Setting Up Insurance > Handling Insurance Plan Information > Understanding Medicare Plans
To estimate insurance payments for flat fee Medicare plans:
Set up accurate payment values in the bluebook for all procedures.
If there is no bluebook entry for the flat fee PPO insurance plan, the percentages specified in the Coverage tab of the Insurance plan record are used.
The following table explains the insurance estimation calculations used for dental and medical flat fee Medicare plans. The calculations show the estimations when the deductible is subtracted first or last.
The calculations are based upon the following example: The fee is $88, the allowed amount is $75, the bluebook insurance payment is $60, the coverage is 80%, the copayment is $30, and the deductible is $25.
The insurance estimation calculations for dental and medical flat fee Medicare plans are:
|
Plan Type |
Calculations |
|
Dental Flat Fee Medicare Plan Bluebook Entry No Deductible |
The allowed amount is subtracted from the fee. The difference is the estimated write-off amount. The estimated write-off amount is added to the insurance payment entered in the bluebook. |
|
Dental Flat Fee Medicare Plan Bluebook Entry Deductible Subtracted First |
The deductible is automatically subtracted from the estimated insurance payment entered in the bluebook. The difference is added to the estimated write-off amount. |
|
Dental Flat Fee Medicare Plan Bluebook Entry Deductible Subtracted Last |
The deductible is automatically subtracted from the estimated insurance payment entered in the bluebook. The difference is added to the estimated write-off amount. |
|
Dental Flat Fee Medicare Plan No Bluebook Entry No Deductible |
The coverage percentage is automatically multiplied by the fee. |
|
Dental Flat Fee Medicare Plan No Bluebook Entry Deductible Subtracted First |
The deductible is automatically subtracted from the fee. The product is multiplied by the coverage percentage. |
|
Dental Flat Fee Medicare Plan No Bluebook Entry Deductible Subtracted Last |
The coverage percentage is automatically multiplied by the fee. The deductible is subtracted from the product. |
|
Medical Flat Fee Medicare Plan Bluebook Entry Deductibles Do Not Apply |
The allowed amount is subtracted from the fee. The difference is the estimated write-off amount. The estimated write-off amount is added to the insurance payment entered in the bluebook. |
|
Medical Flat Fee Medicare Plan No Bluebook Entry Deductibles Do Not Apply |
The insurance coverage percentage is automatically multiplied by the fee. |