DA 6 FEES AND ESTIMATES Flashcards
(27 cards)
What is production?
Fees charged
Production=dentists earn income and pay all practice expenses
Fees charged –
where a dentist earns income and pays all practice expenses
What do fees allow dentists to do?
Pay for practice expenses Income for dentisit such as Salaries dental materials lab fees rent+utilities
Account receivable
money owed to practice for service rendered
Fee Guide
“guide book “
provides suggested fees for any given procedures
How often does the BCDA fee guide change?
Fee guide changes annually on February 1st
Valid until Jan 31
dental insurance and purpose
A plan that assists patients financially
designed to make health care more accessible by reducing the cost to the patient.
WHo is involved in insurace
- Subscriber
- Dependent
- Group
- Provider
- Carrier
Subcriber
insured (employee)
Dep 00
Dependent
child or spouse of subscriber
dep 01,02
insurance Group
union or employer
identified by group/policy number
Provider
Dentist who renders appointment
Carrier
insurance company that pays claims
benifit/policies vary
e.g. PBC, Manulife
Benefits and predetermination of benefits
Benefits = covered services
predetermined: patients eligibility / preauthorized
Benifit approval
receive the predetermination of
benefits from the carrier
– outlining coverage
details
Claim
• A report of dental services to a patient’s dental
plan
Claim form includes
information about, patient subscriber, and treatment provided and fees charged.
Explanation of benefits
provided -based claim amount
received
insurance carrier’s response to a claim
What is an estimate?
• A form that outlines specific procedures and their associated estimated costs
written contract
confirming coverage
prior to procedures
prior to providing estimates
Pacific Blue Cross (PBC)
- uses its own Fee Schedule,
- based on the current BCDA Fee Guide
Ministry
MINISTRY fee guide-lowere than BCDA
not all ministry client eligible
Non-Insured Health Benefits (NIHB
First nations health program
PBC third party admin
non registered pay upfron–> reimbursement FNHA
Adminter of NHIB
(FNHA )First Nations Health
Authority
