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Open Dental Gross/Adjusted (Net) Production

What to do in the Open Dental Settings to change how production is viewed in Practice IQ. 

Open Dental differs in managing UCR fees and fee schedules associated with a PPO Benefit Plan versus other Practice Management Systems.

In Open Dental, most offices have an Insurance PPO plan set up as a PPO Percentage Plan Type.   The fee schedule shows the "Estimated write-off amount," but all transactions are entered at the UCR fee for the office.   When a service code is entered into the patient's ledger, the amount will still be the UCR amount.  This amount will be displayed in your production reports in Practice IQ.   When the insurance statements come in, the write-off amounts will be applied to the gross production of the day the payment was entered. 

Some offices(especially ones that participate in many plans) would rather see on their PBN dashboards how much production they did that day/week in numbers more based on what they can expect to collect, i.e., a number closer to the estimated production after all adjustments.  

A choice in Open Dental would be to change the configuration of a plan to Category Percentage. The option for the Insurance Plan default to show UCR on claims must be checked on the Setup Family Preferences. Keep the fee schedule associated with the plan in the space below. With this setting, the day the service is performed, the amount will be based on the plan fee schedule's estimated amount when the code goes in the ledger. The production numbers in the Practice IQ dashboards will show the lower fee, not the UCR.  

  • The disadvantage of this setting is that only the PPO fee will be present on the estimate when a patient is given the treatment plan. The amount of discount the patient gets would be unknown to them since the UCR would not be displayed. If that is important to the office, keep the plan as PPO Percentage type.   

  • Also, you would not be able to run a report in Open Dental to show the total amount written off vs UCR.  

  • The advantage would be a Gross Production number closer to what you are estimating to collect.  

 

Here is a link to a recent post on Open Dental's site regarding Fee Schedules and Open Dental: https://opendental.blog/2019/05/09/insurance-plan-types-in-open-dental/