PPO Negotiation Solutions

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Dental Revenues

Strategies to Reduce Dental Patient No-Shows

Anyone whose job includes seeing clients or patients for a living understands that no-shows are one of the most difficult and irritating parts of the job. There are numerous reasons why a patient may be a no-show to an appointment. We all understand busy schedules, so it’s likely that a client may forget. Clients may find it difficult to keep appointments if they have anxiety surrounding dental work, struggle with the cost of a dental visit or if their appointment gets lost in the day-to-day hustle and bustle.

If you’re searching for ways to combat patient no-shows due to reasons like forgetful or fearful patients, try these ideas to lessen patient no-shows, increase your profits and improve your patient care.

Dentophobia

Almost everyone has heard another person say they are scared of the dentist. Chances are, if you’re the dentist, you’re wondering why people think you’re that bad. Fear of the dentist is normally caused by negative past experiences.

Consider for a moment that you’re not in a dentist office, but in a restaurant setting. You enter the restaurant and wait at the door for someone to greet you and show you to a seat. It takes a few minutes for anyone to acknowledge you’re there. When a staff member finally shows you to your table, you wait even longer for someone to bring you a menu or take your drink order. The restaurant feels unkempt and your meal is low quality. You feel like you’re being ignored and when you are acknowledged, the staff is less than friendly. Considering the poor service, it’s not likely you’ll return to that restaurant again. And you certainly aren’t going to recommend it.

In the same way, your patients should also be thought of as customers that can choose your business. Or, choose another dental practice. If patients feel at ease with you and your dental staff, they’re more likely to be more comfortable when you’re assisting them with their dental hygiene. From the moment a patient walks in the door of your practice, an impression is being made.

Patients are less likely to feel nervous or afraid of having dental work when:

  • they are met with a clean and welcoming environment
  • greeted warmly
  • they are shown gentle and effective care

Financial Worries

Many patients may make appointments and decide not to keep them if they feel they can’t afford their care. It may be easier for a patient to no-show an appointment rather than call to cancel and feel pressured to reschedule when they know they can’t afford the service. And that may be because of the following reasons:

  • they have an insurance lapse
  • don’t have insurance at all
  • worried about co-pays or deductibles

Patients who frequently miss appointments for fear of the cost may end up needing more extensive dental work. Which, can ultimately lead to a much bigger cost for their care.

To offset worries and stress for the patient, staff at your practice can assist patients by researching what procedures are covered by insurance and what the expected cost may be, depending on their coverage. Even patients without insurance can benefit from alternative payment options. This is to ensure they are able to get the dental care they need while keeping costs as low as possible.

If possible, offer discounted self-pay options for customers paying costs out-of-pocket. Even patients with insurance could appreciate different payment methods like financing options or monthly payments.

Prioritize Patient Relationships

Patients feel connected when their care is prioritized through things like great customer service and concern for their finances, so they may be more likely to keep dental appointments when they feel you are providing the personalized service they are seeking. Monthly newsletters going out to your patients via email is one way to ensure strong relationships. Patients will be able to feel like they are still staying up to date about things happening at your practice. These include policy changes, updated hours, periodic special offers or new staff.

Social media marketing can also be a great way to ensure patients are connected with your practice. There are few people who don’t have social media, so chances are, if patients are made aware they can see everything you’re up to as they’re scrolling through Instagram, Twitter or Facebook, they will gladly give you a like and a follow. Social media platforms are also a great area for patients to review your business, which can easily attract new patients.

No ideas to enhance your patient’s experience in your dental office will eliminate no-shows entirely. Focusing on increased patient customer service, decreasing patient financial worries and prioritizing relationships are just a few ways to try and reduce the number of no-shows at your practice.

After reading these ideas, you can brainstorm more ways to lower your number of no-shows and check out other ideas from PPO Negotiation Solutions to make your dental practice as successful as possible!

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What is a UCR Fee Schedule?

 The letters “UCR” in insurance stand for usual, customary, and reasonable. These are the fee guidelines by which an out-of-network dentist is allowed to charge a patient if the dentist is not a member of the patient’s PPO network. This does affect the patient’s claim payment and how much they are to pay out-of-pocket. You must properly balance your fee schedule to at least 80% in the beginning to ensure your practice remains competitive. By doing this, it allows you room for re-negotiation in the future. The dental benefit contracts you initially obtain from an insurance provider are based on your UCR fee schedule. Therefore, make sure you balance your fees before you negotiate for a PPO reimbursement contract.

Why is a UCR Fee Schedule Important?

Insurance providers control their expenses by using the UCR fee schedule. Each dental procedure is listed, as well as how much the provider has determined each procedure should cost. The benefits paid on your patient’s claim is determined by this list of fees. UCR fees are involved when using indemnity and PPO dental insurance plans. The insurance provider will pay a percentage of the cost they have determined based upon the dentist’s charges or their UCR fee for the procedure, whichever is less.

What Do Geographics Have to Do With It?

The UCR fee levels are different in each state and community. Take for instance the price of a crown is $1,000. If the percentages for the area are in the 80th percentile, it means 80% of the dentists in that state or region charge $1,000 or less for a crown.

If your dental practice is a member of the American Dental Association, you may obtain a survey which contains self-reported fees by procedure from a nationwide, random sample of dental offices. There are over 200 dental procedures listed by specialists and general dentists and their fees charged. If your practice is not a member, you may purchase this list of fees from the ADA Catalog.

However you decide to negotiate fee schedules with the PPOs in your area, it’s best to do the following idea:

  • call the largest employers in your vicinity
  • ask their Human Resources Department to which PPO they belong
  • check out their list of UCR fees
  • determine which PPOs your dental practice would be compatible with
  • then begin your negotiations

How Can UCR Fee Schedules Affect Dental Fees?

Based upon information obtained by the insurance company, let’s say they determine 90% of the dental offices in your area charge $1,000 or less for a crown; then the UCR fee for dental crowns most probably will be set at $1,000. If you charge your patient $800 for a dental crown, the insurance company will pay 50%. And then your client will pay 50% of your bill out-of-pocket. On the other hand, if your dental practice charges $1,200 for the crown, the insurance company will only pay 50% of their $1,000 UCR fee to your practice. Which leaves the patient responsible for the remaining $700 out-of-pocket. There does seem to be a wide fluctuation in charges without any regulation as to how an insurance company decides their calculation.

In the case of a more popular insurance company in your area, it would seem their UCR fee schedule could affect the area prices for dental services. But your practice does not want to be known for charging more than the other dental practices in the nearby vicinity. So the use of UCR fees does help keep the prices charged by all dentists in your area in line. Also, if you decide your fees are short of the UCR fee set by other dentists in your area of operation, this allows you to raise them. Or in the alternative, if your dental practice offers a unique experience, you may decide it justifies your higher fees.

In the end, the total benefits under a policy are usually limited by a deductible and a yearly maximum of payment, so your patients will ultimately have to determine the price they are willing to pay for their services.

PPO Negotiation Solutions can help you determine proper UCR fees and keep them balanced well, as well as increase your dental practice revenue. Do you know most dentists write off nearly 40% in PPO reimbursements per year? It also takes over 30 hours in some instances to complete the credentialing process alone to be accepted into a PPO! Also, 7 out of 10 dental offices do not set their UCR fees correctly from the beginning. We offer 30 years of experience. And as a result, there are hundreds of dental practices just like yours that trust our team as their solution. Contact us for your complimentary assessment and schedule a consultation today!

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Avoid Accidental Insurance Fraud

Insurance fraud costs Americans more than $80 billion per year in higher premiums, according to the Coalition Against Insurance Fraud. Insurance fraud happens when an insurance company is deceived in order to collect money for someone who is not entitled to receive the money. This is against the law in every state, and health care fraud also falls under federal laws. In most of the United States, fraudulent insurance claims can be either a felony or a misdemeanor, depending on the nature and extent of it.

Your dental practice can accidentally commit fraud, and it’s more common than you would think. In most instances, ignorance is no excuse when it comes to committing fraud. In order to avoid the small mistakes that could cost you your license and practice, let’s review the following errors in billing.

Listing the Treating Dentist Incorrectly

To determine the fees for services that are the patient’s responsibility, the dentist signs a contract with a Preferred Provider Organization (PPO). This is an agreement to write off a certain amount of the standard fee for a service that is provided. It is fraudulent if you list the owner dentist as the dentist who treated the patient in question when it was done by an associate dentist who is not in-network with the insurance payor. Whether a provider is in-network or out-of-network affects how benefits are paid to the dentist.

If the dentist receives funds he or she is not entitled to receive, it is fraud. There are different scenarios in different states when it comes to who to list on the insurance claim as the treating provider. As a result, whoever is in charge of filing insurance claims in your office needs to be 100% correct when completing the ‘treating provider’ section on the claim form.

Accident on Dental Claim Form Becomes Fraud

If a patient comes into your dental practice and has broken a tooth due to a fall at home, you have to disclose the treatment is related to an accident. It is also important to specify whether the accident was workers compensation, an auto accident, etc. These specifics determine the type of reimbursement paid to the dentist.

It also may require it to be considered by medical or another third party before payment. Some dental programs will default and leave critical information blank. Unless someone knows to manually go into the program and change it.

Lack of Education and Training Can Lead to Potential Fraud

The most common billing mistake can lead to fraud landing a dentist in prison. Proper training is essential to preventing even the smallest of errors on a dental claim form. Remember, ignorance is not an excuse. For example, recording the name of the treating doctor as the owner of the dental practice when a locum tenens was filling in could be determined as insurance fraud. The owner of the practice needs to have an interest in all areas of the practice at all times to ensure proper procedures are being followed.

Down-Coding and Up-Coding 

Inaccuracies found in coding on an insurance claim can also lead to fraud. Down-coding is reporting a lesser service was performed, which resulted in the dentist getting paid something he should not have been entitled to receive. On the other hand is a procedure called up-coding. This is reporting a procedure paid at a higher reimbursement level than what was actually performed, in order to be reimbursed more money from the insurance provider. Every dentist needs to take note and be aware of these mistakes.

Know the Rules

Education is power. It can be what saves your dental practice huge problems due to common, small mistakes. You and your dental team need to be educated and trained on the rules and regulations of insurance claim submissions and coding. This type of work is extremely tedious and meticulous. But it is essential to do it correctly to prevent the dentist/owner from losing their license or going to prison. Make certain your team is up-to-date on all the best practices to prevent common claim submission errors.

Most insurance companies do not volunteer this type of information. You must request a processing manual from the company. It will include all you need to know about the rules for submitting insurance claims correctly. There are other very simple actions of a well-intentioned dentist/owner to inadvertently commit insurance fraud. In order to avoid these types of instances and others, you must know what is in the PPO contract. Lack of knowledge can lead to very serious consequences. Take the time to learn the rules!

Consider contacting the professionals at PPO Negotiation Solutions for help. Hundreds of dental practices trust them. Their mission is to enrich your dental practice by increasing revenue and understanding. They have 30 years of experience in the field of PPO negotiations and participation. They can assist you in streamlining your daily processes. Take their complimentary assessment or schedule a consultation today!

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Strategies to Recover Lost Revenue from 2020

The COVID-19 pandemic affected businesses throughout 2020 and, unfortunately, most are still struggling with financial loss now in 2021. Business closures, drastic decreases in clientele, and staff layoffs are just a few of the changes that affected dental practices across the United States and the world.

Now that it has been deemed safe by the Centers on Disease Control to reopen your dental practice, how can you recover the financial losses from 2020? Here, we will discuss ways to start recovering lost revenue, including the following:

  • increasing patient flow
  • increasing financial flexibility for patients
  • evaluating collections processes.

Increase Patient Flow

During the pandemic, most dental practices closed for routine appointments and only scheduled emergent appointments to help prevent the spread of COVID-19 infections. In 2019, only 64.9% of adults reported seeing a dentist in the last 12 months. In the year 2020, it is expected that the percentage of dental visits was significantly lower due to financial hardship and dental practice closures.

As the first step to increasing patient flow, make personal phone calls to each client on your established patient list and help your patients schedule routine appointments for themselves and their families. Perhaps you could offer a special on certain cosmetic treatment appointments, such as teeth whitening.

Some patients may be concerned about financial obligations, so discuss your various financial payment plan options during the call. Again, this is a good opportunity to offer an ongoing special for popular cosmetic treatments. Once patients are in for their appointment, be sure to schedule all follow-up appointments before they leave to ensure continuous patient flow.

Offer Flexible Financial Options

Due to financial hardships, many patients may not wish to seek routine dental care or treatment for problems due to being unable to pay for treatments at the time of service. There are many options for payment assistance that you can consider using and sharing with your patients; some that you may not have previously offered pre-pandemic.

One option is interest-free financing. Many offices offer patients third-party lenders to collect payment. The issue with these lenders is patients may be denied due to credit. What some people do not know is that dental practices can offer financing themselves. This is beneficial because the cost of service is the same, but patients will like the idea that they won’t be charged extra for payment plans.

Another option is payment plans for patients who have lost dental benefits or are unemployed. Patients could pay 50% of charges at the time of service and agree to payments for the remaining balance. This is beneficial to both the practice and the patient, as the practice still receives a large payment at the time of service, and the patient can have the flexibility of monthly payments for the remaining balance.

Don’t overlook the convenience of credit cards for payment. Many patients will readily place charges not covered by their insurance, and especially some emergency treatments, on a credit card. Make sure you share which credit cards you offer, including specialty medical and dental cards.

Evaluate for Collections Opportunities

Most patients should pay for treatment and services at the time of their appointment. However, those with payment plan agreements may fall behind due to unfortunate circumstances. One way to help with payment collections is to call patients that are late on payments to offer to take payment over the phone.

When calling patients to collect a payment, ensure you are following proper procedure. Patients should have provided prior written consent to receiving phone calls or text messages from your dental practice. If patients are unable to make a payment when called, you can offer one of your financial arrangement options. Either method gives your practice an opportunity to collect payments. And the patient can continue to receive services from your practice when needed, without facing more financial hardship.

Recovery Plan

The American Dental Association recently released a strategic recovery plan for dental practices recovering lost revenue from the COVID-19 pandemic. The plan suggests setting goals in four main areas for ideal revenue recovery. The four sections are practice, staff, patients, and financials. Examples of financial goals listed include expanded practice hours, cross-training team members, cash saving, and streamlining processes.

Most dental offices are open during weekdays. Consider offering appointments on weekends or late appointments on weekdays to service patients who have started back to work. Cross-training team members and streamlining office processes can save time and money by being more efficient. Finally, evaluating your cash flow to look for ways to save money is an easy method to save money for emergencies. Selecting specific recovery plan goals and planning accordingly for improvement will help ensure success in revenue recovery.

Seeking assistance from a professional agency like PPO Negotiation Solutions to perform a revenue assessment on your dental practice can be a great option for recovering lost revenue fast. PPO Negotiation Solutions starts by analyzing your practice’s payor mix index, reviewing PPO schedules and negotiating PPO fees. The company will ensure credentialing of all providers and monitor the implementation of their established game plan to increase your practice’s revenue. They will also provide education to staff on the best way to reduce costs and renew processes to save money. Give them a call today and get back on track in 2021.

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How Safe is Your Dental Practice Revenue from Claims Repricing?

Medical costs for a medical procedure can vary from one medical provider to another, by hundreds and, sometimes, even thousands of dollars. Costs can also vary by whether a provider is in-network or out-of- network with an insurance plan. What is the role of insurance claim repricing when it comes to paying for medical services? How can you ensure that your practice is making the most revenue and making the best of claims repricing? In this article we will discuss how claims repricing works and how you can prevent loss of revenue in your dental practice due to claims repricing.

What is Claims Repricing?

When a medical or dental practice treats a patient, a claim report is filed with a patient’s insurance company. This claim contains a detailed description of the care received by the patient, such as medication the patient received, procedures performed on the patient, material used for treatment and provider’s fees.

Once a claim is received, insurance companies adjudicate if the patient is eligible for the service that was received based on the terms of their insurance plan. Then, the charges are repriced based on the terms of the contract between the insurance carrier and the medical provider. The information is sent back to the medical provider, along with the amount owed. The patient can then be billed the remaining, new out of pocket charge that the insurance company has dictated.

For example, a claim from a medical provider may be very detailed and include several individually priced items on a list. However, an insurance company may only allow a set amount for a medical service per a contract, so the claim amount and the billed amount can vary in price. Allowed amounts can vary depending on geographical location, whether a provider is in or out of network with the patient’s insurance and the average charges of other practices in the general area.

Claims repricing is, in effect, a determination by the insurance company of how much of your dental practice’s set fee will be paid and now much will be passed on to the patient, after the services performed have been approved and paid according to the insurance company contract. Of course, you want to avoid passing on too much expense to your dental patients, or risk having them move to another practice with better pricing practices.

What are the Benefits of Claims Repricing?

Claims repricing can be beneficial to both a business and the customer receiving a medical service. Billing errors are common in medical and dental practices due to large amounts of paperwork. Medical claims repricing can help eliminate errors that increase costs and lead to underpayments or overpayments on insurance claims.

Insurance companies have a set amount that can be paid to providers for select services. This is meant to avoid instances where customers are overcharged. By having a claims repricing process, insurance companies can also monitor for fraud by overstatement of claims, by frequently checking and validating claims that are submitted. This prevents consumers from paying larger out-of-pocket expenses that are not necessary.

How Can Claims Repricing Affect my Practice?

Claims repricing can affect the revenue of your business either negatively or positively. For example, a patient with Pretty Smiles dental insurance comes into your practice for a root canal. You expect to get paid $750 for this service from insurance, since this is the total cost for materials and labor. You send the claim to the patient’s insurance, but Pretty Smiles only allows $600 for a root canal procedure. Simply explained, your dental practice is spending more than it is earning in this scenario.

Another scenario could see a patient coming to your dental practice for a routine cleaning and exam with Happy Smiles insurance. Your dental practice is not in-network with Happy Smiles, but you are connected with other networks that participate with Happy Smiles. After submitting a claim for $300 to cover the exam, x-rays and dental cleaning procedure, claims repricing by the insurance company’s adjudication system reduces the amount paid to you by Happy Smiles to $198. Since you are not in-network with Happy Smiles, you are reimbursed at the lowest possible cost for these provided services.

In this case, your dental practice should investigate whether it should become in-network with Happy Smiles to obtain a better rate, or simply refuse to accept Happy Smiles insurance because of such a low reimbursement rate. If you only see a patient here or there that has Happy Smiles insurance, your practice may be better off refusing the insurance.

How Can I Make the Best of Claims Repricing?

There are a few ways that you can avoid losses due to claims repricing. When filing a claim, charge standard rates, but ensure that what you are charging is updated and in line with what is being charged at similar dental practices in your area. Assess which insurance providers you are in-network with and whether it is beneficial to your business.

For example, 20% of your client base may have a Pretty Smiles insurance plan, so it would be important to be in-network. Adjusting your pricing to work with this company will earn you more through patient volume over time. Another way to prevent losses is to protest any involuntary changes made during claims pricing that could affect your current clients. This is best done in writing to maintain a paper trail.

You should also consider utilizing a professional company that specializes in PPO negotiations. PPO Negotiation Solutions is a company that can help navigate claims repricing, increasing your reimbursements by nearly 24% and minimizing losses to your existing clientele.

The most important focus in your dental practice is your patients. Do not let insurance struggles and stress over reimbursement get in the way of quality patient care. Contact PPO Negotiation Solutions today to increase your practice revenue, so you can continue providing excellent patient care.

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How to Make UCR Work for Your Practice

How your dental practice gets paid is of supreme importance. There are numerous elements that surround the entire area of accounts receivables, and it literally “pays” be know how these aspects factor into your overall income strategy. A working knowledge of UCR can actually benefit your dental practice and help you avoid financial losses.

First, let us define what UCR is as it pertains to dentistry. The acronym stands for usual, customary and reasonable. However, to many dentistry practices, it seems rather unreasonable and not at all fair. Basically, the term UCR applies to the fees and reimbursements that insurance companies pay to dentistry offices for services. It has been adopted by dentistry and can be found on EOB (Explanation of Benefits) forms that offices use to request reimbursement from insurance plans. Since the reimbursement amounts can often seem unfair, here are some ways to make UCR work for your practice and avoid taking a financial loss.

Understanding UCR

UCR is not actually a number; instead, it is a range of numbers based on percentages. Insurance companies will pay out a certain percentage based on the cost of a dental procedure. Even though it is based on percentages, there is also a cap on how much the company will pay for each procedure and insurance will pay out whichever cost is less. Zip code and percentage plays a large factor in determining UCR at insurance companies. Geographical area has some weigh-in on the amount that insurance will pay. Let us look at an example.

In your geographical area, let us assume that the majority of dentists chart $200 for a crown; so, the insurance company would set the fee at $200. Let us say that your office charges $150 for crowns. A patient’s insurance plan pays 50% toward the charge, which is $75, leaving a $75 remaining balance. In another scenario, let us say your office charges more than the average $200; say you charge $300. Insurance would still pay 50%, or $150 and there would be a $150 balance remaining.

How UCR Affects Your Practice

Dentist offices may be forced to lower charges for services in their area to retain clients. However, lowering charges for services too much can result in a financial loss to the business. Knowing UCR levels could mean increased revenue for your business.

An article details a hypothetical scenario about an average dentist office’s profit: “…dental practice grossing $400,000 per year. The average overhead in a $400,000 practice is 70 percent. If our hypothetical office is open 40 hours per week, 50 weeks per year, then the dentist works 2,000 hours per year. The office overhead is $280,000. Total overhead ($280,000) divided by 2,000 hours gives us an hourly overhead of $140. That is the fixed overhead before the doctor is paid a single penny.

Now say a patient were to come in needing a prophylactic cleaning and claimed it to be covered at 100%.” …the office submits the claim form. The fee for the cleaning was $85, the overhead cost was $140, and the doctor`s/hygienist`s salary must be added to that. The office just lost $55, plus the salary of the doctor/hygienist.”

In another explanation of the effects on patients and business, it is stated, “In situations where a single company serves one geographical area, their usual, customary and reasonable fee schedule affects the prices of dental services in the area. Where a dentist charges more than the set usual, customary and reasonable fees, they have no option but to lower their fees in line with the average charges in the area. Consequently, when a dentist realizes that they charge less than what is set in their area of practice, the chances are that they will raise their fees.”

How to Make UCR Work for You

One item on your agenda should be analyzing your fees. By assuming that you will only be reimbursed 70%, for example, you could be losing money. Different plans could be paying 80% or even 90% but could be reimbursing you less money because you are charging less for your services. Routinely monitor your EOBs (explanation of benefits) and find out which plans cover at what percentages.

Pre-certification and pre-authorization are easy steps to take to ensure maximum benefits. Pre-certification verifies that a patient is active with an insurance plan. Pre-authorization involves submitting a request for treatment to insurance for payment. Some insurance companies require this for payment! Verifying benefits can be combined with the pre-authorization process. You want to be sure that the procedure you are requesting to be performed is covered under the patient’s insurance plan.

So how can companies like PPO Negotiation Solutions help your business? PPO Negotiation Solutions has an eight-step process to save you money and increase your revenue. Part of that process is to evaluate your current UCR and PPO fee schedules in comparison with other dental practices in your area. Also work on PPO fee negotiations, provider credentialing, and staff education. Let the experts educate you and set you on the path to success. Call or click today!

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