Is this a Glaring omission

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enamelrod
Posts: 462
Joined: Tue Jul 24, 2007 9:51 am

Is this a Glaring omission

Post by enamelrod » Thu Oct 10, 2013 7:26 am

Did I miss something?


Is there a way to see the insurance plan notes and or the patient insurance notes anywhere else other then the family module.

It would seem that this very important information would be visible in other modules such as the treatment planning module and the chart module.

There needs to be a place to warn staff when there is a waiting period. the pop op feature is not really a solution its a band aid. clinical staff spend very little time in the family module. this information is veryimportant to getting paid and needs to be readily visible. I would even say that you should be able to set a major waiting period date in the future and OD would inform people who schedule those proceedures there is a waiting period. This is the third time this month that a patients insurance payment was denied because of a waiting period. How are others dealing with this.

MKM
Posts: 30
Joined: Wed Mar 16, 2011 4:07 am

Re: Is this a Glaring omission

Post by MKM » Thu Oct 10, 2013 12:55 pm

We put anything a clinical person has to know about that patient in service notes. You are right, a clinical person is not going to click open the family module unless they are looking for something specific.
In addition, I would think your front desk should flag these people with unusual insurance situations and give your clinical team a heads up at the morning huddle. The pop up function works to a degree, but it is simply too easy to override to put anything important there.
We also will set all the insurance percentages to zero percent so when you treatment plan something you will question why insurance isn't paying, click on the family screen, and there you can have a big note regarding the wait period.
I believe though, that the really important stuff your clinical staff needs to see has to be in front of their nose..put it in service notes and train them to read them each and every time they access a patient's chart.
Mary Kay
Practice Administrator
Medina, Ohio

enamelrod
Posts: 462
Joined: Tue Jul 24, 2007 9:51 am

Re: Is this a Glaring omission

Post by enamelrod » Fri Oct 11, 2013 6:17 pm

1. its something that needs to be addressed from the software side also
2. front desk told the clinical , pt rescheduled and was 3 days shy of waiting period when they were rescheduled.
3. we use pt service notes for creature comforts
4. if you 0 out the insurance coverage does that not affect everyone on that insurance..in our case husband was the subscriber had no wait and the wife did have a wait.
5. it does need to be in front of the clinical pt nose its called put the insurance plan notes and pt insurance notes in the chart module!!!!!! It needs to be right under where it says primary insurance! and the training comment i know you mean well but that not what im getting at, it was the clinical staff who brought it to the fore front of this discussion. they caught it but a financial plan had been arranged based on coverage that was not there. the pt paid their portion of the 6000 treatment plan all of the dental work was completed but the wife had a waiting period so we did not receive all of the estimated 1500 insurance benefit.

MKM
Posts: 30
Joined: Wed Mar 16, 2011 4:07 am

Re: Is this a Glaring omission

Post by MKM » Tue Oct 15, 2013 7:44 am

In my office, restorative treatment is planned clinically, and then the patient talks to my front desk, who are the insurance experts, for an Financial Arrangement and to schedule.
I guess my question is who in your office developed a treatment plan and financial arrangement without looking at available benefits? IMHO, That is the real problem.
Mary Kay
Practice Administrator
Medina, Ohio

enamelrod
Posts: 462
Joined: Tue Jul 24, 2007 9:51 am

Re: Is this a Glaring omission

Post by enamelrod » Wed Oct 16, 2013 6:22 am

your missing my point insurance expert.the chart module has the primary and secondary insurance listed why not the insurance notes here also, so you dont have to look for it. It should also be printed on the treatment plan so it is visible to everyone!

the event occured because of an unusual situation. husband is the guarator he has no waiting period wife did. it was in the family module notated but was missed because when you print the insurance out for treatment plan presentation OD show the person as having insurance when they actually do not. The patient financial arrangement was based off the insurance calculations which obviously are wrong because they had a waiting period. The patient paid their portion but the expected portion from the insurance was wrong. If you look on the guarantors plan there is no waiting period but on his wife who is also on the same plan there is a waiting period. This information is in one box under the patients insurance note. THIS note needs to be more visible.

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