Orthodontic Setup & Billing Disclaimer: This is a resource/guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner. For dental offices that practice both general dentistry and orthodontics within the same database, the following setup has been successful in meeting the needs of the ortho practice. Setup 1. Go to Lists Person and click New. 2. Create a separate patient in ALL CAPS, making the patient their own Responsible Party, regardless of age. Each ortho patient will receive their own statement which will clearly separate the ortho and general dentistry services. 3. Create a patient and/or account Alert, ORTHO PATIENT, to attach to each ortho account. 4. In the Edit Patient screen, select Preferences. 1
5. Check the box for Orthodontic Patient and enter the correct orthodontic billing information. 2
6. Create a duplicate entry of the policy holder in ALL CAPS for the ortho insurance information. 7. Create a duplicate employer/insurance in ALL CAPS for the ortho patient. 3
8. Go to Employer Preferences and select Lifetime Maximum Applies 9. Create a duplicate provider in ALL CAPS which will be used for all ortho services. General Provider Ortho Provider 4
10. Discuss Collections Go To with the office to determine proper setup. 11. Create payment types in ALL CAPS (ORTHO INSURANCE PAYMENT, ORTHO CASH, ORTHO CHECK, etc) 12. Create an ortho exploding code (ORTHO) which includes all service codes used throughout the entire treatment. 13. Add this code to a Quick Pick button for staff to easily identify, see button 8 for example. 5
14. Create an appointment type(s) for Ortho if you require one. 15. Add a new service code, COMM, or RETIE. Mark the code to allow free form description and do not submit on insurance, $0 fee. The code can be used by the staff for the amount of time needed for the next appointment. You can create additional service codes for each type of ortho appointment if desired. Codes can be posted to walkout for documentation purposes as well. 16. Create auto notes for ortho to be posted for staff to save time or to see details for next appointments that are too long to include with COMM service code. 6
BILLING During the first visit the ortho service is walked out, creating a charge to the account for the full amount. Due to the periodic nature of ortho billing, the treatment plan is used to create a claim to bill the various services without re-charging the patient s account. 1. Create a treatment plan using the ORTHO exploding code. 2. You can add the dates of the periodic billing so the plan includes all dates for billing, or post one service code and manually change the date each time. 3. Leave the treatment plan open until the ortho case is closed. 4. The following example shows an ortho lifetime benefit of $1000. $100 is paid when the first claim is received (This is the initial billing of the D8080 walked out on the account). The rest of the $900 benefits are received as the claims are submitted, based on the billing frequency. 7
To print the claim: 5. Process the treatment plan and select Print / Submit Pre-Authorization. If the periodic billing is phased you can select By Phase #. Check the box Submit as Statement of Actual Services to create a true claim. 6. Create a payment plan for the patient portion of the ortho treatment. In our example the total amount of the ortho expense is $4500 with $1000 being paid by insurance which leaves $3500 as the patient portion. If you use outside financing this step can be skipped. 8
7. If you require a down payment, you can enter the amount in the Truth-In Lending Contract and then apply in the account. 8. Use the Orthodontic Patients by Insurance Billing Period to locate all patients for insurance billing. This report is located under Reports Patients. 9
9. There are certain reports in Eaglesoft that allow you to exclude or include only ortho patients in report totals. The example below is the filter for the Accounts Receivable by Responsible Party report. 1 NOTE: The filter will identify ortho patients based on the box Orthodontic Patient being checked in the Edit Patient Preferences screen. NOTE: For offices that do only orthodontic work this setup is not needed. 1 Roy T. Nakai DDS - Responsible for creating the Ortho Workaround. 10