category percentage vs PPO percentage

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category percentage vs PPO percentage

Postby enamelrod » Mon Sep 10, 2018 12:49 pm

Can some one please explain to me why OPEN Dental does not recommend using category percentage
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Re: category percentage vs PPO percentage

Postby cmcgehee » Mon Sep 10, 2018 2:59 pm

We recommend using category percentage for an insurance plan that you are not in network with. We recommend using PPO play types when you are in network with a carrier. In this situation, PPO is better than category percentage because PPO will calculate write-offs on procedures where you are contractually obligated to reduce your fees.
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Re: category percentage vs PPO percentage

Postby enamelrod » Tue Sep 11, 2018 8:20 pm

SO if I dont want to track write offs I need to use category percentage for all of my insurance plans.
The production number and collection number are always so far off because of the this write off value.

Are there any negatives to using category percentage for my in network insurances

If I have a contracted amount thats all I am going to get reimbursed the write off is phantom money it does not exist! whats the point of tracking it?
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Re: category percentage vs PPO percentage

Postby enamelrod » Tue Sep 11, 2018 8:20 pm

SO if I dont want to track write offs I need to use category percentage for all of my insurance plans.
The production number and collection number are always so far off because of the this write off value.

Are there any negatives to using category percentage for my in network insurances

If I have a contracted amount thats all I am going to get reimbursed the write off is phantom money it does not exist! whats the point of tracking it?
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Re: category percentage vs PPO percentage

Postby cmcgehee » Mon Sep 17, 2018 9:12 am

There are several benefits to tracking writeoffs:
1) It helps you decide if you want to drop a carrier that you are in network with. If after a couple years, you find that Carrier X is only paying you 30% of your UCR fees, it might save you money to stop accepting patients from that carrier.
2) When using PPO, you can bill the full amount to insurance while still having accurate patient portion estimates. The reason why you want to bill the full amount to insurance is because the insurance company will use the information from offices UCR fees when calculating fee schedules the next year.
3) Patients can see that they are getting a discount. Generally, people are more willing to pay $50 on a procedure when they see that it originally cost $500.

When you are looking at your production numbers, you'll want to look at net production since that will take writeoffs into account.
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Re: category percentage vs PPO percentage

Postby enamelrod » Wed Sep 19, 2018 5:15 pm

so you cant send your UCR fee on a category percentage insurance claim?
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Re: category percentage vs PPO percentage

Postby cmcgehee » Thu Sep 20, 2018 8:06 am

It depends on how you have your fee schedules set up on the insurance plan. Suppose your UCR fee on a procedure is $100, the PPO allowed price is $60, and insurance covers 80%. If you attach a fee schedule to your insurance plan and enter $60 for the procedure, then the procedure fee will be reduced to $60 and the patient portion will be correct at $12. But now when you bill the claim, the fee billed will be $60. Alternatively, you could choose to not attach a fee schedule to the plan. The procedure fee will remain $100 which will calculate the patient portion as $20. But in this setup, you will be able to bill your UCR fees to insurance.
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Re: category percentage vs PPO percentage

Postby Jorgebon » Fri Sep 21, 2018 5:42 pm

You can also send your standard fees on the claim to the insurance if in the Edit Insurance Plan window you select "Claims show UCR fee, not billed fee".
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