Accurate A/R

[djanash@mac.com]

Hi Everyone, here we go....

A VERY large dental facility I recently acquired accepts many PPO and Union Plans (No medicaid). We use 1 fee schedule to bill everyone and have an inflated "Outstanding insurance claims" $$ amount.
e.g.
Insurance A, We send out $1500 for a crown, get $400, write off the difference
Insurance B Ditto... get 800, write off the rest. The little box to send out the higher fees instead of the contracted insurance fees is checked

The write off amount is HUGE! It isnt a problem for me, since I look mostly at collections and have a general sense of A/R. Now our accountant is saying we need to go to accrual basis reporting and needs an accurate A/R. Obviously a necessary change and figure needed for the office.

After speaking with some people and mulling it over, we have decided to bite the bullet and go ahead and enter about 200 fee schedules into OD. We just started yesterday.
Heres the problem, the "Outstanding insurance claims" report still shows the same $1500 per crown number even though the lower fees have been entered for plans A and B.
I know it will take time to actually rinse these inflated fees out of our system but why do they still show up at the office rate? and how or where can I calculate what the actual A/R from insurance will be after we enter all the fee schedules. It seems the inflated numbers will always be there and I'll have to mine for additional figures

Maybe we are entering things wrong? HELP!

[bpcomp]

Do any new claims still have the old rate or is it just the outstanding claims? If it is just the outstanding claims then OD is functioning correctly. $1500 was the rate you sent out the door and that amount will (and should) be fixed unless you modify or delete the claim. I think at this point, your accounting will get "clean" after all the fee schedules have been entered and all outgoing claims are correctly using fee schedules AND ALL outstanding claims that were sent out without the proper fee schedules have come back.

In short, newly entered fee schedules only effect accounting for newly created claims. Any outstanding claims will reflect the numbers at the time that the claim was sent.

[djanash@mac.com]

Do any new claims still have the old rate or is it just the outstanding claims? If it is just the outstanding claims then OD is functioning correctly. $1500 was the rate you sent out the door and that amount will (and should) be fixed unless you modify or delete the claim. I think at this point, your accounting will get "clean" after all the fee schedules have been entered and all outgoing claims are correctly using fee schedules AND ALL outstanding claims that were sent out without the proper fee schedules have come back.

In short, newly entered fee schedules only effect accounting for newly created claims. Any outstanding claims will reflect the numbers at the time that the claim was sent.

The issue isnt waiting for things to "rinse out", it's that the numbers will always reflect the higher fees in the outstanding insurance claims report. Technically (according to Nathan @ open dental), the fee expected for that crown is 1500 until I get a check from the ins co. What Im looking for is a way to know what it will be ASSUMING the insurance will pay what it should based on coverage tables. Nathan mentioned some math I'd have to do but I cant seem to figure it out.

[jordansparks]

You would need a report that shows (fee-WO) instead of just (fee) for the pending procs. Right? It seems like there ought to be some reports like that on our query examples page.
http://70.90.133.65:1942/ODQueryList/QueryList.aspx
After adding the writeoff filter on that page, I get 32 results. One of those might be a match for what you need. If not, then we can write a query for you for a few hundred dollars.

[atd]

Sorry I didn't post this earlier, haven't had much time to read the forum lately. I created a custom query for this years ago that we still use. In order for this to be accurate a month-end, we had to turn off the automatic updating of the aging date and manually update it as needed. I also included a column for the negative balances per our CFO's request. Here's the query:

DROP TABLE IF EXISTS tempins;

CREATE TABLE tempins(
Claim mediumint unsigned NOT NULL,
Guarantor mediumint unsigned NOT NULL,
Writeoff float(2) NOT NULL,
Estimate float(2) NOT NULL,
PRIMARY KEY (Claim));

INSERT INTO tempins
SELECT claimproc.ClaimProcNum, patient.Guarantor, SUM(claimproc.WriteOff), SUM(claimproc.InsPayEst+claimproc.InsPayAmt-(claimproc.InsPayEst*claimproc.Status))
FROM preference, claimproc
LEFT JOIN patient ON claimproc.PatNum=patient.PatNum
WHERE preference.PrefName='DateLastAging'
AND ((claimproc.Status=0 AND claimproc.ProcDate<=preference.ValueString) OR (claimproc.Status=1 AND
claimproc.ProcDate<=preference.ValueString AND claimproc.DateCP>preference.ValueString))
GROUP BY patient.Guarantor;

SELECT CONCAT(p.LName,', ',p.FName,' ',p.MiddleI) as 'Guarantor'
,p.Bal_0_30 as '$0-30 Days .',p.Bal_31_60 as '$31-60 Days .', p.Bal_61_90 as '$61-90 Days .',p.BalOver90 as '$> 90 Days .'
,(CASE WHEN p.BalTotal<'-.005' THEN p.BalTotal ELSE (p.Bal_0_30 + p.Bal_31_60 + p.Bal_61_90 + p.BalOver90) END) as '$Total .', tempins.Writeoff as '$Writeoff .', tempins.Estimate AS '$InsEst .',
((CASE WHEN p.BalTotal<'-.005' THEN p.BalTotal ELSE (p.Bal_0_30 + p.Bal_31_60 + p.Bal_61_90 + p.BalOver90) END)-(CASE WHEN tempins.Writeoff IS NULL THEN 0 ELSE tempins.Writeoff END)-(CASE WHEN tempins.Estimate IS NULL THEN 0 ELSE tempins.Estimate END)) as '$Patient .',
(CASE WHEN ((CASE WHEN p.BalTotal<'-.005' THEN p.BalTotal ELSE (p.Bal_0_30 + p.Bal_31_60 + p.Bal_61_90 + p.BalOver90) END)-(CASE WHEN tempins.Writeoff IS NULL THEN 0 ELSE tempins.Writeoff END))< '-.005' THEN ((CASE WHEN p.BalTotal<'-.005' THEN p.BalTotal ELSE (p.Bal_0_30 + p.Bal_31_60 + p.Bal_61_90 + p.BalOver90) END)-(CASE WHEN tempins.Writeoff IS NULL THEN 0 ELSE tempins.Writeoff END)) ELSE NULL END) as '$Neg. Bal.'
FROM patient p
LEFT JOIN tempins ON tempins.Guarantor=p.PatNum
WHERE (p.Bal_0_30 > '.005' OR p.Bal_31_60 > '.005' OR p.Bal_61_90 > '.005' OR p.BalOver90 > '.005' OR p.BalTotal < '-.005')
GROUP BY p.PatNum /*this is the guarantor, not the patient*/
ORDER BY p.LName,p.FName;

DROP TABLE tempins;