Billing Problem

[atd]

I'm having a billing problem and thought I'd ask for advice before putting in a feature request, in case I'm doing something wrong.

Procedures that show up on the "Procedures not billed to insurance" report are also triggering statements for patients. Shouldn't those procedures be excluded from patient statements until the claim has been created? Is there any reason that you'd want the "unsent" procedures that need a claim created to be on statements?

Most offices probably make sure all claims are created at the end of the day and then send claims and statements. However that won't work for us because we have 4 different clinics with a wide range of hours and a centralized billing department that is only 7:30-3:30. Also, for our mobile clinics, the claims are created the following day back in the office (because we don't have an on-site "front desk" person for mobile) - so we'll always be a day behind with creating claims.

We want to send statements daily, but I can't think of when we'd do that. Even if we print the procedures not billed to insurance first and go through and manually exclude those statements from printing, one or two could slip in when someone is setting an appointment complete during this process. Also, with the volume of claims and statements we send every day that would be a long list to go through. Any suggestions on how to prevent this problem?

[drtech]

We create the claims before the pt even walks out of the tx room, then you never have to worry about it (and have the indicator on appointments show up when claims need to be created, and that way they are done right away)

[jordansparks]

Can't you just uncheck the box in the billing options window for including accounts with new procedures?
http://www.open-dent.com/manual/billing.html
You can also save this as the default. The only disadvantage I see is that when claims get paid, it won't automatically trigger another statement. But it will still catch them a month following their previous bill if they still owe any money.

[atd]

We create the claims before the pt even walks out of the tx room, then you never have to worry about it (and have the indicator on appointments show up when claims need to be created, and that way they are done right away)

I guess I don't feel comfortable having our clinic staff creating claims - I'd rather have our support staff do that since they know the insurance rules the best and can check for any errors (a second set of eyes is good before sending to insurance). In the nursing home setting only the clinical staff is there, so the next day their scheduler goes through the previous days appointments and creates claims, mails treatment plans, makes sure there's a planned appt, etc. Even if we did have the dentist do it, there's that window of time between marking the procedures complete and creating the claim. So, there's still the risk of sending out statements for unsent procedures.

Can't you just uncheck the box in the billing options window for including accounts with new procedures?
http://www.open-dent.com/manual/billing.html
You can also save this as the default. The only disadvantage I see is that when claims get paid, it won't automatically trigger another statement. But it will still catch them a month following their previous bill if they still owe any money.

OK, this sounds like the best solution. I'd prefer to send the bill right away, but I'd rather have the delay than have people calling because they received a bill they shouldn't have. Thanks for the suggestion.

[atd]

Can't you just uncheck the box in the billing options window for including accounts with new procedures?

I did more testing and found that unchecking that box doesn't solve the problem for me. New patients that have never received a statement will still be included. Also, if the patient has a legitimate balance from a previous claim and a month has gone by since their last bill was printed, the new "unsent" procedures will also be included on the bill.
I have found a workaround though. We'll print the "Procedures not billed to insurance" report first, find the cutoff date, and then change the "End Date" in the date range section of the billing window.

[atd]

The workaround I posted below which I thought would work does not. Setting a cutoff date excludes those procedures from showing on the statement detail, but they are still reflected in the total statement balance. Also, if a payment came in after the cutoff date it is not included in either the details or the total, so it looks like they still owe money for old procedures when they don't. I have tried every possible option here and have come back to the conclusion that the "unsent" procedures that show up on the "Procedures not billed to insurance" report need to automatically be excluded from the statements - I can't find any way to do it manually that will work properly. The only other option I can think of is to have the insurance estimates for procedures be calculated immediately when procedures are set complete rather than after the claim is created - but that is probably even more complicated.

[jordansparks]

Then let's talk about how to word the feature request? I don't think the feature request should be to exclude procedures from statements. That's really hard. I think the feature request should be to add a filter to exclude families from billing that have any unsent procedures. Would that work?

[atd]

Yes, that would work great.