat date. Yet, when we polled over 50 dental carriers, we discovered that about half pay crowns based on the prep date and the other half pay on the seat date. In reality, it is the employer contract that identifies the carrier’s liability date for paying multi-visit procedures. While most carriers try to keep all of their employer contracts consistent (i.e., either all Guardian plans paying on the prep or all Delta of Iowa plans paying on the seat), you may find carriers that have some of each. In other words, you may have one MetLife plan contractually obligated to pay crown claims based on the prep date and another MetLife plan contractually obligated to pay crowns based on the seat date."
"Technically, a crown, onlay, bridge, etc., has not been completed until it has been seated. However, based on the language on the current ADA claim form, carriers do not know if the date of service represents the date the crown was prepped or the date that it was seated unless it has been specifically noted on the claim form. Some carriers will automatically assume that dental offices are billing upon completion, interpreting the service date as the seat date. This can cause problems for offices that routinely bill crowns on the prep date. If a carrier assumes the service date provided on the claim is the seat date and pays the claim based on that assumption . . . you may find yourself having to refund money if the carrier later discovers that its plan was not in effect at the time of the seat."
http://www.dental-ins-solutions.com/is/ ... sampleid=2
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Re: Reminders for different phase of treatments

Post by Rickliftig » Wed Feb 06, 2013 4:23 am

Rob - we are in the middle of this conundrum on two patients at this very time (pardon the thread drift for a moment):

Both patients had endo tx in 2012. A provisional crown was placed and the final crown was cemented in 2013. At the New Year, both patients had switched insurance plans. The 2012 plan paid on the date of insertion and the 2013 plan on the day of preparation. Totally backwards.

We are pursuing this and have asked the patients to pursue this with their HR departments. It may very well end up in the State Insurance Commissioner's office

Just serving as a heads up to anyone reading the thread.

Rick
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Re: Reminders for different phase of treatments

Post by Hersheydmd » Wed Feb 06, 2013 1:19 pm

Rickliftig wrote:Rob - we are in the middle of this conundrum on two patients at this very time (pardon the thread drift for a moment):

Both patients had endo tx in 2012. A provisional crown was placed and the final crown was cemented in 2013. At the New Year, both patients had switched insurance plans. The 2012 plan paid on the date of insertion and the 2013 plan on the day of preparation. Totally backwards.

We are pursuing this and have asked the patients to pursue this with their HR departments. It may very well end up in the State Insurance Commissioner's office

Just serving as a heads up to anyone reading the thread.

Rick
Oh boy. What a headache!
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Univ. of Penn 1982
Brooklyn, NY 11234
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