Andre Explains how to Show a Discounted Fee On A Claim from Eaglesoft
You can offer anyone a discount that you like as long as you follow a few rules.
The total amount you submit on an insurance claim form is the total amount you intend to collect.
Treat insured and uninsured patients exactly the same.
You may not violate any contracts that you have with insurance. This includes things like discounting or waving copays and/or deductibles.
While there is no way to add a Discount to the ADA form (using Eaglesoft or not), If you are offering specific insured Patient a discounted fee for a service, you will need to make sure that discounted fee is represented in box 31 on the ADA claim form and represent the total amount that will be collected from the insurance company (including any Contractual Adjustments (write offs)) and the patient.
Example:
The office does a filling for me at $100 where the Standard Fee is $180. The claim form shows the $100 fee. My Employers/Coverage Plan may consider that $100 at 80% and pay $80. I am responsible for the $20 difference. The office must follow the Explanation Of Benefits.
To make sure the discounted fee shows on the ADA Form, you must remove the Bill Standard Fee on Insurance Claim from the Employer Preferences BEFORE you do a Walkout.
Go to the Patient’s Employers/Coverage Plan, click Preferences, Uncheck the Bill Standard Fee on Insurance Claim (see picture)
Finishing the walkout, you have to go back to the Employers/Coverage Plan preferences to check the box for Bill Standard Fee on Insurance Claim.
Question: Can I give a “Seniors” Discount?
Answer: You can give a discount to “seniors” (clearly defined by a set age), so long as it’s given to all Patients who fit that defined criterion. Those Patients with and without insurance. What you can’t do is charge $1,000 on a claim for a service and charge all cash patients $900 for the same service.
Scenario 1:
I come by your practice, and you are doing a Crown for me. Your Standard Fee is $1,500. But... you do it for me for $1,000 because I helped you with this question (a 1-time adjustment).
In the Walkout you Edit the service and change the Fee from $1,500 to $1,000. With "Bill Standard Fee on Insurance" checked $1,500 will show on the claim. With the "Bill Standard Fee on Insurance" UNchecked, $1,000 shows on the claim.
Scenario 2:
I come by your practice, and you are doing a Crown for me. Your Standard Fee is $1,500. But... I am a "senior" and you offer a 15% "Senior Discount to those Patient over 62. There is a "Senior Discount" in my Patient Preferences for 15%. The Walkout will add $225 in the discount column.
With "Bill Standard Fee on Insurance" checked $1,500 will show on the claim. With the "Bill Standard Fee on Insurance" UNchecked, $1,275 shows on the claim.
Section 5.B, “Representation of Fees,” is particularly relevant to the question posed. This principle states that “[d]entists shall not represent the fees being charged for providing care in a false or misleading manner.”1 Regarding the question of multiple fee schedules, Advisory Opinion 5.B.2 addresses overbilling: “It is unethical for a dentist to increase a fee to a patient solely because the patient is covered under a dental benefits plan.”1 Furthermore, Advisory Opinion 5.B.3, Fee Differential, asserts that “[t]he fee for a patient without dental benefits shall be considered a dentist’s full fee. This is the fee that should be represented to all benefit carriers regardless of any negotiated fee discount.”1 At issue here are transparency and honesty concerning the fees being charged. The fee is for the service provided and not for the means of payment, and, thus, the charge should be the same across the board.
Reference
American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012
DISCLAIMER:
This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner of the practice. Eaglesoft is a registered trademark of Patterson Dental Company. All other software or products mentioned are the property of their respective owners. Although Andre Shirdan was an employee of Patterson Dental, he is not associated with Eaglesoft or Patterson Dental Company or endorsed by Patterson or any other Company Mentioned in this blog.
