Practice Management Terminology 

 

 

 

Office 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

 
 
 
 
 
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