If Dentrix were used correctly, your Fee Schedules should be entered and routinely updated in the fee schedule area. The allowed amounts when then be used correctly for downgrades. In the insurance world, you have your negotiated fee (sometimes called contracted fee or approved amount), then you have your allowed amount fee (called allowed amount or amount eligible for coverage by the plan). This is the fee which your insurance company is going to base their payment on, but the office still gets to charge up the contracted fee for the procedure code you charged for. Example: We perform a D2392 (2 surface composite) @ $100. The insurance company bases their payment on a D2150 (2 surface amalgam) @ $80. As the contracted office, we still get to charge the patient the additional $20 above the downgraded price to the patient. In your system, it assumes that we will accept the $80 as payment in full. I talked to a Dentrix rep and he explained that the allowed amount in Dentrix is the Fee Schedule amount. First of all, why would you have this in 2 places. If you are using Dentrix correctly, you wouldn't need a 2nd place to put your fee schedule. No office is going to write off the additional amount just because the insurance company downgrades. They would be taking a huge financial hit. Second, we have been asking for a way to do downgrades for years and Dentrix missed the opportunity big time when they programmed the allowed amounts this way. Third, the programmers obviously do not process insurance claims because they are not aware of the terminology on claims.
If you are going to keep it as the Fee Schedule amount, change the name to "Fee Schedule". If you're actually going to make the software function so it's useful to offices, reprogram it to calculate correctly so that we can actually use it for it's namesake "Allowed amounts"....meaning the patient is responsible for the difference between the allowed amount and the contracted amount.
By the way, it calculates as a downgrade in the ledger on the family portion, but not on the patient portion or the treatment planner.
Amy
