Using Ortho with Dentrix Ascend

Many dental practices use Dentrix Ascend for invisalign or other small ortho cases that are often done by general practitioners. There are numerous benefits to using Ascend for ortho, namely that this saves the practice from the cost of an additional ortho software and the subsequent separation of information between multiple systems. At the same time, Dentrix Ascend is not an ortho software, meaning it does not include cephalometric tracing features nor the classic ortho tooth number structure and financially, it does not include a future due payment plan feature so ortho cases must be charged out in full.   

One patient record for both general dentistry and ortho treatment has several benefits: 

• Save time by having all clinical notes, appts, contact/recare info, etc. in one account 
• Able to pull reports based on provider or code 
• Ascend will track both general and ortho insurance benefits on 1 account 
• Line item accounting ensures payments easier to track 
• Will not throw off your total active patient numbers 
• If insurance default set up to use the provider of service, no need to change tax IDs 
• Patient receives one statement 
• Could add a “location” ortho in future as location grouping is available for multi-locations 
• Right now because Ascend charges out the full ortho case, it’s easy to see what the total payout for the ortho case would be – just use a walkout statement 
• Can run AR including/excluding/targeting the ortho procedures 

Basics of the Ortho Workflow 

• Patient dental benefits include both general dentistry and ortho 
• Charge out full ortho case, create ortho claim, collect down payment, set up payment plan  
• In ortho procedure – enter placement date and # months remaining - you can set this to required in order to send these ortho claims.
• Most ortho plans pay automatically from the initial claim; some require claim to be submitted to generate payment monthly or quarterly 
• Best practice to simply resubmit the same claim with updated months remaining; when applying payment – just enter partial payment
• To track patients that need claims resent – can create a recare named ortho insurance, add to this patient and then establish a recare system for ortho claims 
• Enter claim payments as partial payments to keep the ortho claim open 

Limitations of Ortho with Dentrix Ascend 

• No future due payment plan feature – So, the entire ortho case is charged out at one time, inflating AR and showing the full ortho amount due on walkout statements.  
• To determine actual AR, run Aged Receivables with or without ortho procedures 
• Another option to avoid inflating AR – Manually charge out the ortho charge each month 
• No ortho specific clinical features – ceph tracing, ortho numbering, etc.  
• Coupons are not available 
• Payment plans dates do not limit the walkout statement/ledger expecting the next payment – i.e. even if the next ortho payment is not due for 3 weeks, if the patient comes in today for a filling Ascend will show as due today both the filling copay and the next ortho payment. 

When charge out ortho case – Can enter placement date and # months remaining 

Ascend handles dental insurance and ortho benefits per plan 

To send additional claims to ortho insurance, enter partial payment on the initial claim and then edit the claim to change the months remaining and total months. If you entered a placement date in the procedure, you will have to manually change the months remaining date.

Ascend has ability to run AR including or excluding ortho procedures

Workflow for non-automatic ortho claims

• Create a recare type for each ortho billing cycle (monthly, quarterly, etc.) - including the matching procedure code
• Create a procedure code to match - set to $0 and not submit to insurance 
• When you submit an ortho claim (for carriers that do not pay automatically), then also post the matching procedure code
• Then, monthly, quarterly, etc. run a recare report using the Recare Management to find the claims needed

Train your team for Ortho / General Dentistry patient collections

We recommend creating an ortho account for training your team and then review how it looks when general dentistry is performed.  

Step 1: Create ortho tx plan

Collect down payment 

Submit claim 

Set up payment arrangement 

Step 2: Treatment plan for filling 

It’s easy to see on this treatment plan that the patient owes $30.80 for this filling. 

However, once this filling is charged out into the ledger – the walkout statement wants us to collect the $30.80 for the filling PLUS the monthly ortho payment (even though I set the payment arrangement to start next month). AND, look at the bottom of the statement – it’s showing $3,280.80 as patient portion. 

If I collect the $166.21 – then I have overcollected on this account.  

When you're using one patient account for both ortho and general dentistry, then coach the team to only collect the “Please pay this amount” if the ortho payment was due as well. Otherwise, I’d recommend they use the treatment plan amount to know how much to collect.  

Handling a change in Ortho Insurance

If ortho insurance ends and new ortho insurance begins – it's easy to end the coverage date and then start new coverage for the patient. If this happens during ortho treatment, then we recommend: 

• Post a production credit adjustment (see image below) for any outstanding amount unpaid by the current plan 
• Close the ortho claim 
• Post the ortho procedure (call the carrier with any questions regarding the fees/adjustments they expect in this situation) and submit the claim 
• Post a production credit adjustment for the amount that has already been paid – this will leave a correct balance due 
• Then, continue to enter partial payments to keep the claim open 
• Resubmit the original claim as needed to the carrier to trigger payments

Decision: 1 vs. 2 Patient Records

If you've decided to use Dentrix Ascend for ortho, a second decision you need to make is whether to use 1 or 2 patient records. In most server-based software, it was necessary to create a duplicate patient record just for the ortho treatment so that you could run separate reports. However, with Dentrix Ascend, that's just not necessary. Since it can be difficult to change old habits -here are a few things to consider if you're tempted to continue using 2 patient records:

• How will you know where the x-rays are stored? If you take a pano at the patient's cleaning visit and then want the orthodontist to use that later - everyone is hunting between the 2 patient records to find the xrays.
• Do you want your clinical notes to be separated? Often an orthodontist will want to see a full patient record - and since most groups allow the general patient record to include all perio, oral surgery, general dentistry and all other specialty work to be in that one record - does it make sense to keep ortho separate?
• Do you want to duplicate patient notes and medical alerts? Keep in mind this is just twice the work.
• Do you want the orthodontist to go back to the general patient record to look at any prescriptions the patient is taking? 
• Do you want to look at the document manager for both patient records to find what you need? 
• As general dental treatment is planned and completed - if you maintain a separate ortho patient record, then your orthodontist may need to go to the general patient record to find updated dental visit information. 
• Be aware - if you maintain 2 patient records, then you have impacted your active patient count - this can throw off the accuracy of your reports - including active patients in recare or new patients, etc. 
• Once ortho treatment is complete, would you set up a process to inactivate that ortho patient record or turn that into a duplicate so it no longer stands alone and causes inaccuracies in your reporting data?
• If you use digital patient forms and you have 2 patient records, then if you're delivering forms in an automated manner, your patient will receive duplicate requests - this may cause some patient frustration. 
• If you use online booking and you use 2 patient records, how will you know the correct patient was scheduled? Both patients will have the same name and birthdate. And, if you removed the prophy recare date from your ortho patient record - so that there was no recare for the ortho patient, now this patient will show up in your recare management report as needing a recare date.