Paying Dentists on Net Production

Effective July 2021, our best practice recommendations have changed, please see this Known Reporting Issues article for instructions. At this time, we do not recommend using the Provider Production report due to power reports issues. 

Once these issues have been resolved, we will again recommend this approach for paying providers.

Recommendation Below On Hold

The best report to use to pay providers on net production (and to simply see your net production) is the Provider Production Report.

Most groups that pay on production do the following:

• Tighten their transaction locking (often 5 days or less)
• Turn on the Auto Post PPO Write off switcher*
• Create claims on the date of service (required for the auto post to occur)
• Maintain accurate fee schedules for all PPO, HMO and discount plans

A few groups prefer to leave the Auto Post PPO Write off switcher off – these groups are often fee for service or unable to maintain accurate insurance fee schedules. *One item to be aware of is that if the primary insurance is out of network and a secondary plan exists, the auto post generates based on the higher fee schedule, so not consistently. 

The Provider Production Report Today

(Based on Created/Modified date)

Found in the Insights dashboard or in Power Reports, this is a pre-built report that is now based upon the created/Modified date. This report shows all charge adjustments, credit adjustments, procedures (gross production) and a grand total (net production). You will use the Grand Total column as the Net Production number to determine provider compensation.

To customize:

• Add the primary guarantor name (if you want to show your providers the detail)
• Exclude any initial balance forward adjustments or other adjustments set to production that you do not want to impact doctors compensation
  • To do this: Add the subcategory field and exclude the adjustments that are simply transferring money between your legacy software and Ascend. Once this filter is set, you can remove the subcategory from the report and just retain the filter.
  • Note: If you have not used an adjustment with a patient yet, then the system will not allow you to filter for it (it just doesn't recognize it). To handle this, go to a test patient and enter every type of adjustment you want excluded from your provider compensation. Then Run the report, filter as needed and then go back to your test patient and delete these fake adjustments.
• Exclude any procedure codes that your providers do not get credit for

Saved Provider Production Report

(Based on Transaction date)

If you have a saved net production report that was created prior to our 369 release (delivered to all our Ascend clients by April 14, 2021), then likely this was built on transaction date and you can either update it or delete it and start using a new one that is automatically based on created/Modified date. We recommend using the created/Modified date as this will reflect accurate production in current and past months reports.

To update:

• Remove the existing month and existing year (these are based on Transaction date)
• Add Created/Modified Month and filter to the month you want to pay (normally prior month)

View Revisions

If you ever want to see more detail for patient ledger revisions and how this impacts your doctor’s compensation report, you can use this same report and add the fields: Revision history, Revision order, and Revision type plus the procedure code and primary guarantor.

For a deeper dive, you can also add transaction date and look at any transactions that reflect different transaction vs. created/Modified dates. If anything looks suspicious, then add primary guarantor and patient and drill down. For reference: https://support.dentrixascend.com/hc/en-us/articles/360061724974-Understanding-transaction-revisions-and-dates

Side note, if you are trying to re-create a report to match our prior approach using transaction dates, then you would replace the created/Modified date fields with transaction date fields and filter to include the current revisions only. And, we generally recommend using the date range picker for past periods. 

How the Day Sheet Compares

The estimated net production in the day sheet will not exactly match the net production in the provider production report. This can occur for several reasons:

#1: The day sheet’s estimated net production number is referencing the service date, while the provider production report now references the created/modified date.

The following reports use the following date types:

• Deposit slip – Transaction date
• Aged Receivables – Created/modified date
• Provider AR Totals - Created/modified date
• Power Reports – You can choose the date type

The benefit to using the created/modified date in your reports is that there are a variety of power reports to deep dive into exactly what occurred – by patient, procedure, insurance, adjustment, on any timeframe – and this allows your doctors/team to build confidence that the numbers match and make sense.  By not using the day sheet, you avoid the entire series of questions around why reports do not match. 

#2: If there is any amount in the Estimated Insurance Write off line on the day sheet that will prevent reports from matching because this is an estimate of what will happen in the future when the claim is created and the adjustment posted into the ledger. This is not a transaction that you can find listed out by individual patient because the adjustment does not exist in the ledger – and therefore cannot be captured in another report.  - If you have auto post turned on and you see an amount listed in this Estimated Insurance write off line on the day sheet, you may want to go to Home / Create claims to look for any patients/procedures on that date of service that have not yet been created and need to be.

#3: The estimated net production in the day sheet only takes primary insurance into consideration, not secondary insurance. The provider production report includes both primary and secondary insurance adjustments. 

#4: Additional credit adjustments posted outside the date range on the day sheet report will also cause these reports not to match. For example, let’s say the Auto Post is turned on and in January, procedure is completed, the claim is created and the adjustment is created/auto posted into the ledger. Then, in February, insurance pays less than expected and an additional insurance adjustment is posted. The estimated net production for January will not reflect the additional insurance adjustment, while the provider production report run for January will include all credit adjustments.

#5: If the Auto post option is turned off, then your day sheet will be drastically different than your provider production report because of reason #2 above impacting every insurance patient.

#6: If the Auto post option is turned on, but claims are not created on the day of service, then the estimated net production in the day sheet will be different from the provider production report.

#7: In a multi-location group where dentists travel between offices, if charges are entered into the wrong location, then the day sheet for a location will not match the provider production report.

#8: If transaction locking allows backdating into a prior period and items are deleted, this also will cause reports not to match.

One more recommendation: If you have saved an Adjusted Production Report - delete this. The Adjusted Production report will only factor in the insurance adjustment for primary insurance only. It also does not include any of the additional adjustments, such as professional courtesy, etc. until they are posted. The Provider Production Report as outlined above will include all posted adjustments.

So, what is the purpose of the day sheet?

The day sheet is helpful to get an estimated net production number in real time as the day progresses and ends. For practices with a daily net production goal for the office, viewing this report provides a guide of “how did we do today” from an operations perspective. For the accounting functions of matching other reports and paying providers, different reports are recommended.

The release notes also review updates to the Deposit Slip, Day Sheet and Provider AR Totals. For reference: https://support.dentrixascend.com/hc/en-us/articles/1500003165581-Release-Notes-April-06-2021-Prod-367-369-

To do after reading this article:

• Check the transaction locking date – Confirm this is set to 5 days or less
• Check the auto post – Confirm this is turned on
• Check the ledger options adjustments – Confirm the production-related adjustments
  • Confirm the initial balance forward – if this is set to impact production then we will need to exclude that from the doctors compensation report
• Get a copy of your dentist’s contract to identify any special cases for compensation
  • Does the dentist receive production credit for x-rays?
  • Are there any procedures the dentist does not receive production credit for?
• Build your doctors compensation report using the Provider Production report
  • Exclude the initial balance forward adjustment
  • Exclude any other procedures the dentist should not get credit for
  • Be sure to use created/modified date
  • Include guarantors to show the provider detail on who they were paid for
  • Rename this report in Ascend – save in My Reports
  • Also, create a folder in excel – save for that payroll date
• Understand the items that impact the accuracy of this report
  • Must have all fee schedules loaded and accurate
  • Must attach fee schedules to all plans
  • Must create claims day of service
  • Run your day sheet – if you see any $ in the estimated insurance write off line, this means claims were not created and your net production is inflated

(Article authored by J. Alldredge, J. Nesbitt updated February 2021)