Fee Schedule Update Service....

[opensource]

Hello Team,

Maybe I am losing it .

I am being told that the Insurance Carrier Fee Schedule changes without notice to the dental office (you can tell, I am not a dental guy )

I am sure that there are thousands of dentist and X number of insurance carriers and 'Y' number of fee schedules.

If I am a dental office, How often should I be keeping a check on the Fee Schedule and update them ?. We are signed up with about 10 major carriers (Metlife, Cigna, etc)

Would it not be possible for some kind of a XML or any other service (maybe a simple XLS version of the fee schedule from the carriers) that can be downloaded and then imported in the Practice Management Software

I am sure I am missing something here....but it is frustrated that my office staff tells me that we have to make adjustments since the carrier changed their fee schedule. What am I missing here ?

Cheers,

OpenSource

[cneelley]

I don't know of any service that just does what you are wanting. Insurance answers plus includes as many fee schedules in their program as they can get, and will attach it to the employer plan.

The best thing to do is to "Always" send your UCR fees to the insurance company. In insurance plan, check the send ucr button. That way you will always get the max the insurance company will pay, and you can compare that payment to the fees you are charging to see if there is an updated fee schedule, and you can see if you are using the right fee schedule. I find that insurance companies like Metlife, Aetna, Cigna, etc are pretty good about yearly fee schedule increases and will send the schedule out well in advance of when it is effective. However, they don't have to. And keeping up with all of the various plans is an impossible task. We just do the best we can given the limited info the insurance companies provide. I think it is a crime.

As a side note, it is the patient's insurance company and it is their responsibility to provide the appropriate fee schedule. Unfortunately, that is not how it works in the real world.

Dr. Neelley

[jordansparks]

Our long term plan is to keep a database of these fees on our server, and have all of our users automatically populate that database with fees as payments come in. Then, have those fees go back out from our database to each office. The huge problem with making this work right now is that there is no unique identifier for insurance plans. This might be changing soon, as each plan might have to obtain a unique plan id number. This would greatly simplify the automation of centralized fee schedule tracking. But even if it doesn't happen, we can still make this automation work. As I always like to say, "There's a technical solution to every problem." And now that we have our server reliably automating the update process, it's just a matter of time before we expand into fee schedules, language translation, forms, and all kinds of other data that it makes sense to share among offices.

[Jorgebon]

There's also a problem in that the same plan can have different fee schedules depending on the zip code of the dentist.
Jorge Bonilla, DMD

[jordansparks]

Forgot about that.