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:
- Insurance company downgrades a composite restoration to the amalgam fee.
- 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!