Top Tips for Providing Good Faith Estimates
Patient collections are imperative to running a practice. Giving your patients accurate estimates before treatment is one way to help increase your collection percentages. It is not only ethical but also a law.
After many years of discussion, the No Surprises Act went into full effect in 2022. This Act was formed to provide transparency to our patients regarding treatment costs.
Although many of us have been doing this for years, it is now a law we must abide by. We are charged to do our absolute best to give an accurate estimate to each patient for their treatment, leaving no surprises at checkout, hence the name “No Surprises Act.”
Here Are My Top Tips for Providing Good Faith Estimates:
Tip #1- Familiarize Yourself with Insurance Terminology
First, familiarize yourself with the terms fee schedule, never-ever rule, coverage table, and benefit breakdown.
A fee schedule is a list of fees you have negotiated with the insurance companies you are in network with. If you don’t already have them, you will need copies of the fee schedules from the insurance companies. This will help you determine what you’ll be able to charge your patient and what your write-offs will be.
You will also want to check your state laws to see if the “never-ever” rule applies in your state. The “never-ever” rule means you can bill the patient your full fee if the plan never covers a code. Otherwise, you can only charge up to the fee schedule.
For example, if the plan doesn’t have crown coverage, you could charge the patient your full fee for the crown, versus if the plan has coverage for crowns but will only be covered once the waiting period has been met. In that case, even though the plan will not cover the crown now, it will in the future, so you can only charge the negotiated fee.
A coverage book is next on the list of terms to familiarize yourself with. A coverage book describes how you enter what percentages or amounts of things will be covered into your PMS, the most common being percentages.
Tip #2- Insurance Breakdowns
Before the patient’s appointment, you will get insurance benefit breakdown information and enter it into your dental software.
Creating a benefit breakdown form for your team to use when verifying coverage for all your patients is advisable. When everyone uses the same form, you can be sure things are consistent across the board regarding the information you obtain on each patient.
This will matter when you are entering all this information into your PMS. You will want to get category percentages, frequency and age limitations, downgrade rules, waiting period, missing tooth clause information, and preventative code history. I have a breakdown form I would be happy to share upon request.
Tip #3-Utilizing your Practice Management Software
Do you know if your Practice Management Software or PMS can do the math for you?
No need to grab the calculator.
Eaglesoft, Dentrix Core, and Dentrix Ascend, to name a few, can do the math for you.
In Eaglesoft, you can use the fee schedule, the coverage book, or both. In Dentrix Ascend, you will need both the fee schedule and the coverage book. In both programs, you can account for downgrades and different dollar amounts or percentages of coverage to get the correct estimate. Most PMS programs have this ability; some even allow for age and frequency limitations. Use it all if your PMS has it!
Once you have all this information, you can enter it into your PMS; you must check with your software company to see exactly how to do this. In a few steps, you will attach the fee schedule and breakdown to the patient and present your treatment plan, otherwise known as a good faith estimate.
These tips allow your office to abide by the good faith estimate rules and allow your team to collect the correct patient portion at the time of service, thus raising your collections and lowering your accounts receivable.
It takes a little work at the beginning, so you don’t have to chase it at the end. WIN – WIN!
About the Author
Debbie Meadows, CDA, MAADOM
Debbie has been in the dental field since 1997 and is a Practice Manager and Director of Operations at a busy practice in Kentucky. She is a certified dental assistant with additional radiography and coronal polishing certifications, which she received from the University of Kentucky.
Debbie graduated from Western Kentucky University with a degree in Business and is a Lifetime member and Master of the American Association of Dental Office Managers. She co-founded the Kentucky DPLN Study Club of Dental Office Managers.