You are committed to providing excellent care to your patients, and they count on you. Your dedicated staff also count on you to pay their wages. In order to be there for your patients and your staff today, next year, and a decade from now, you have to manage your receivables and collect what you are owed. In this post, we’ll cover the Aging of A/R report that helps you manage Patient Receivables, the integrated TSI Collections Interface, and the Outstanding Claims Report to track Insurance Receivables and assign staff to follow-up on them as needed. We’ll also discuss the reports you’ll want to run regularly to make sure nothing slips through the cracks!
Managing 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.
What about payment plans?
If you’ve set the pay plan logic in your Account Module Preferences to Age Credits and Debits, payment plan due amounts are included in the A/R balance, and will be reflected in the Aging of A/R report described above.
Let’s dig a little deeper
Without Aging Debits and Credits:
Let’s say you have an Ortho Case of $5,000, that whole $5,000 would show as aged from the day the charge started on the A/R report (the day the procedure is set complete). As the patient makes payments, the credits start eating up the charges. However, the large balance eventually goes to 90+ and stays there as it’s slowly paid on.
When you have your pay plan logic set to Age Debits and Credits:
For that same Ortho Case, you’ve created a payment plan where the patient paid $250/mo starting on 10/1/2021. The beauty of the payment plan is that it immediately credits the ledger for the full $5,000 and ‘moves’ the balance to the payment plan. The payment plan slowly charges the ledger each month for the agreed-upon amount and applies the credit once the patient pays their monthly payment. Your Aging of A/R would only show $250 in the 0-30 bucket. Once the $250 payment is made, the 0-30 bucket would show $0. If you ever need to see the total amounts owed by your patients with payment plans (at tax time, for example), you can run the Payment Plans report.
It’s a difficult subject, but when patients don’t make payments in a timely fashion, collections efforts may be needed. Following up on delinquent accounts adds stress to your staff, and can strain the doctor-patient relationship.
The TSI Collections interface is fully integrated into Open Dental. Once set up, it automates the handling of past-due accounts – increasing collections, reducing collection timelines, and allowing your staff to focus on other duties.
TECH TIP: 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.
Managing Insurance Receivables
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.
From here you can also update tracking status for many claims at once or delegate claim follow-up to specific staff members.
- Right-click on any item to:
- Go to Account: Jump to the patient’s Account module without closing the report window.
- Assign to Me: Assign the claim to the logged on user if there’s more you need to do.
- Assign to User: Assign the claim to any user for follow-up.
- Update tracking status for many claims at once by selecting one or multiple claims and setting them to a certain claim tracking status.
Not familiar with Custom Claim Tracking Statuses?
Added in Setup > Definitions > Claim Custom Tracking, they are a fantastic way to automatically filter the Outstanding Insurance Claims Report by status and automatically have claims excluded from the report for a certain number of days after a status is changed.
A claim’s status tracking history can be found in the Status History area, allowing you to see the various claim follow-up activity that’s been taken.
Troubleshooting the Outstanding Insurance Claims Report:
If you have claims showing up that shouldn’t be there, here are some troubleshooting tips:
- Claim payment has been received, but claim still shows on this report because claim status was manually set to sent-verified.
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 was manually set to “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. Verify that the remaining procedures on this claim have received payment, then change Claim Status in upper left to Received, and click OK. This allows you to maintain visibility of unpaid portions while displaying the correct amount of receivable.
- Claim payment has not been received.
Contact the insurance carrier for status on payment.
Reports to keep things from slipping through the cracks
Unfinalized Insurance Payments Report
Conveniently located in your Reports menu, this report should be run every day to ensure that all insurance payments you’ve posted have been finalized. Once finalized, they will show up on your Payments Report and your Oustanding Insurance Claims Report balance will be more accurate.
TECH TIP: Making sure payments have been finalized is critical because once you’ve posted the payment to the claim, the claim will be marked as received, and will no longer show up in your Outstanding Claims report (you’ll lose visibility to the receivable). The insurance payment will also NOT show up in your Payments Report or Production & Income Reports until finalized. The only way to see unfinalized payments is to notice the note on the payment in the patient’s account, or by running this report.
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 procedures
Create the claim and send it.
- The completed procedures don’t need to be billed to insurance
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-Procedure 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.
Claims Not Sent Report:
This report shows claims created on the date/in the date range you select that have not been sent to insurance. It also shows secondary claims that are in “Hold” status until the primary insurance claim payment is received.
Manage all unsent claims through the Manage Module.
The upper grid shows all items waiting to be sent. When you click Send, claims will be validated and any issues that need fixing will show.
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.
TECH TIP: Preauthorizations waiting to send are also displayed – you can tell them apart because preauths show at the top of the list with a Date of Service of 01/01/0001 .
Managing receivables plays an important role in the growth of your practice, and we’re here to help! Please reach out if you need any help with these or any other features in Open Dental.