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Some procedures involve more than one appointment. For crowns, bridges, dentures, partials, etc, there is usually a prep or impression appointment and then a seat or deliver appointment. You probably already have policies in place that specify whether the fee is charged at the first appointment or the last appointment. You need to decide which method to use before setting up your procedure codes. Here is how you handle each situation:
Fee due at first appointment
The advantage of making the fee due at the first appointment is that it is a
more effective way to ensure that the practice collects the money for the procedure.
The responsibility then falls on the patient to follow up and to make sure the
crown gets seated, etc. They are charged whether or not they return. This makes
sense because most of the time and money that is invested by the dentist is
at the first appointment and the lab work. Some insurance companies also prefer
the procedure to be billed on the prep date, although many of them do instead
request to be billed on the seat date. In spite of any insurance company's preference,
you are probably within your rights to bill on the prep date. The treatment
is substantially finished, and whatever crown or appliance comes back from the
lab will not fit any other patient. Beware, however, that the insurance company
may have a clause that the coverage date of the patient may only apply to the
seat date. This may affect annual renewal dates and termination dates, so always
keep the insurance company's peculiarities in mind when scheduling and billing.
Make sure to include a sentence in the financial agreement that new patients
sign explains that the fee for major cases involving lab work is due when the
work is initiated. When they sign and agree to those terms, it will make following
up on their bill easier.
The first appointment would be scheduled as the crown, denture, or whatever. The procedure would be the standard ADA code with the proper fee attached. Your default note that you set in the procedure code would be notes for the prep or impression, for instance: 3 carps 2% Lido-1:100k epi, prep, cord with hemostat, PVS, etc. -or- Alginate impression, opposing alginate, shade 102, etc. The second appointment would then be a special no-fee code that would not get billed to insurance. The code should not look like an ADA code. You can use a beginning N for no-fee instead of the usual D. The procedure might be "Crown Seat" or "Denture Deliver". The procedure note would be your standard note for seating or delivering. For instance: Removed temp, checked contacts and bite, showed to patient, cemented Fuji. -or- Delivered. Checked fit, bite, appearance, etc. Also be sure when setting up the second appointment to mark it "do not bill to ins", and set the fee to $0.
To track the lab case, when the assistant is creating the Planned appointment in the Chart module, the box marked Lab Case Sent should be marked. A note should also be made in that appointment regarding the due date. Then, when the patient goes up front to get scheduled for their next appointment, the Lab Case status will follow, and it will be very easy to see on the appointment in a couple of weeks that there is a lab case that needs to be watched. When the lab case comes in and is checked, then the appointment can be opened and the lab case status changed to received. Because this appointment has a lab case attached to it, it should never be deleted. If the patient does not want to immediately make an appointment, then the appointment should go on the unscheduled list so that it will be followed up on.
Fee due at the second or last appointment
The advantage of making the fee due at the second appointment is that it tends to follow more closely to most insurance company policies. There will be less arguments with the insurance companies, less surprises, and less incidents of accidently scheduling the patient in such a way that insurance will not cover the procedure. If the patient does not return for their second appointment, you should have policies in place to follow up and charge the patient for the lab fee that they incurred. It may be hard to explain to the patient, however, that they did not originally owe anything, but since they did not come back, they now owe a fee.
See the explanation in the above section on what procedure code to use for the first and second appointments. The difference would be that the first appointment would be the no-fee procedure, and the second appointment would be when the ADA code would be entered and billed. So the no-fee code would be something like "Crown Prep" or "Denture Imp", with the appropriate notes for that procedure.
Tracking the lab case would be exactly as in the first situation above.