Do you pay your dentists a percentage of collections? Are you looking for the right report in Dentrix Ascend to help you do that? Depending upon how your dentists’ contracts are written to determine their compensation, you can customize a Power Report in Dentrix Ascend to provide you with the information you need.
The report we recommend for paying providers on collections is the Applied Collections report - found in the financials tab in power reports and based on the applied date.
Here is a sample guide you can use to pay your dentists:
Let’s say your contract shows a provider will be paid 25% of collections less lab fees on a monthly basis. To find collections for each provider, you will run the Applied Collection report. Using the Total Collection column, find the total for a dentist. Let’s say it shows $100,000. You can see the name of each provider listed above the total, how much patients paid, any credit adjustments or charge adjustments that were applied and the total collection on patient accounts.
Now, take this $100,000 in Total Collection x 25% compensation = $25,000 to be paid to your dentist (less their lab fee).
If you wanted to auto calculate this 25%, then here are the instructions:
- Right click on the Total collection blue box in the report - this brings up a window - select User Defined Measure
- Choose Create calculated measure - this brings up a window
- You can enter a Display Name (this will show up as the name of the column in your report) - I chose Doctor Comp at 25%
- Leave the format at Default and 2 decimal places
- In the right box, you can add *.25 to have it automatically take the total collection and multiply by 25%
- Click ok to save
Here is a sample of how this report looks when you add this column:
Now, you can name and save this report - and the 25% calculation will be saved each time.
For future auditing purposes, save this report in Excel, with each worksheet labeled for a specific pay period and the document labeled using a pattern like Applied Collection Year Provider Name, for example “Applied Collection 2019 Dr. Salvatore Smith”.
This report will show payments that have been applied to a procedure. This report does NOT include pre-payments made that show up as unapplied payments. So, if a patient pays you $5000 today for a procedure that will be completed next month, the dentist that completes the procedure next month will see that payment applied when a team member manually clicks to apply that existing payment to the completed procedure.
This suggests that to make sure your providers are paid accurately your team must be regularly going through their unapplied payments and clicking to apply them. To learn more about applying a previously unapplied payment, read Applying unapplied credits in the Help Center.:
Best practices recommend that as each patient checks out after a visit, the team member handling their checkout should review their ledger; if they see a blue negative number under Unapplied Credits, they need to click on that number and apply the credit. (If the credit cannot be applied, clicking this number doesn’t hurt anything.)
In addition to performing this at every checkout, a second best practice recommendation is to run the Aged Receivables report at the end of the month, and assign a team member to go into the ledger for each patient that has an unapplied credit listed and click the blue negative number to clear out as many of these as possible.
By regularly applying pre-pays and running the applied collection report, you should be gathering accurate total collection numbers and paying your dentists accurately. Obviously, depending upon your dentist’s contract, you may need to customize a power report differently to meet your needs. Please call support for help with this.
How to Handle Patient and Insurance Refunds That Impact Doctor Compensation
If you are responsible for running reports to determine dentist compensation in Dentrix Ascend, you also need to understand (so you can explain to your doctors) how patient and insurance refunds should be handled.
For example, a patient pays $5000 for a treatment plan and the work is done and all $5000 is applied to the dentist who is paid 25% of collection, therefore $5000 x .25 = $1250. Next, a couple months down the road, the patient comes back in and is unhappy with something and the office agrees to refund the patient. This refund needs to come off of the dentist’s future collections.
Here is an example to show you how to enter adjustments correctly. Let’s say your patient had a crown done and paid for ($500 from the patient and $500 from the insurance), and then just a few weeks later, the patient is unhappy and wants a refund. The patient’s ledger shows that he has a $0 balance now, but the crown generated $1000 production.
To enter the refund, follow these steps:
1. Enter the patient refund charge adjustment. Click Charge (+) Adjustment. Choose Patient Refund as the type and set $500 as the amount. Leave the Payment date field value at the default [None]. In this case the patient or guarantor (it doesn’t matter) will receive a $500 refund.
2. Next, create another refund charge adjustment for the amount paid by the insurance company. Select the Insurance Over-pmt Refund charge type.
3. This results in new charges on the ledger that add up to the $1000 value of the crown.
4. Next, enter a credit adjustment. Click Credit (-) Adjustment. Choose the Credit Adjustment type in the amount of $1000 total. Manually edit the Applied amounts for the two refunds.
This results in the ledger going back to its previous balance. In the reports, however, the production decreased and the collection decreased as well.
This impacts provider compensation on the next payroll when you use the Applied Collections Report. The patient refund charge adjustment will reflect in this report, and that reduces the collections for the dentist. The patient refund charge adjustment will show up in the blue column labeled Charge Adjustments.
With this approach, you do not need to audit for refunds. The refund will be accounted for in your Applied Collections Report.
Auditing Your Collections Reporting
In order to maintain consistent reports that do not change, we recommend tightening your Transaction locking to less than 5 days and running regular audits. The primary reason for inconsistent reports is that the transaction locking has been edited by a user in order to enter back dated transactions – and as soon as that happens, that changes reports in the past. Another reason that reports can change is in the case of reapplying an existing payment or entering an insurance overpayment if a guarantor payment exists. If you post a patient payment and then receive an insurance check for more than estimated, the system will automatically pull the amount needed from the patient payment into an unapplied status so that the full insurance payment will post. Since this can cause changes in past periods, auditing is required for absolute accuracy. (As an aside, we are currently working on a feature named 'credit and rebill' that will stop this from occuring, this is due to release by end of Q1 2021.)
So, as you establish your auditing procedure, the first thing you will want to do is confirm that your transaction locking has not been changed. You also can restrict the rights to change transaction locking and educate all team members who have this ability on the impact of back dating.
Next, we recommend running a more detailed report – adding in patient and guarantor names – and saving this into a file for the sole purpose of simplifying any investigation into why previous report numbers have changed.
Here are the instructions:
- At each payroll, run the regular provider compensation report – save.
- Next, run the same provider compensation report and add in guarantor and patient names – this will be saved for future auditing.
- On a quarterly basis, re run the last 3-6 months of provider compensation using the same dates and confirm that the numbers for production or collection are the same. If you see any differences, then go back to the detailed reports to find the specific patient and ledger differences.
From a software perspective, if you follow these recommendations for using the blue link to unapplied credits and using adjustments to handle patient refunds, then your numbers will be accurate—and no auditing would be necessary. However, because most offices do not set their transaction locking to only a few days, it is possible that users can back date procedures, payments, adjustments, etc. and this causes numbers in the past to change. To review your transaction locking settings, review this article: Locking the Transaction Date to Avoid Backdating.
Again, to dig into the details, you can edit your Applied Collection report to include patient names--and you can filter by date to narrow down where the differences occurred. Once you’ve confirmed why changes occurred, then you can amend your dentist’s compensation if necessary.
How Long Should You Continue to Audit Your Collections?
The answer depends on the lengthiest treatment provided in your office. If your normal treatment plans are completed within 6 months, then you would want to audit your applied collections report for perhaps 7-9 months because until you feel “safe” from the possibility of refunds, you would want to track for this.
If you have an orthodontist in your group and normal cases last 2 years, but 20% of the time there are cases that last 2 ½ years, then you may want to audit for 3 years.
Another important factor in maintaining accurate reports is having well-trained staff. If you follow best practices and regularly apply payments using the blue link Unapplied payments in the patient ledger, then you will find fewer errors that impact the accuracy of your reports.
Another way to increase your accuracy of reports is to train your team to edit PPO fee schedules when they identify that the insurance estimate is off. For example, when your team enters insurance payments, ask them to notice when the payment is different from what automatically is entered. If they see a difference in what the PPO’s covered fee is, then have them edit the associated fee schedule so that future procedure codes will show up with the correct insurance estimate.
How unapplied credits work with this applied collections report approach
By using the applied collections report to calculate compensation for your providers, our unapplied credits work seamlessly with this approach. When you apply a previous payment (or even part of a previous payment) in the ledger, this amount will be displayed in the applied collection power report. It is important to know that there is no indicator of the applied date in the payment or in the ledger, only in the applied collection report. This approach works even when the original prepay was collected in January, the procedure completed in February – but then the prepay was applied in April. There is no way to apply a payment in the past, so this applied amount will show up on the most current applied collections report – and the doctor that did the work back in February will be compensated appropriately.
Why pay dentists on collections using the applied collections report and not the day sheet?
It can be confusing for an associate dentist to look at "applied payments" on the day sheet and then the "applied collections report" and see two different numbers when the language seems similar.
The reason for the difference is based on the dates used:
- Day sheet: Based on transaction date
- However, the Estimated Net Production number is based on service date
- Applied collections: Based on applied date
Also, the day sheet includes payments that were entered and applied to charges within the date range selected when you run the day sheet. A payment applied to a charge outside the date range of the day sheet report, will be included in unapplied on the day sheet.
To clarify the difference in these dates, let’s use an example:
Let’s say a $100 payment was entered 8/20/18 but entered as an unapplied payment. You will see this on the day sheet as an unapplied payment, and this will never appear on the day sheet again under the doctor because the day sheet deals with transaction date. If you run the applied collection report for that doctor for that day, you will not see this $100.
Now, let’s say that $100 was applied on 9/20/18 to the procedure and the dentist, you will see this $100 on the applied collection report. However, if you run the day sheet for this day, you will not see the $100.
This would suggest that if the day sheet were used for doctor compensation, the dentist may be underpaid.
To see this difference, run a collections detail report with both the transaction date and the applied date – and then take turns filtering on each of these dates. You can see side by side the applied date vs. the transaction date – and you may see that the transaction date is earlier than the applied date.
So, if a patient prepays, that would be one reason that you would see a transaction date (date the patient prepaid) and then a different applied date (date this was applied to a procedure).
You can see how the transaction date and applied date are different in this report:
As you are reviewing this applied collections report for paying your providers, you may also want to confirm the transaction locking dates are limited to avoid backdating as well.
Also – by only using day sheet, this will not take into consideration the patient refunds. Here’s why:
Let’s say the patient paid $500 for a crown (total fee $1000) on 6/1/18 - and let’s say this was a same day treatment and payment, so it was entered as a transaction and applied same day. This $500 will show on both the day sheet and the applied collection report.
Now, a month later, on 7/1/18 – let’s say the insurance overpays – and they pay $600 (we expected only $500). And, let’s say that same day we issue a refund to the patient of $100. On the day sheet, we will see $600 in applied payments for the doctor, but the $100 refund will show up under charge adjustments – and therefore it did not get factored in that really the dentist should have been paid $500 only.
By using the applied collection report for that day when the insurance paid $600 and the patient refund of $100 was processed, then we would have captured both these transactions and the dentist would have only been paid on $500.
In this example, by paying your dentist off the day sheet, you would have overpaid the dentist.
So, if you are the owner of the practice and you are explaining to your dentists why you use the applied collection report to determine their compensation, there are a few reasons:
- To make sure you receive payment when patients pre-pay
- To handle refunds fairly
- To provide a single report including patient names that can be confirmed for accuracy in order to build trust and transparency
Comparing the Provider AR Totals Report to the Applied Collection Report
Many offices want to compare reports to make sure their numbers are accurate. The Applied Collection report uses the applied date and the Provider AR Totals report allows you to choose whether to use the created or applied date - if you choose the applied date, then these two reports will match as long as you select the same timeframe.
(Article authored by J. Alldredge, J. Nesbitt 2017 - Updated 2020)