Dentrix offers greater variety in its setup and implementation of functions to support capitation plans. Two methods are available for capitation setup and use. Review the overview sections of each option to decide which method works best for your practice.
Both of the available options estimate patient portions quickly and accurately, both in treatment planning and in displaying the amount to collect from the patient per visit. You can use the capitation plan utilization report with either option, both for in-house management and for monthly submission to the carrier. Both of the options differ in their presentation of fees and also in the reports available for management. These differences are illustrated in the overview section for each method.
If you do capitation business with more than one company, you can use different options (from those listed below) from one carrier to another. For all plans under the same company, however, you should use the same option for best results.
Setup – Co-payments are entered in the coverage table.
Daily Use – The Fee column in the Dentrix Presenter lists the dentist's normal fee, which is also the amount posted to the account when the procedure is set complete. The Pat. Portion column displays the co-payment as listed in the coverage table, and the insurance column displays the amount written off for each procedure.
When you set procedures complete, the day's charges display in the Ledger automatically, listing the correct amounts to collect from the patient and adjust off. In the example shown, $25 is collected from the patient, and $75 is adjusted off the account. All calculations are done for you automatically.
Management – You can send the Utilization Report for Dental Insurance (in the Office Manager, click Reports > Ledger) monthly to the carrier as required, and/or you can use it for utilization management in your practice. For management benefit, the report lists the practice or provider's normal fee for each procedure completed and the co-pay charged, totaling these items for each individual plan.
Because an adjustment is made each time charges are posted, Option 1 allows the additional availability of the Adjustment Summary Report (in the Office Manager, click Analysis > Practice > Reports). This report gives you access to the following useful capitation figures for the selected time period:
· The number of total adjustments made (number of capitation appointments).
· The total amount written off for capitation, and the average amount of each write-off.
If your practice supports fewer than six capitation plans, create a new billing type for each individual plan. If your practice supports more than five plans within a given company, you can choose a grouping of several plans and add a billing type for each grouping.
If your practice services several different capitation carriers, you can add a billing type for each company name instead. Your end goal is to use no more than five billing types for capitation purposes.
To enter capitation type plans using this method
1. In the Office Manager, click Maintenance, point to Practice Setup, and then click Definitions.
The Practice Definitions dialog box appears.
2. In the Definition Type list, select Adjustment Types. Add a new credit (-) adjustment type for each billing type created.
3. Click Close.
4. Create the capitation plans as an individual insurance plan in the database.
a. In Family File's Insurance Information dialog box, click the Subscriber search button to select a plan subscriber. If the insurance plan already exists in the database, edit it according to the specifications listed here. If it does not already exist, create a new insurance plan and enter the carrier name, address, and so forth.
b. Click Benefits/Coverage.
The Dental Insurance Benefits and Coverage dialog box appears.
5. Click the Coverage Table tab.
The Coverage Table appears.
a. Click the Select a Standard Coverage Table Down arrow, and then select All Procedures (Cap Plan) from the list.
b. Add in the correct co-payment for each listed procedure. Procedures that are covered by the plan, but that do not require a co-payment, should be left with a zero co-payment. Delete procedures not covered by the plan to have your normal fee charged when treatment planning or completing these procedures.
c. Under Co-Payment Calculations for Ins. Portion, click the Down arrow, and then click (Fee - Co-Pay) x Coverage %.
6. Click Save.
Tip: If you have already entered a capitation plan that has the same or similar co-payments, you can select this plan for the current subscriber and edit it to create a new plan. After you make the first edits in the Dental Insurance Plan Information dialog box, click OK ,select Change Plan for All or Add as a New Plan. The first time this message appears, select Add as a New Plan. The previously existing edited plan remains, and a new plan is created with the current information. To save the current changes to the now existing new plan, select Change Plan for All.
Capitation Patients Per Visit – On all visits, you can treatment plan and post procedures normally. After posting the day's procedures for the given patient, the Estimated Patient Portion on the Ledger reflects the total co-payments for the current day. The Insurance Portion displays the amount to adjust off the account. Enter the adjustment, making sure to use the correct capitation adjustment type.
Create a claim for the procedures and enter a zero payment on the claim. The claim will not require printing.
Monthly Operations/Management Analysis – If the insurance carrier requires a Utilization Report for submission, you can print this list at any time for a given date range.
Optional – You can enter a capitation plan "family" to record monthly payments from each plan to show on the receipts reports. You can add a new payment type under Definitions for this entry. The amounts are written off so that the balances of the capitation families are always zero. You need to add a new adjustment type for this task. You can also want to assign these families a special billing type.
Setup – Capitation fees are entered as separate fee schedules, which are then attached to the individual plan.
Daily Use – The Fee column in the Dentrix Presenter lists the co-payment for each procedure, which is also the amount posted to the account when the procedure is set complete. The Pat. Portion column is the same as the Fee column, and the insurance column displays zeros, showing no portion covered by insurance.
When you set the procedures complete, the day's charges displayed in the Ledger automatically list the correct amount to collect from the patient. No adjustments are necessary.
Management – You can send the Utilization Report to the carrier as required and/or you can use it for utilization management within the practice. For management benefit, the report lists the practice or provider's normal fee for each procedure completed and the co-pay charged, totaling these items for each individual plan.
To enter capitation type plans using this method
1. Follow the instructions for setting up billing types in Step 1 in the Preliminary Setup section for Option 1. Remain in the Practice Definitions after adding the new billing types.
2. Each plan is assigned its own fee schedule that you can name from Practice Definitions. Select Fee Schedule Names from the Definition Type drop-down menu. In the fee schedule listing, highlight a fee number which you know to be currently unused. The appropriate number appears in the ID field above. Enter the name you want to label the fee schedule in the Definition field. Click the Change button to attach the name. Complete this step for each capitation plan with a different schedule of co-payments. Click Close when completed.
3. To enter in fees for each plan, click Maintenance, and then Practice Setup in the Office Manager. Select Procedure Code Setup and the Diagnostic category. Double-click the first procedure listed to view the Procedure Code Editor. Select the fee schedule you want to edit and enter the appropriate co-payment for that plan. Enter your normal fee for procedures not covered by the plan. You can enter the co-payment for the current procedure on all of the capitation fee schedules you will be entering and click Next Code to move on to the next code in the list.
4. You must create capitation plans as individual insurance plans in the database.
a. In Family File's Insurance Information dialog box, click the Subscriber search button to select a plan subscriber. If the insurance plan already exists in the database, you can edit it according to the specifications listed here. If it does not already exist, create a new insurance plan and enter the carrier name, address, and so forth.
b. When editing or adding information at the Insurance Plan Information dialog box, attach a fee schedule by clicking the Fee Schedule search button and selecting the fee schedule that corresponds to the plan being entered.
c. Select Do Not Bill to Dental Insurance option. There is no need to set up or edit the Coverage Table.
Capitation Patients Per Visit – On all visits, you can treatment plan and post procedures normally. After posting the day's procedures for the given patient, the Today's Charges and Estimated Patient Portion fields in the Ledger reflect the total co-payments for the current day. The Insurance Portion will always be zero. There is no need to create an insurance claim or enter a zero payment.
Monthly Operations/Management Analysis – If the insurance carrier requires you to submit a Utilization Report, you can print this list at any time for a given date range.
Optional – You can enter a capitation plan "family" to record monthly payments from each plan to show on the receipts reports. You can add a new payment type in the Definitions for this entry. The amounts are written off so that the balances of the capitation families are always zero. You need to add a new adjustment type for this task. You can also assign these families a special billing type.