Paying Dentists on Net Production

Most dentists and team members are familiar with the day sheet to look for gross and net production as well as collections. In the Dentrix Ascend day sheet, here are the terms to identify each of these items:

Procedure charges = Gross Production

Applied Payments + Unapplied Payments = Total receipts (for the bank)

Applied credit adjustments = Adjustments entered and applied to charges within the report range (for example professional courtesy)

Unapplied credit adjustments = Adjustments entered and either not applied or applied to charges outside the report range (for example another professional courtesy but outside the date range on the day sheet)

Charge adjustments = Adjustments entered within the range of the report (for example patient refund)

Charges billed to insurance = Procedure charges within the date range of the report that have been billed to insurance

Estimated net production = Procedure charges – estimated write off – adjustments applied to procedures in the report range

The day sheet is a great report to use to pay dentists, because most dentists are looking at their day sheet and are familiar with it. To use this to determine a dentist’s compensation, you will first run your day sheet for the date range of your pay period. To do that, choose Custom Range as your date range and select the dates of the pay period. Each time you run this day sheet to determine your dentist’s compensation, be sure to save this in a digital (or hard copy) file labeled for the pay period and the date it was run. (Tip: the day sheet information pastes nicely into Excel.)

In this example day sheet below, you can see that the estimated net production is $1,198. If you are paying your dentists 25% of net production, then you can use this number x .25 to determine their compensation.

Since the day sheet reflects an estimated net production, this suggests that this number can change. Over time, once all the insurance claims have been closed for this date range, you will see the Estimated Insurance Write-offs goes to $0. When that happens, your estimated net production is now your actual net production.

(As an aside, if you’re thinking “Wouldn’t it be great to wait until we have actual net production to calculate our dentist’s compensation?” you may want to consider setting up a draw for your dentists and then calculating their compensation using the day sheet 3 months back. On this payroll schedule, if you can successfully close all your claims in 90 days, then you would never have to worry about auditing your net production reports.)

Unfortunately, the reality is that sometimes we have open claims for several months, and that means we need to audit our net production numbers to make sure our dentists are being paid accurately.

To audit your net production, re-run your day sheet for that same pay period. Look at your Estimated Insurance Write-Offs. If it’s anything other than $0, that means you have open claims and you will want to find these open claims, get them paid and closed. This suggests that your audit for net production will continue until you run a day sheet for that provider’s pay period and finally, the estimated insurance write-offs are $0. Once you hit $0, you can stop running that date range in your auditing process.

Auditing Net Production and Tracking Open Claims

Since the day sheet does not show which patients have open claims, you will want to identify which patients have claims that are outstanding. To find this, use the Outstanding Claims report located in Home, under the Reports category. Best practices recommend running this report at the beginning of each month for the month previous, and working through each open claim until all claims are paid.

Another report you can use to audit net production and identify open claims is the Adjusted Production report (found in the Financial tab of Power Reporting). This report is only as accurate as your fee schedules set up for your insurance carriers, but it is a quick way to view open claims.

This report defaults to include 3 filters:

• First, you need to change the date from the 7 previous days, to reflect last month. To do this, click the X beside the date filter to delete this filter. Do not delete the date field, only the filter.
• Next, look in the Available Fields column under Service Date (YMD) and double click on the Month. This will add the month into the report.
• Next, right click on the Month in the yellow box on the report and choose Filter. Now checkmark Previous Month and click Ok.

As you make changes to the report you will see an alert letting you know it has been modified. Click the Refresh Report button on the far right to see the updated information.

Now you will have the following columns in your report:

 Since this is hard to see, here they are:

• In yellow:
  • Provider
  • Date (this is date of service)
  • Patient
  • Procedure Code
  • Procedure Description
  • Claim Status
  • Month
• In blue:
  • Procedure Charges
  • Applied Credit Adjustments – this is a collection item and needs to be removed. In the Layout column click the dropdown and select Remove from Report.
  • Contracted Fee
  • Estimated Write-Off
  • Adjusted Production

Click on the yellow box labeled Month in your report and drag it all the way to the left (you’ll see a blue line appear for where this column will move to). This will automatically group your data by month first.

Now, to understand this report, you have the following columns:

Looking at the yellow column items there are several best practice reviews you can perform.

• First, you may want to have a team member look down the dates. If there is only one procedure charged out on a day, perhaps it was charged out in error?
• Next, look down the code and description columns. Make sure your dentist is being paid for the proper procedures. For example, let’s say your dentist is not paid on x-rays, if you see any x-rays listed, you should go into that patient’s ledger and change the provider.
• Finally, you will want to look down the Claim Status column. Are there any claims that have been rejected or are still outstanding that you can resend or clear up? This doesn’t impact the net production, but it does help the practice maintain cash flow.

Moving to the blue column items, there are also some best practice reviews you can perform.

• First, review the Procedure Charges column just to confirm that the fees look accurate. If you see any $0 fees, you may want to check that individual patient ledger to confirm this is accurate.
• Next, looking down the Applied Credit Adjustment column; this is where your insurance write-offs will show up. If you see any large amounts, you may want to review that patient’s ledger and confirm adjustments are applied accurately and for good reason. Best practices require a note for every adjustment created including the reason for the adjustment and the initials of the team member that applied it. You may also want to just pop quiz a couple ledgers to make sure the adjustment looks correct as well.
• Finally, look down the Estimated Write-Off column. Go to the ledger for every patient to try to close this claim.

As usual, for future auditing purposes, save this report in Excel, with each workbook labeled for a specific month and the document labeled Adjusted Production Year Provider Name, for example “Adjusted Production 2017 Dr. Tom Smith”.

One question many dentists ask is, “Why doesn’t my day sheet match my power report?” The answer lies with the dates. The day sheet only looks at the transactions that occurred inside the date range. So let’s say your month just ended last week. As part of your auditing protocols, your team caught that a patient seen within that month had a duplicate x-ray taken and so an additional adjustment was added. The day sheet would not include this additional adjustment inside the estimated insurance write-offs because the transaction date is outside of the date range. 

On the other hand, the power report (in this case the Adjusted Production report) is based on procedure date—so no matter when an adjustment is posted, it will reflect in this report. The day sheet is generally more limited by date range than the power reports.

(Article authored by J. Alldredge, J. Nesbitt 2017)