Discounts do funky math

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irfan
Posts: 216
Joined: Thu Oct 21, 2010 9:09 am

Discounts do funky math

Post by irfan » Wed Feb 25, 2015 6:09 am

On a $1000 procedure with no write off, it works. A 50% discount will give a net of $500.

On a PPO fee its screwy. Say I have a $1000 procedure with a 0 insurance payment but a $300 writeoff (yes, in Ohio a PPO can knowck down your fee and pay 0 themselves)... in this situation if I wanted to discount more for a 50% total discount, I cant just punch in 50%... if I do that I get:

$1000 fee minus $500 discount minus $300 writeoff = $200 net.

I feel like the discount button should give me a $500 net for a 50% discount.. would be nice if it realized 300 was already being written off and then added an extra $200 to still give a 500 net.

Or just discount the patient portion an even amount and then I can atleast see before than the pt portion is $700, and I can give an extra 29% discount and the math works out. The insurance company isnt paying a dime in this situation anyways, im just discounting services more to the patient.

allends
Posts: 235
Joined: Fri Aug 23, 2013 11:29 am

Re: Discounts do funky math

Post by allends » Wed Feb 25, 2015 7:07 am

The current treatment plan discount feature isn't designed to work with PPO plans. It would be a feature request to add this functionality.

I am not sure about the legality of that feature in all states though. Adding a feature that discounts contractual PPO fees, regardless if the insurance company is paying or not, seem like it could be unsafe.
Allen
Open Dental Software
http://www.opendental.com

cchindmd
Posts: 4
Joined: Sun Feb 22, 2015 8:37 pm

Re: Discounts do funky math

Post by cchindmd » Wed Feb 25, 2015 9:12 pm

Can you actually discount a patient portion? If the PPO audited you and found that they would request money back. Of course in this case they paid nothing but who knows what they would do. If the insurance is going to pay nothing can you just not submit it? I'm sure that would tick them off too... just thinking out loud.

sam-I-am
Posts: 85
Joined: Thu Aug 16, 2012 7:58 pm

Re: Discounts do funky math

Post by sam-I-am » Thu Feb 26, 2015 11:54 am

In other states, they have made illegal these types of fee setting by insurance companies, when they aren't paying any of the bill....time for some political action by your state dental society.

Sam Barr

spsheffield
Posts: 19
Joined: Sat Feb 11, 2012 6:30 pm

Re: Discounts do funky math

Post by spsheffield » Fri Feb 27, 2015 1:40 pm

The problem is that Open Dental does not apply the discount to the fee billed to the insurance company, which is what is required if you are going to give a discount to anyone who has insurance, in-network or not. If you bill insurance one fee, then discount the patient portion after insurance has paid, then that is insurance fraud, and Open Dental really is configured to make it very easy to commit insurance fraud, because there is no way to use the discount feature to change the fee that is billed to the insurance company. You have to manually change the procedure fee before the claim is created. It would be GREAT if Open Dental realized how big of an issue this really is, and made a way for us to easily discount the fee charged to the insurance company. While this is not an everyday occurrence, there are plenty of times I would like to do this, and it would be nice to discount the fee rather than change the fee so the patient can see that the fee was discounted when we print out a statement.

tgriswold
Posts: 122
Joined: Fri Jun 07, 2013 8:52 am

Re: Discounts do funky math

Post by tgriswold » Wed Apr 01, 2015 11:05 am

This feature was initially developed for offices with cash only patients. We have updated the documentation in our manual to reflect this http://opendental.com/manual/treatmentp ... ounts.html.
The discount feature is intended for use with cash only patients and is not currently programmed to interact with insurance. Use this feature only if you know it complies with your local laws. Laws vary between regions and Open Dental does not differentiate legal and non-legal use of the program. For example, we have been told that it may be illegal to use different fee schedules for cash only patients vs. insured patients.
Travis Griswold
Open Dental Software
http://www.opendental.com

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