Eaglesoft



Since I started writing posts for this blog, I’ve been keeping track of all the questions and concerns that come to me. I get questions from sales reps who work with offices, office staff members and other Eaglesoft trainers on a daily basis. I want my posts to be meaningful and helpful to your practice so I decided to start the New Year off with the number one most asked question – should I be using fee schedules or coverage books and if so, which one?

I find this topic confuses a lot of folks so I hope this information clears up the confusion and helps you get on the right track for the New Year! The first thing to know is a fee schedule is the amount you charge to the patient. So, you would use a fee schedule to charge your patient anything other than the office’s standard fee. The best example of when to use a fee schedule is if you participate with PPOs. Your standard fee for an exam might be $50 but you’re contracted with a PPO and can only charge $30. The best way to set this up in Eaglesoft is to use a fee schedule. Your production would be $30, not $50 (which is accurate and you can only collect $30 so why inflate your production?). Now, I know what you’re thinking “I need to post my full fee so the patient can see the write-off” or “I need to always bill the full fee to the insurance company” and you are absolutely correct! Eaglesoft manages all of this for you with preferences. There is a preference to “Show Standard Fee and Adjust on Walkout Statements and Treatment Plans” and one to “Bill Standard Fee on Insurance Claim”. In addition, when you use fee schedules you can run several reports to help you manage productivity and write-offs. I highly recommend using fee schedules for your PPOs, your reports and treatment plan estimations will be accurate and you won’t have to do manual calculations.

Coverage books estimate the amount the insurance company is going to pay for a particular service. For clarification, the fee schedule is the amount charged and a coverage book estimates what the insurance company will pay. When you use coverage books you are always posting your full fee. The amount paid by insurance and the patient portion are calculated based on the information in the coverage book. In addition, you can calculate write-offs with coverage books also. The write-offs will happen during the insurance payment as opposed to the beginning (when services are posted) like fee schedules. Here are a few scenarios:

  1. Insurance company downgrades a composite restoration to the amalgam fee.
  2. You need to calculate the patient portion when insurance pays 50% of their fee, not your fee for a crown.

When setting up a coverage book, you enter a UCR fee. This is the ‘amount allowed’, not your fee. So, in scenario #1 you would enter the amalgam fee as the UCR fee into the coverage book. Eaglesoft will charge the patient the composite fee but estimate a percentage based on the amalgam fee (i.e. insurance will pay 80% of $90, not $110) and the patient portion will be accurate. For scenario #2 if you are not contracted with the insurance company you can setup a coverage book and enter the fee they allow for a crown into the UCR field. Again, the patient portion will be accurate.

My best advice to all my offices is to set up your fee schedules and coverage books and then keep them updated. There are lots of FAQ answers relating to fee schedules and coverage books to assist you. I promise you will save yourself so much time by having accurate estimations, treatment plans and reports. It’s well worth the effort!

As always, if you have any questions or need assistance please work with Eaglesoft Support or contact a local trainer who can help you realize the possibilities!

31 comments on “Eaglesoft – Fee Schedules and Coverage Books

  1. Jenny,
    I’m a hygienist learning to take a position in a large PPO practice as financial consultant and treatment planner. The practice uses Eagle soft, but they do all treatment/insurance estimates on paper and calculator. It’s hard enough learning a new job, but the manual method is so labor intensive. Any suggestions for me?
    The current person in this position (and my trainer) and the lady in collections are both older and may have been more comfortable with older methods. I’m not great with computer skills, but there has to be an easier way even with multiple fee schedules. I have no idea what it takes to “set up” this info in the system. Would love your imput.
    Thanks,
    Kim

  2. Hi Kim,
    Congratulations on your new position! I recommend you setup fee schedules and/or coverage books within Eaglesoft so the system can calculate the patient portion accurately on both Treatment Plan Presentations and Patient Walkout’s. This will make your daily postings and reports more accurate which is important if you want to get the most out of your practice management software.
    We do have a few webinars and some documentation available on our FAQ site and we also offer customized training.
    Please give us a call at 1-800-475-5036 and we will help you get started!

  3. Pingback: Eaglesoft Tip: Updating Fees | Off The CuspOff The Cusp

  4. I am new to an office that is getting setup with Eaglesoft this weekend. They have been using a pegboard, type daily schedules, and hand write every insurance claim. I am familiar with Eaglesoft but need some clarification regarding fee schedules and coverage books. For example, I plan on using fee schedules for all of the PPO plans we participate with because that is what I am familiar with. Can I use a coverage book for only the items that are downgraded that would override the fee schedule item or should I make a complete coverage book for PPO plans that have downgrades? Thank you !

  5. Hi Nancy,

    Absolutely! Set up your fee schedule with the allowable fees and attach that to the employer. Then, create a coverage book for those rule exceptions such as your example of ‘posterior composite downgraded to amalgam’. The coverage book would only be necessary for those few codes. When creating the coverage book you will not need to use the write-off feature. All you need to do is enter the allowable fee for the amalgam in the ‘UCR’ field (Your PPO fee schedule already has the fee you charge listed. The coverage book will be to determine the patient portion). You can ‘ignore’ the coverage and deductible because Eaglesoft will look back to how the employer is setup to determine that. Feel free to call us at 800-475-5036 if you have any questions. Thank you ~

  6. Hi,
    Just a couple questions.. I am insurance coordinator in a small dental practice. I am totally proficient with eaglesoft but not with the coverage books aspect. We have fee schedules set up but I would like to implement the coverage books.
    1. I have seen it recommended to do them by Employer.. Is that your recommendations as well??
    2. Why would you not use by Insurance company?
    3. Some big company’s offer employees multiple options for benefits, are we to just put in all plans under that employer, and pick from those then??
    Any information that you can direct me to as well would be helpful…

  7. Hi Dandi,

    Thank you for reaching out!
    I just emailed you a great document I think will be beneficial to your office. Let me know if you have any further questions.

    Thanks ~

  8. I would love the document you were talking about above, I am having the same situation. And also where should we write off the insurance adjustments? It seems to go under adjustment but should it be under collections? Thank you.

    • Hi Beate,

      The document is available on FAQ 20376. As far as adjustments, please call 800-475-5036 to speak with one of our support specialists. I would not recommend having your insurance adjustments impact collections as you cannot take away something that hasn’t been collected. To best assist you and provide a more complete explanation, it’s better to have a conversation with a support specialist.
      Thank you ~

  9. Pingback: Managing Patient Benefits in Eaglesoft

  10. Insurance companies are downgrading my X-rays to code D0210 when I perform a panorex (even though a panorex is extraoral not intraoral. When I receive payment the only way to make downgrade is by deleting the original codes and reentering the code D0210. Is there any other way to do this, By law I need to enter the codes that were performed not the codes that the insurance is allowing.

    • Hi Barbara,
      Thank you for your comment. I agree, you do need to post the codes you performed. If you are in network and the insurance company downgrades BWX + Pano taken on the same day to an FMX, you must take this adjustment down to the FMX fee. You can create a coverage book item for the pano code and enter the FMX allowable fee as the UCR. I hope this helps.

  11. Trying to go almost completely paperless. We are use to having a breakdown showing frequencies of cleanings, radiographs etc allowed by insurances. Is there a specific spot to list how often insurance allows these procedures or should we just scan a page in?

    • Hi Erika,

      You can certainly scan those breakdowns into SmartDoc. If you are doing that I suggest creating a document group for ‘Insurance Breakdowns’ or whatever you want to call it. This will help keep them organized and easy to find.
      Another option is to add those as ‘Notes’ in the Edit Employer window. The employer notes are viewable from several windows and many offices like to put the frequencies there.
      Finally, if you participate in Eaglesoft Eligibility, those Eligibility responses from each insurance company are stored on the Edit Patient screen and can be accessed again, anytime.
      I hope this helps!

  12. Hello, I bought my current practice about two years ago. This office had Eaglesoft, but was just using it to schedule patients. Now that I have moved the staff use to digital notes, films, and eclaims I would like to dive further into using Eaglesoft. Specifically a more accurate estimation of what the patient would owe on the day of service. It seems all information I come across states I should use Fee Schedules OR Coverage Books. However wouldn’t I want to use both? Wouldn’t I want I want the PPO Fee Schedule attached to the employer so that we are posting an accurate amount to our production. Then for each procedure want Coverage Books to state weather the insurance company is going to pay 0%, 20%, 50% or 100 % of that procedure so that I know what amount to collect from the patient that day. In this circumstance the UCR would match the fee schedule, but then I would know to collect 0 dollars if the coverage book has it at 100% or to collect 20% if coverage books states 80% for that procedure. Like other article I have read the above states “When you use coverage books you are always posting your full fee”. Why wont it calculate things based off of the fee schedule attached to that employer? Will using both cause problems? If this wont work for me how can I go about setting up Eaglesoft to give me the information I am looking for?
    My goal are as follows.
    1) Collect the correct amount due on the day of service. To increase our collection rate and not waste resources sending out repeat statements to patients.
    2) Show our actual daily, weekly, monthly, production. So staff members have an accurate Idea where we stand day to day.

    I have looked into your eligibility and eRA. The companies that are my problem areas are not on those lists.

    This is a great blog. Enjoy it very much. Thanks Levi

  13. Hi Levi,

    Thank you for the comment. To answer your question, yes you can use both a fee schedule and a coverage book but it is unnecessary to use a coverage book with a PPO fee schedule as you described above (e.g. coverage book estimates 70%, 80% etc.).
    The fee schedule is the fee we charge out. So to answer #2 above – fee schedules for your PPO plans are a must. Once your PPO fee schedules are put in accurately and attached to the correct employers, Eaglesoft looks at the coverage (Service Type, Percent and if Deductible Applies) info. at the bottom of the Employer window. So, if your fees are correct (meaning the correct fee schedule is attached) and the percentages listed for the employer are correct, there is no need for a coverage book.
    In this case, any items in a coverage book would only be any exceptions (e.g. insurance downgrades posterior composite to amalgam fee. In the coverage book you would list all of your posterior composite codes and in the UCR column put the ins. co. allowable fee for amalgam. Then choose ‘ignore’ for % and deductible because Eaglesoft will look back at the employer to see how to estimate. If the fees are entered correctly, the patient will be charged for the composite but Eaglesoft will estimate insurance to pay (because of the coverage book) 80% of the amalgam fee, making the patient responsible for the difference).
    Coverage books can also be used for plans you are not contracted with, helping get a better estimate of what insurance will pay. Because we list the insurance companies UCR fee in the coverage book, the fee charged will always be your standard fee and Eaglesoft is estimating what they will pay based on the allowable fees in the coverage book.
    I hope this helps. Please know your office can contact us anytime if they have questions. In addition, our local Patterson branch would be happy to send a trainer onsite or you can work with our phone training team to customize a training on this topic.
    Sincerely,
    Jenny Allen

  14. Hi! First, I just have to say I am extremely impressed with your timely responses! I never see that on q&a’s like this.
    My question is : I have always worked for a in network dentist, however recently I just took a job with an out of network dentist. Where do I find the most accurate UCR fees in order to implement them in Eaglesoft?

  15. Hi Erika,

    Thank you so much! I’m glad you find our tips helpful.

    In my experience, allowed fees are not readily provided to out of network providers. My best advice is to update your coverage books with your EOB’s. As insurance payments come in you can update your codes, a few at a time and eventually you will have a good list of allowable fees. You should also look into our online eligibility service. Some insurance companies provide a set of allowable fees per code with an eligibility check. Finally, pre-auths will always come back with/allowable fees. I realize those are not immediate so you will have to weigh your options. Good luck!

  16. If we are using the coverage book to estimate the amount a patient will pay with an out of network insurance company, how would I enter that into the coverage book?

    • Hi Whitny,

      Great question! You would want to put the insurance companies allowable fee into the UCR field. The best time to build coverage books is when you are entering insurance payments because you have the EOB in front of you with all of the allowable fees.

      Here is an example, Cigna’s allowable fee for a crown is $600 covered at 50%. Our fee is $900.

      In the employer window, you would have your maximum, deductible and percentages already setup. Now you need to create and attach your coverage book. In the example above the UCR would be $600. Under the drop down for coverage and deductible you could leave both at ‘ignore’ because this is already set in the employer screen. Super easy to keep updated information this way. You may also select ‘percentage’ and ‘yes’ if you would like but my preference is to leave those at ignore.

      I hope this helps! If not, please call one of our support team members at 1-800-475-5036.

  17. Hello,
    I am mainly back office and am learning front office with a start up pedo office. I am wanting to enter coverage books but am a little confused as to what numbers i put in. We have our fee schedule on what we are supposed to charge and then we have deltas fee schedule who we are contracted with. Which fee do i put in for the UCR?

  18. Hello Melissa,

    Congratulations on your new position! I made a similar move in my career (many years ago!) so I understand what you are going through.

    My recommendation would be to setup a fee schedule for your Delta fees. Go to lists / fee schedules / new and create your Delta fee schedule. IF your fee schedule is correct and attached to the correct employers and IF your employer percentages are correct, you will only need a coverage book for a few codes (e.g. posterior composites downgraded to composite fee).

    Remember, the fee schedule is what we are charging and the coverage book is what the insurance will pay. Coverage books are most effectively used for plans we are not contracted with (UCR will be the insurance company allowable fee). Best example, I’m not contracted with Metlife and their allowable fee for an exam is $25.00. Our fee for an exam is $50. So, if the insurance covers 100% of their allowable fee, I create a coverage book that shows Metlife UCR is 25.00 covered at 100%. We charge our fee which is $50.00. Eaglesoft will calculate the patient portion to be $25.00.

    I hope this makes sense. If not, please don’t hesitate to call one of our support specialists at 1-800-475-5036.

  19. Hello. We are having issues with insurance estimates, charging out, etc since participating with BCBS and Delta Premier. We have created complete BCBS and Delta Premier fee schedules. We have called and asked the same question to 4 different Eaglesoft reps and have gotten 4 different answers regarding the following situation:

    One employer offering BCBS Federal pays 100% for diagnostic and preventative. All other categories are employer categories are correctly entered as 0%. Today, I did a root canal on #22 and there should have been 0% insurance coverage. Eaglesoft calculated correctly that 0% is being paid; however, the write-off for that procedure was still showing up on the production report at the end of the day. Instead of the root canal being $700, it showed the patient owed $500. This is the exact amount of the write-off that would have been taken if there was endo coverage. I have no idea how, or why, the write-off is being included on a non-covered service. Should I create a coverage book that lists all exceptions (no coverage for any restorative, endodontics, etc., and uncheck use write-off?).

    I would think that Eaglesoft should be able to look at the percentage paid for a procedure and do a simple if, then, else calculation: “if 0% insurance coverage, then patient owes 100% with no write-off, else use designated insurance % + write-off to reduce patient portion.”

    I would GREATLY appreciate you clearing this issue up for me. It is very frustrating for us because we have correctly set up the employer percentages and have a complete UCR fee schedule that is being used. One rep even said to not use UCR fee schedules and just create coverage books for ALL employers with ALL procedures. That would take a month to put in! Thank you in advance,

    Steve

  20. Hi Steve,

    I’m sorry you are frustrated. I know Eaglesoft can calculate insurance correctly, it’s all in how it’s entered into the system. With a fee schedule, whatever fee you place in that schedule is the fee that will be charged out. If you had a $500 fee for the root canal and the fee schedule was tied to that patient, then that is what will show on the walkout. If this particular plan does not cover a root canal and you want to charge your standard fee, you will need to override the fee schedule with a coverage book. I recommend you click on ‘show estimation’ to see where the mistake is happening. This way, you know where to go and make changes.
    My best advice to you is schedule some time with a trainer. We have phone trainers available as well as trainers who can come to your office. It is much easier to understand what you are trying to do if we can see what you are seeing. There is more than one way to set this up so it’s helpful to see each option so you can determine which one works best for the needs of your practice.

    Sincerely,
    Jenny Allen

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