How Andre Sets Up Membership Plans (Discount Plans) in Eaglesoft
SETTING UP YOUR OWN MEMBERSHIP PLAN
Disclaimer: This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner.
So many offices have decided to create their own in-office membership plans. They are typically considered Direct Primary Care Agreements (DPCA). While I can’t advise clients on the legalities of these plans, I can show them how I would set them up in Eaglesoft so that they can be monitored for renewal and so that Walkouts process properly. This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner.
As you construct your Membership Plan, consider what discounts you will be offering and what services will have a $0 fee. Look at the Managed Care Analysis report for the Prior year to calculate how much you are currently adjusting office as an In-Network Provider. Consider your toughest competition. I don’t mean other dental offices. I mean the self-purchased Employers/Coverage Plans like those you see advertised on TV or are offered by groups catering to retirees. As someone who qualifies for many “senior benefits” I have looked into Coverage Plans for myself. A plan that has a $2,000 max, $40 deductible with 100% Preventive, 80% Basic and 50% Major (after a 9-month wait period). The monthly premium would be $65.91 (that’s an annual cost of $790.92). As a comparison, the plans that I have designed with practices have had annual Membership fees that are close to $299. I have recommended that offices have a 3-tiered Membership Fee:
WARNING: Before putting a Membership in place, it is imperative you have the plan and accompanying agreement reviewed by a competent attorney.
Setting up the Membership Plan
I have found that the best way for tracking Memberships is to set them up in the following way:
Create an Employer/Coverage Plan using the name your created for your Membership (i.e. “Crew Dental Membership Plan”)
Create a matching “Insurance Company” that matches the Employers/Coverage Plan (i.e. “Crew Dental Membership Plan”). No need for an address or phone number.
The Employer/Coverage Plan should have no deductible and no maximum (this really doesn’t matter as there is no Estimation calculated).
Under the Service Types it really doesn’t matter if they are set to a percentage since there is would be $0 available under the maximum and no estimation calculated.
Set the Claim form to None.
6. Under the Preferences of the plan, select Do Not Track Claim (red box). This will automatically switch your calculation Preferences to Patient Responsible for All (orange box).
7. Next, create a new Fee Schedule based on the fees you will be charging to Members. Creating a new Fee Schedule allows you to set the fees at a percentage (i.e. 90% is 10% off, 85% or 15% off, etc.) of your Standard Fees (see example below). When your office does a Membership Fee increase, don’t bother to update this Fee Schedule, create a New Fee Schedule (using this method) and attach it to the existing Membership plans. Then delete the old one.
8. For those services that have a $0 fee, in the Fee Schedule "zero" out the fees. This is an important element of a Membership Plan. By giving the procedure a $0 fee, the patient couldn’t attempt to get reimbursed by insurance at a future date if they became insured.
9. Attach this new Fee Schedule to your Membership Plan Employer.
Walkout of Initial Membership
When a Patient decides to become a member of the plan, the initial walkout should include the Membership Fee as well as the services rendered on the first visit. To do this I create an Admin Code to add the Account for the Annual Membership Fee. Even if you have opted to use a monthly payment toward this Membership Fee, I recommend the total amount be posted on the first visit and payments go towards this balance.
Example:
Patient is paying $32 a month for 12 months = $384. So, the Annual Membership is $384 and each monthly payment “chips” away at that Membership Balance.
Here are the Admin Codes I have created for my Membership plans. I have even created an Admin Code for tracking if/when a Patient declines participation:
These codes get posted to the Account during the first Walkout.
Let’s use an Example of a New Patient purchasing the Membership.
When you Save the Walkout, you will be prompted to complete a claim Submission. Because you set the Default Ins Form in the Employers/Coverage Plan and None, you can select the Submit Manually option of submission.
This will “manually” create and close the claim. No claim will be printed, submitted or linger in the Outstanding Claims report(s).
What Should the I make my annual Membership Fee?
I always create my Membership Plan Fee to equal the Maximum Allowable Fees of a first visit services (i.e. Comprehensive Evaluation, Full Mouth Diagnostic Imaging, Prophylaxis and Fluoride (if applicable)) combined with a follow-up periodic visit i.e. Periodic Evaluation, Prophylaxis and Fluoride (if applicable)).
More information about setting up Memberships
Many state laws see collecting money in advance of delivering a service as “creating and insurance”, where this Membership Plan design differs is that you are collecting a Membership Fee, in the same way you buy a Costco, BJ, Sam’s Club membership fee. This fee is NOT in exchange for Services but for membership in a saving club. Future services have reduced Members only fees (of which some are “zero dollar” preventive services).
I also create Exploding Codes for both a Membership Plan Initial Visit:
And for a Periodic Visit:
For Membership Tracking
I create a unique Employer/Coverage Plan for each month of the year, so the office knows what month the individual Patient joined. (i.e. “Dental Membership Plan 01 Jan, Dental Membership Plan 02 Feb, Dental Membership Plan 03 Mar”). By creating these separate plans, you can run the Patients by Employer report each month to see which Patients are coming due for renewal.
It is also possible to create a Custom Intellicare based on these Membership plans so that you can see a custom icon on the OnSchedule Screen and Clinical Screen indication which Patients have your Membership plan and even their renewal month.
There is always a question about how to make sure to collect the Annual Membership Fee. This is pretty “simple”. If the Patient joins the plan March 2nd the pay the Annual Membership Fee “today” then nothing on the 6-month visit. Then on the next visit, they would need to pay the renewal of the membership and should be reminded:
“Mary, today is your second visit of your Membership Plan. Today there is no charge. When you come back next march. We will be renewing your membership, and you will be responsible for the Annual Membership Fee at that time. See you in March!”
Q: How do you track Hygienist’s production?
A: Two thoughts:
As Patients are “onboarded” to the plan, the Membership Fee is posted to the Hygienist who treated the Patient. Over the course of the year, IF Hygienist A saw that Patient twice the production would average out. Example: one visit at $299 and one visit at $0. $149.50 each. This is similar to Crown Prep and Cementation. On visit there is a Fee and one there isn’t.
As Patients are “onboarded” to the plan, the Membership Fee is posted to a “generic pool” for all the Hygienists that is divided.
The Managed Care Utilization report will show the total of your Standard Fee that would have been billed and the “adjusted” Membership Fees charged out. You can filter by Provider to see Preventive vs Restorative Care.
Q: What if our office wants to offer patients the choice to pay for membership monthly?
A: I would never suggest an office try to manage these plans monthly. I’ve always recommended using an outside company to do monthly Membership payments. Even with a monthly payment option, you can post the annual Membership Fee (say the $299 in my example) than any "recurring platform" payment would go towards that balance.
Initial Account balance $299
First recurring platform monthly payment $24.91 (x 12 months)
New Balance: $274.09
You can do the same thing by making a Contract of $299 and each month $24.91 post to the account with the EOM processing and each month the balance would be $24.91, and a payment would post. Either way it works. ONLY difference would be the ageing of the $299.
Q: What about a third cleaning (if only 2 are included in the annual plan)?
A: I create Admin Code for Prophys beyond the two that are in the Membership Plan (and even for use outside the plan) then you can attach a fee and walkout at that fee.
Q: How do you track compensation for an associate who does an exam on a Membership Plan patient?
A: An associate gets compensated by the restorative treatment that is treatment planned from the Membership Plan Patient’s Evaluation. The Membership Plan is a "lost leader" that keeps patients "loyal" to the practice and away from buying a Delta AARP or Aetna Dental Advantage plan. If this doesn’t work for your business philosophy, see my answer above for Hygiene compensation.
Example: Patient buys a Membership for (example) $300 and on that visit gets Exam, Images and Professional Cleaning completed. The code for the Membership Plan (Example: A0101 MEMBERSHIP PLAN - ADULT FIRST) is posted to Provider treating the Patient (say Mary the Hygienist). The Services are ALSO posted to Mary but have a $0 fee attached. For tracking purposes, Production today for Mary's is $300 and Collections for Mary are $300. The doctor doing the Exam has $0 production BUT did the exam. All future Membership restorative visits are done at the discounted rate (example $100 filling at $85 gets posted $85 to the doctor and collections of $85 to the doctor). The next hygiene visit is $0 with $0 in collections (but is averaged over the 2 hygiene visits. The fee for a Perio Membership would be higher to be averaged over 3 visits). The Managed Care Utilization report tracks the amount "written" off based on the membership. Let's say you break off the Exam value from a Initial visit of $399. Say it's 1/3 or $133. Most Associates get 30-40% of that ~$55. Is $55 really going to be a game changer vs the ability to see that patient for restorative care outside the "rules" of insurance?
Q: Can’t you just put a Fee Schedule in the Patient’s Preferences to avoid all this work?
A: I don't like putting Fee Schedules attached to patients. Here's my logic. Most practices with one doctor have 1,600 patients. In theory you will have to change hundreds of patients if you update the plan design. There is also no tracking method if the "plan" is attached only in Patient Preferences. Using my Employer/Coverage Plan method, I can do all kinds of updates, tracking, Intellicares, whatever I want. Biggest fault I see in using Patient Preferences: Employee error. Someone doesn’t want to re-up their plan but still getting charged out the Members Fees.
Q: Can you use Account Types to filter Membership Patients?
A: You “can” but there are cases when one family member is in the Membership plan, and one is not. So, Account Types would be correct for one and not the other.
Q: If the membership plan requires patients to not have other dental insurance policies, how do we deal with Medicare patients who automatically have that policy?
A: Within your Membership Plan sign up documentation, Patients should see the following restriction:
Patients who are currently covered under a dental insurance plan are not eligible for membership (this is because of the contractual restrictions placed on you and us by the insurance plan). Membership fees do not apply for treatment originating from a Workers Compensation or Employer Liability Claim.
AND...
If you become eligible and begin participation with a traditional dental insurance plan during the time period, The Dental Care Club becomes null and void with no refund of fees.
Because the fee for Preventive Treatment is $0, as reported in box #31 on the ADA form so there would be no reimbursement. For Restorative care you would need to uncheck the Submit Standard Fees on Insurance so that you are submitting the offices Membership Plan fees. This would also apply to patients who had any purchased discount plans like.
Twenty states include dental in the definition of health care provider authorized to engage in DPCA. There are states where patients with insurance can NOT enroll in your in‐house discount dental plan. They are (as of the last update of this page): Idaho, Illinois, Maine, Montana, Nebraska, Oregon, Tennessee, and Washington. There are States that REQUIRE a Certificate of Authority or License to be used in conjunction with insurance. They are Connecticut, Rhode Island and West Virginia.
Q: What is your favorite 3rd Party company to help create an in-house discount plan?
A: here is my “Top 5” list:
Do-It-Yourself
Plan Forward
Kleer
Do-It-Yourself
Do-It-Yourself
There is more information available about Membership plans from the ADA here.
For a 3rd part option like Kleer, look here: https://1drv.ms/b/s!AjhYviAiEzNIr_F99ap4Rr0QYcgDVA
I will continue to update this post as new information becomes available
If you use are considering using Kleer to manage your Membership plan with Eaglesoft, use the link below:
If you use are considering using Plan Forward to manage your Membership plan with Eaglesoft, use the link below:
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
