Setup: Co-payments are entered into the coverage table.
Daily Use: The Treatment Planner Fee column will list the dentist's normal fee, which is also the amount posted to the account when the procedure is set complete. The patient portion displays the co-payment as listed in the coverage table, and the insurance column will display the amount that will be written off for each procedure.
When the procedures are set complete, the day's charges displayed in Ledger will automatically list the correct amounts to collect from the patient and adjust off. In the following example, $75 would be collected from the patient, and $125 would be adjusted off the account. All calculations are done for you automatically.
Management: The Utilization Report can be sent monthly to the carrier as required and/or can be used for utilization management within the practice. For management purposes, 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, this option allows the additional availability of the Adjustment Summary Report. 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 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. Or, if your practice services several different capitation carriers, you can add a billing type for each company name. Your end goal is to use no more than five billing types for capitation purposes.
While in the Practice Definitions dialog box, select Adjustment Types from the Definitions list. Add a new credit (-) adjustment type for each billing type created.
Add the capitation plans as individual insurance plans in the database:
From Family File, select a plan subscriber. If the insurance plan already exists in the database, you can edit it, according to the specifications explained here. If it does not already exist, create a new insurance plan, entering in the carrier name, address, etc.
In the Insurance Coverage dialog box, click the Select Table search button, select "All Procedures (Cap Plan)" from the list, and then click OK.
Add in the correct co-payment for each procedure listed. Procedures which are covered by the plan, but for which there is no co-payment, leave 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. Beneath the coverage table, select Co-Payment Calculations for Ins Portion, and then click the formula [Total Fee - Co-pay] x Cov %.
All additional plans can be entered with the same settings.
Tip: If a capitation plan that has already been entered with the same or similar co-payments, you can select this plan for the current subscriber and edit the insurance information. After you click OK, you will be prompted to either Change Plan for All or Add as a New Plan. Click Add as a New Plan to leave the previously existing edited plan as it was and create a new plan with the current information.
Capitation Patients Per Visit: On all visits, you may treatment plan and post procedures normally. After posting the day's procedures for the given patient, the Est. Patient Portion in the Ledger will reflect the total co-payments for the current day. The Est. Dental Ins. Portion will display 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 a Utilization Report is required for submission to the insurance carrier, this list can be printed at any time for a given date range.
Optional: A capitation plan "family" can be entered to record monthly payments from each plan to show on the receipts' reports. You can add a new payment type to Practice Definitions. The amounts are written off so that the balances of the capitation families are always zero. You will need to add a new adjustment type for this task. You can also assign these families a special billing type.