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Teresa Duncan, MS, FADIA, FAADOM is an international speaker who focuses on revenue, dental insurance & management issues. She is a Fellow of the American Association of Dental Office Managers. Her memberships include the Association of Certified Fraud Examiners, National Speakers Association and the Academy of Dental Management Consultants. She has been named one of the Top 25 Women in Dentistry by Dental Products Report. Teresa received her Master’s Degree in Healthcare Management.
Insurance experts Teresa Duncan and Bridget Fay break down the things you need to know about insurance in the dental practice.
Fee schedules: these two words are extremely important to your practice’s metrics and measuring productivity.
If you are a fee-for-service office that does not bill to insurance, you are in the clear and don’t have to worry about this issue. However, most dental practices have to be conscious about their insurance numbers. As a preferred provider (PPO) office, you should first come to terms with the fact that you won’t collect your full fee. With this in mind, you will need to keep a strong grasp on your fee schedules.
Here are some tips for you to manage this process:
1. Base your metrics on the insurance fee, not your full fee
I know it doesn’t sound very appealing considering what you get from the insurance company, but you can’t expect to collect your full fee unless you are fee-for-service. Basing bonuses and financial expectations on your full fee will not provide a realistic outlook on your accounting. The alternative is making sure your adjustments are accurate and that you are watching them closely. It’s worth putting in the time and effort to set up your practice management system so that it does the adjustment work for you.
2. Putting fee schedules in your PMS
This is a crucial step to tracking and maintaining your fees. A good software program should have a way for you to enter in your contracted fees and then calculate your production from those fees, not your full fee. Even better, both fees should print out on your treatment plans and show on your ledgers. What is wonderful about this is you are showing your patients the discount they obtain by utilizing an in-network provider. You should have no shame showing your full fee and what you are actually getting paid. I believe in being transparent and this is the perfect way to show it.
3. Maintain and track your fees
The explanation of benefits you receive from insurance companies will be your system of checks and balances. Ideally, you won’t have to make any adjustments when the checks are posted. If they don’t match up, then there is research to be done. You’ll need to determine why your numbers are not matching up. Not sure who to contact? Try your software support first, but be specific about what you’re trying to achieve. Ask to speak with someone who might be known as an expert on entering fee schedules. If that doesn’t work, consider hiring a trainer or a consultant with specific knowledge on the subject.
4. Review claims and EOBs
Part of maintenance is ensuring your full fee goes out on all your claims. We’re often asked why this is so important. One reason is if the insurance companies won’t see your full fee otherwise which impacts their levels of decided reimbursement. Your fees should be reasonable and not just random numbers. When you receive insurance payments, carefully look at the numbers. If your software is set up properly, you should be able to spot discrepancies fairly easily.
5. Outsource fee negotiations
Unless you are negotiating only 10 services codes for a single provider with a single insurance company, you probably won’t have the time to do it on your own. This is one of the most time-saving services you can outsource. Services like Unlock the PPO not only help start-ups establish their base fees, they will completely take over the negotiations and help you determine what fee schedules are best for you. If it’s been a while since your office has evaluated your fees and contracts or you’ve had a specialist join your practice, it would be beneficial to investigate this type of resource.
If you are about to open a new practice, it’s much easier to follow these steps and start out right from the beginning. Changing an existing system is a little harder and requires more time, but it will help keep ledgers clean and give you a clearer financial outlook. Who doesn’t want that?
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