Terminology
Financial Report Terms:
Accounts Payable (AP): payments and bills that are currently due by the office
Accounts Receivable (AR): money that you are owed (either by insurance or patients)
for a procedure that was done
Aging Insurance Report: a report to see the outstanding balance owed by insurance companies to the office
Aging Patient Report: a report to see the total outstanding balance,
or unpaid amount, owed by patients
Collections: total amount of earnings (ex. cash, credit card payments) that the
office gains- can be per day, month, or year
Collections: a service that dental practices can utilize if a patient does not pay their portion for a prolonged amount of time
Certified Public Accountant (CPA): a valuable person to have on the team; will let know you what write-offs are beneficial for you to take advantage of as well as other financial aspects that you may not be an expert on
Daily Collection Report: a report to see how much money payment the office collected in a specific day
Daily Production Report: a report to see how much money in services the office produced (based on insurance or full fees) in a specific day
End of Day Report: a culmination of important information for the day; determined by each specific office; usually contains information including total collections and production, number of patients seen, number of cancellations, treatment plans presented and accepted, etc.
Patient Related Terms:
Confirmation Calls: calls sent out to patients to remind them of their upcoming appointments
Insurance Breakdown: determination of maximum, remaining, deductible, percentages of preventive, basic, and major, and service history, at the very least; the breakdown can be received by getting a fax from an insurance representative or from extracting information from the insurance company’s provider portal
Insurance Verifications: each patient’s insurance status needs to be verified as eligible and their breakdown needs to be determined at each visit
Net Income (NI): the office’s total income after accounting for taxes, depreciation, expenses, etc;
can be calculated monthly or yearly
Records Release Form: a form that patients fill out and sign before being sent their xrays, dental records, doctor’s notes, etc
Referral: when a patient is sent to another office for a service that cannot be provided at the referring office; often patients are referred to a specialist
Office Logistics Terms:
Assets: items that have value; for example, machines like an autoclave or an operatory
Cash Flow: the amount of money that comes and goes from the office
Due Diligence: the inspection of a practice before purchasing the practice; ex. getting an attorney, an appraisal (estimation of value), etc.
Fixed Expenses: charges that stay (relatively) the same over time; ex. loan payments, insurance payments, employee payroll
Goodwill: nonphysical assets that a practice possesses; ex. patient loyalty,
rating, employee satisfaction
Lab Fee: the fee that the office is charged by the lab when it fabricates
a case for the office
Lab Prescription Slips: slips that need to be filled out in order to send impressions for prosthetics to the lab; will vary based on the specific lab
Lab Tracking: some form of organizational method to track when cases had impressions taken, were picked up by the lab, were returned from the lab, and when they were delivered to the patient
Overhead: the expenses that an office has that keeps it going; ex. payroll, rent, etc.
Payroll: the amount that an office spends on paying its employees
Production: the full fee (see full fee) that the office charges not accounting for write-offs or discounts
Tax Identification Number (TIN): a number assigned to a practice by either the Social Security Administration (SSA) or the Internal Revenue Service (IRS) for tax purposes; also used to identify a practice when calling insurance companies to verify patient eligibility
Variable Expenses: charges that change over time; ex. advertising, office supplies, etc.
Write-Offs: the amount of money that is difference between an office fee and an insurance fee; writing this amount of money off in a patient who has insurance’s account will avoid having an unnecessary balance on that account
Insurance Terminology
Allowable charge: the maximum amount an insurance will pay for a a procedure, provided by the insurance or third-party payer
Annual Maximum: the total amount that an insurance company will pay for that benefit period
Beneficiary: a person who is covered and eligible to use benefits under an insurance plan
Benefit Year: the one-year period where a beneficiary can utilize their benefits up to their annual maximum; can start from any given month, does not have to go off the calendar year
Calendar Year: when the year is categorized from January to December
Claim: a request for payment that is sent to the insurance company that lists the procedures, date of service, and cost of service
Coinsurance: the percentage the beneficiary is responsible for; the cost sharing between the beneficiary and the insurance company; ex. in an 80/20 cost sharing situation, insurance pays 80%, the beneficiary pays 20%
Copayment: a fixed amount that the beneficiary must pay for a specific visit every time the beneficiary goes in for the visit; ex. an insurance plan may have a $15 copay for a cleaning visit that they must pay every time they get a cleaning, a set amount a person pays to fill a prescription
Covered Services: the procedures that will be paid for (in some portion) by the insurance as defined by the specific benefit plan
Deductible: the amount the beneficiary has to pay towards dental services before the insurance will start paying for procedures, often an annual payment
Dependents: the individuals covered under a beneficiary’s plan, usually a spouse or child
Downcoding: attaching a code with a lower money value to a procedure
Eligibility/Effective Date: the date at which an individual is covered and is eligible to use their benefits
*Important to take note of because if the patient is not eligible but gets treatment, no payment will be received
Exclusions: procedures not covered under an insurance plan
Exclusive Provider Organization (EPO): a specific plan in which the beneficiary must go to providers that are in network to receive coverage; if the beneficiary goes to an out-of-network provider, they are only coverage for emergency care
Explanation of Benefits (EOB): a statement that shows which procedures were covered or not covered from a specific claim and includes the check paid by the insurance company to the office; EOBs are sent to the office and should be recorded and added to the patient’s account to maintain a zero balance for each patient if they have paid their portions correctly
Extension of Benefits: extending coverage for specific procedures after the eligibility end date to ensure that treatment started prior to plan expiration is completed
*great tip for crowns or multi-appointment services
Family Deductible: an amount that is paid before the insurance will pay towards services, similar to the deductible, however, it satisfies the deductible requirement for the whole family covered under the plan regardless of the amount of family members
Fee-For-Service: a payment structure in which the dentist is paid their full procedural fee by all patients regardless of if the patients have insurance or not
Fee Schedule: the prices that a dentist agrees to for each specific service offered;
often contractually determined by each individual dental insurance
company meaning there are different fee schedules for each insurance plan
Flexible Spending Account: employee reimbursement account that allows the employee to spend these funds on health expenses, including dental
Full Fee: the amount that the dentist office determines to reflect the value of a service regardless of any contractual fees negotiated with insurance companies; the price that a patient with no insurance would pay for a service done at a practice
Indemnity Plan: when the beneficiary can go to any provider, but the insurance pays a set portion towards a specific fee
Limitations: characteristics that may limit coverage of an individual including age, frequencies, and waiting periods
National Provider Identifier (NPI): a number assigned to all providers; type 1 is an individual practitioner, type 2 is a provider that is part of a group or corporation
Nonduplication of Benefits: how secondary insurance companies will determine how much they will pay towards a service that a patient receives; the secondary will only pay towards the service if it has a coverage percentage greater than that of the primary insurance plan
*the primary always pays out first before the secondary will even consider paying!
Participating Dentist: dentist who has a contract with an insurance company that allows them to provide services to eligible individuals
Participating Practice: dental practice who has a contract with an insurance company that allows them to provide services to eligible individuals based on that insurance contract
Payer: anyone who pays for claims of a covered individual; i.e. insurance companies, a governmental agency, worker’s compensation, or other responsible party
Preauthorization/Predetermination: a statement that the payer will be covered for a prospective service beforehand;
has to be submitted by the dentist office; will often require
the attachment of xrays, a perio chart, and/or a narrative
Prepayment: a payment towards a procedure before the procedure is done to alleviate the
high cost of the procedure on the date of service
Waiting Period: the period where the individual is enrolled in an insurance plan, but is not yet covered for services
