Dentrix Fee Schedule Problems and Solutions

I get many clients asking me how I recommend billing for PPO patients in Dentrix. The problem with Dentrix is the treatment planner will not use the PPO Fees schedule to estimate fees and also post your fees to the patient ledger. You are able to set up the system to post the fees schedule to the patient ledger, however, and send your fees to the insurance companies.

The problem with doing the above is the fact that many offices are not updating their fee schedules, thus they have to add charges back on when the EOB returns to the office. Also, the legality is in question when the fees sent to the insurance company differ from the fees posted on the patient ledger. I, personally, like to know what I have adjusted for each individual insurance company, thus I prefer to make the adjustment through the insurance claim when posting the EOB.

What I have done to correct this is:

Option 1: take the coverage table and increase the percentage in order to estimate insurance payment as if it will pay more of my fee to include the write off. This may not get you exactly to the penny but it works well. If insurance downgrades to silver fillings, it will also help to pull out those procedure codes and leave at the regular percentage (do not increase) and this should help to avoid the issues that offices have with underestimating patient copays on posterior composites that are downgraded to amalgam.

NOTE: If you decide to do this program it is very important that you DO NOT UPDATE THE PAYMENT TABLE when entering EOBS. We want to use the percentage NOT the payment table! If you update the payment table it will override the percentage.

Option 2: pick the codes that you use the most, then take your fees schedule and the PPO fees schedule and do the following math:

Your fee – PPO fee = X (write off)

Then take PPO fee x {c91082aefe0e580fe546c40af534787b48cfd474f8c9ab8dac50bf49a7a1c43a} of coverage (80, 50 etc. per individual insurance plan) = Y (insurance payment for individual code)

Then take X + Y = Z (amount to go in under procedure code in payment coverage table/book)

As a result, when you use the treatment planner it will show the insurance as paying both their payment plus the write off. This will allow the patient portion to be accurate.

NOTE: I do understand that this will take some time as you will have to go code by code and take the percentage for each company. However, we have found that most percentages are similar (100/80/50) and the calculations really did not take much more time than entering all of the individual fee schedules as many offices are doing.

Until Dentrix allows us to enter adjustments as an additional coverage table, these problems will remain present.

Please contact Dr. Schaeferle at (614) 312-2796 with any questions or concerns regarding this matter.

About the Author

Dr. Tammi Schaeferle grew up in Lafayette, Ohio and obtained a B.S. in Biology from the University of Toledo. She went on to graduate from The Ohio State University College of Dentistry and has furthered her dental education by completing an Advanced Education in General Dentistry at US Naval Base in Great Lakes, Illinois. She currently holds an active membership in the American Academy of Cosmetic Dentistry and has a Fellowship in the Academy of General Dentistry. More information about Schaeferle & Schaeferle Cosmetic & Family Dental Care can be found here.