You work hard to care for your patients. Once the work is done, let your practice management software do the work of tracking your activity from procedure completion to billing. Open Dental has the tools you need to manage your receivables so you can keep your focus on patient care as you continue to grow your practice.
View the webinar on these reports: Procedures Not Billed to Insurance, Claims Not Sent, and Outstanding Insurance Claims Reports.
Step 1: Tracking completed procedures that aren’t attached to a claim
Procedures Not Billed to Insurance Report
This report shows patients with procedures completed on the date/in the date range you select, where no claim has been created. Go to each patient’s account to take the appropriate next step.
- No claim has been created for the completed procedure(s).
Create the claim and send.
- There is no need to create a claim for the completed procedure(s)
If there is no need to bill insurance in this instance, double-click to open the procedure and check the “Do Not Bill to Ins” check box. Once checked, procedures will show as “No Bill Ins” and will no longer show in the report.
* For procedures that are rarely or never billed to insurance (regardless of plan), go to Lists-Procedures Codes, double-click to open the Edit Procedure Code window, and check “Do not usually bill to Ins.”
- Claim was created for the procedure(s), but procedure showing (Unsent)
Double-click to open the Procedure Info window, and check in the Insurance Estimates and Payments grid to see if any duplicate estimates exist. If they do, you can open and delete the estimate.
Step 2: Tracking claims created but not sent
Claims Not Sent Report
This report shows claims created on the date/in the date range you select that have not yet been sent to insurance. It also shows secondary claims that are in “Hold” status until primary insurance claim payment is received.
Manage all unsent claims through the Manage Module. Click the Send Claims button – the upper grid shows all items waiting to be sent. (NOTE: Preauthorizations waiting to send are also displayed – you can tell them apart because preauths will have 01/01/0001 as the Date of Service.) Right click on a claim to go to the patient account to investigate further or take the necessary action to correct any missing information before sending. You can also validate and send claims from the Manage Module, using the Send Claims button.
Step 3: Tracking insurance claims where no payment has been received
Outstanding Insurance Claims Report
This report shows claims that have been sent to insurance, but are still awaiting payment. The report defaults to claims at least 30 days old but this can be customized to show the claims you want to see. Narrow down by provider, carrier, or custom tracking status, and click Refresh.
- Claim payment has been received but claim still shows up on this report.
If payment has been received for all procedures on the claim and you are not expecting any additional payments, change claim status in upper left to Received.
- Claim payment has been received for some, but not all the procedures on the claim – claim manually marked as “sent-verified” to maintain visibility of expected amounts.
Do this instead: Double-click to open the Edit Claim window. First, click to select the specific procedure(s) where payment is expected but not yet received. Click “Split Claim” and split these off onto a separate claim that can remain open. Then, once you’ve confirmed that all other procedures on this claim have received payment, change Claim Status in upper left to Received, and click OK. This maintains visibility of amounts still expected from insurance, but closes the portion of the claim that has received payment. For a claim (like Ortho) where insurance payments are expected over time, create an insurance payment plan to track payments. Claim can be marked as received when you receive the first insurance payment, but expected amounts can then be tracked through the Payment Plan report (see below for more information on this report).
- Claim payment has not been received.
Contact the insurance carrier for status on payment.
Step 4: Tracking patient receivables
This report tracks patient balances and aging. It defaults to run for all Billing Types, all Providers – simply uncheck to customize your report options. The “=Patient” column on the far right is the one you want to focus on – it’s the estimated patient balance owing after insurance and write-off estimates. If you have patients whose accounts are overdue and you want to prevent any further scheduling until their balances are reduced or paid in full, you can set up Automation to restrict patient scheduling.
If your office uses payment plans, also run the Payment Plans report, which shows any payment currently due, along with the principal balances still owing. This report can be run to show both patient and insurance payment plans.
Using these tools will help you manage your receivables so you can keep your focus on patient care as you continue to grow your practice! If you need help troubleshooting, please feel free to chat or give us a call.
Categories: Growing Your Practice