Adjustments were $31,000 last month. Production was $180,000. Is that fine? Nobody can say until the $31,000 is split into the part the office agreed to in advance and the part somebody decided on the day.
The write-off report is where that split happens. It is also the report most owners never run by user, which is the one view that matters.
What is the difference between contractual and courtesy adjustments?
| Type | What it is | Expected? | Who should be able to post it |
|---|---|---|---|
| Contractual (PPO, HMO, Medicaid) | Office fee minus the plan’s allowed fee | Yes, on every in-network claim | Insurance coordinator, at claim payment |
| Courtesy or professional | Owner’s decision to reduce a fee | Occasionally, with a note | Owner or office manager |
| Senior, cash, family discount | A published office policy | Yes, if the policy exists | Front desk, per the policy |
| Bad debt | Account sent to collections or forgiven | Rarely | Owner only |
| Correction | Fixing a posting error | Occasionally, same day | Whoever made the error |
The first row is not a problem. The other four are decisions, and decisions have a person attached.
How do you run it in each system?
Open Dental. Set up adjustment types so that contractual and non-contractual have different names (Setup, Definitions, Adj Types). Then run the Adjustments report under Reports, filtered by date, adjustment type, provider and user.
Dentrix. Adjustment types live in Office Manager under Practice Setup. Run the Adjustment Summary from Office Manager, Reports, Ledger. Note that admin.adjustment_view carries no user column, so “by user” is only available through the Audit Trail Reports.
Eaglesoft. Adjustments are rows in transactions_header with type C (credit, reduces the balance) or D (debit), and adjustment_type names the reason. Run the Adjustments report from the Reports menu and group by adjustment type. The user_id on each row is the provider, so for the person who posted it you need the audit utility.
What does a healthy report look like?
Work through a month with numbers you can check.
- Gross production: $180,000
- Contractual adjustments: $27,000
- Courtesy and discount adjustments: $2,800
- Corrections: $900
- Bad debt: $300
Net production is $180,000 minus $31,000, which is $149,000. The contractual share is $27,000 divided by $180,000, or 15.0%. That figure should move only when payer mix moves. The non-contractual share is $4,000 divided by $180,000, or 2.2%, and every dollar of it is a decision someone made.
Now run the $4,000 by user. If three people post courtesy adjustments and one of them posted $3,100 of the $4,000, that is the row to ask about. The answer may be “the doctor told me to” every time. It may not.
Which rows deserve a question?
- A courtesy adjustment on an account that also had a payment deleted within the previous 30 days.
- A PPO adjustment on a patient whose insurance is fee-for-service or none.
- Adjustments posted by a user outside their role in the table above.
- Round amounts that exactly match a patient’s share after insurance.
- A rising non-contractual share month over month with no new discount policy.
- Adjustments posted after hours.
None of these is evidence on its own. Each one is a reason to open the account ledger and read the sequence of entries.
How often should the owner look?
Weekly for the by-user view, monthly for the contractual share. Fifteen minutes a week is enough. The prevention page puts this review into a short weekly routine alongside deleted payments and the deposit check.
What Calibic adds
Protect is LIVE and includes a write-off card. Calibic reads adjustments read-only from each system, splits contractual from non-contractual using your own adjustment type names, shows the non-contractual share by user and provider, and flags the specific sequences above (a courtesy adjustment following a deleted payment, an adjustment type that does not match the account’s insurance). Where the system does not record who posted the row, Calibic says so instead of guessing. It never writes to the practice software.
Next step: the Protect product page.