Insurance Estimating - Write-Offs Without Insurance Estimating

MacPractice can automatically pull a write-off amount when entering an Insurance payment without enabling Insurance Estimating. The following formula calculates the write-off portion:

Fee (-) Allowed (=) Write Off (only when Participating on the Plan level)

To pull a write-off without Insurance Estimating, create a plan and participate with the insurance company. In References > Insurance Companies > Plans, create a new record with the plus button and rename the plan. Within the Coverage tab, check the Participate checkbox. If participation for the plan varies amongst providers, specify participation in the Participate tab.

Within the Allowed tab, enter the allowed amounts for each procedure code (fee) in accordance with the plan. Add procedure codes to the list individually with the plus button, or select the Add from Fee Schedule item from the Update Fees menu to add all procedure codes from a selected Fee Schedule. Add the Allowed and Work RVU amounts within the respective columns for each code.

The Update Fees menu lists additional items which may be used as alternatives to manually entering each code.
  • Add From Fee Schedule: This item imports procedure codes from a selected Fee Schedule, mapping the amount of the fee as the allowed amount. If a carrier's fee schedule is used to establish fees, the allowed amounts and fee amounts may be the same. Any code for which the fee amount is not equal to the allowed amount for that plan can be adjusted after the fee schedule codes are imported.
  • Copy Allowed: This item imports allowed amounts from another plan. Plans for an insurance company may have the same allowed amounts, despite different coverage or deductibles. Set up the allowed amounts within one plan, select the plan to populate with the allowed amounts, then select the Copy Allowed From Selected Plans option.
  • Delete Allowed Amounts: This item clears all allowed amounts.
To associate this plan to the patient, select the plan in the Primary or Secondary tab in the Patient Account within the Plan tab.

Insurance Payment
When an Insurance Payment is made, the Allowed column within the Insurance Payment window will be populated with the amount set in the Plan. Enter the Insurance Payment Information and the write-off will be calculated from the total Fee amount minus the Allowed amount.

The Insurance Payment window can also be used to add allowed amounts to the Allowed tab of a plan as an insurance payment is made. If an allowed amount is entered with the payment check the Save Allowed checkbox and the corresponding allowed amount will be saved to the plan. From then on, the same allowed amount will pull to the Insurance Payment window for that procedure whenever the patient has this plan.
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