Whether you’re starting out as a fee-for-service practice or transitioning from an in-network, insurance-based model, Open Dental has plenty of features to make the setup process easy and efficient. Let’s dive in and explore how Open Dental can benefit your fee-for-service dental practice.

Handling Reimbursement

As a fee-for-service practice, the first thing you’ll need to decide is how you want to handle insurance reimbursements. Do you want payment coming back to your practice? Or do you want the payment to go directly to the patient?

If you choose to have payment coming back to your practice, many things will continue to work the same way as an in-network-based model. If instead, you choose to have your patients pay in full and have insurance send any reimbursement to them directly, there are a few things to do differently.

In Preferences:

• Disable Insurance plans default to assignment of benefits. This ensures that by default any insurance plans you create in Open Dental have the Assignment of Benefits (pay provider) setting unchecked, so when you submit claims, payment will be sent directly to the patient – rather than back to your office.
• Enable Auto receive claims with no assignment of benefits. Since your office won’t be receiving reimbursement for claims, this preference will automatically mark the claims as received with $0 payment once they’re created. That way staff don’t have to go through the extra steps of doing this or have to worry about having claims outstanding when you’re not expecting any payment.

If your practice is transitioning from an insurance-based model to fee-for-service, you may also want to disable features that were previously enabled.

In Setup, Show Features, some features you may want to disable include:

• Capitation
• Medicaid
• Medical Insurance – If you no longer plan to create or send medical claims on behalf of your patients. If you still wish to create medical claims, even if you’re not accepting assignment of benefits, you’ll want to leave this enabled.
• Use Insurance – If your practice no longer plans to create insurance claims whatsoever or give any insurance estimates, you can disable insurance features in Open Dental. This is uncommon – even for fee-for-service practices.

Setting up Insurance

Unless your practice has chosen to completely stop billing to insurance, you will still need to set up insurance plans in Open Dental, even if you’ve gone fee-for-service and are out of network.

See our webinar below for steps to add insurance.

When setting up an out-of-network insurance plan, choose the Category Percentage Plan Type and do not assign a fee schedule to the plan. If you’re using Blue Book. You can assign a Manual Blue Book fee schedule, if you have one.

Treatment Plans and Estimates

If your practice is choosing to not accept assignment of benefits for any insurance claims, it’s unlikely that you will know what insurance fees are for carriers, since you are not contracted with them, because of this it can be difficult if not impossible for your practice to give accurate insurance estimates to your patients.

If your practice is continuing to accept assignment of benefits, you can choose to enable the Blue Book feature. This will allow staff to track insurance-allowed fees when receiving claims. This way your office can still provide insurance estimates to patients – even when you’re out of network! Watch our Blue Book webinar for more details.

Since you’re dealing with insurance fees from past EOBs, they may not be as up-to-date as when you were in-network and getting the latest fee schedules from insurance carriers. If you want patients to pay in full upfront, this is information that may be helpful to put on patient Treatment Plan. In Preferences, you can change the Default Note to be more applicable to your practice (e.g., payment is required in full at the time treatment is rendered. Final charges may differ from the estimate shown). The Treatment Plan note can also be edited on individual Treatment Plans.

Claims

Even if your practice is no longer going to be accepting reimbursement from insurance, you may still wish to send claims on your patients’ behalf. If sending via a clearinghouse, this process is the same as an insurance-based practice. If you are instead mailing claims or printing claims for patients to submit to insurance themselves, here are a couple tips.

• Print Multiple Claims from the Manage Module: If you’re printing claims to mail on patients’ behalf, you can print the claims for a day (or any unsent claims) from the Manage Module, click Send Claims.
• Print Single Claims from the Account Module: If you’re giving your patients a copy of their claim so they can submit it to insurance themselves, from the Account Module, double-click to open the claim, then Print.

If your practice is continuing to accept assignment of benefits from insurance, claims will remain outstanding until your office receives payment from insurance. Once ready, staff can receive the claim in Open Dental and finalize payment. If you enabled the Blue Book feature we mentioned earlier, when receiving claims, staff can enter allowed fees from EOBs into Open Dental.

Helping Patients Afford Care

Discount Plans

As a fee-for-service practice, you may find yourself with more cash-pay patients. You may choose to incentivize those patients with an in-house plan. This can be set up in Open Dental as a Discount Plan. For more details see our webinar or recent blog post.

Payment Plans

If your office wants to handle the “loan” to the patient, Payment Plans are a great fit. Open Dental has two different types of Payment Plans for patients. For more details, see our webinar or recent blog post.

Financing with the CareCredit credit card

With CareCredit integrated right into Open Dental, your practice staff can quickly identify which patients are pre-approved or already have a CareCredit credit card, even before they visit your office. Take a look at this video and blog post for more on the integration and how it can help your patients, and your staff.

If you have any questions, call or chat with our helpful Support Team.

Information in this post reflects features available in Open Dental Version 23.1. For the most up-to-date information, please visit our manual.