Hello, my name is Michael. Today we’re going to talk about the importance of doing a fee schedule analysis on your practice. If you’re a practice with more than five insurance and PPO contracts, you’re likely frustrated by the low fee schedules required by the insurance plans just so you can be listed in their network. Low fee schedules create a lot of problems for the practice, where you end up working a lot harder for a lot less money.
If you’re ready to take the first step in experiencing better fee schedules, and higher revenue, a fee schedule analysis by Dental Advocacy Group is a great place to start. By analyzing your contracted fee schedules and revenue sources, Dental Advocacy Group can diagnose the health and performance of your primary revenue source, your insurance contracts. Consider the analysis like an initial office visit with an exam, x-rays, and such, where you diagnose any problems, so you can develop solutions for your patient.
The fee schedule analysis will show the effective discount, or in other words the cost of the insurance contract. This is reflected in terms of the discount from your standard practice fees. This is important to understand, as it shows how much free dentistry you’re giving away in return for being in the network for the insurance plans. It’s not unusual to see discounts in the 40% to 50% range, which means that every third patient you see for that insurance, is basically being treated for free. The analysis will also indicate if your fees are in line or if they need to be updated.
Next on the analysis is to understand the sources of your revenue, and what each represents in terms of patient volume, and billings. Understanding the source and volume will allow you to make informed decisions on which plans are worth keeping. For example, if you have a deep discount with a plan that represents less than 2% of your revenue, you’re probably better off just canceling the contract. Likewise, you can also identify good contracts, that have better fee schedules and strong patient volume. Lastly, the analysis will show any potential fee sharing and overlapping contracts.
Most dental insurance companies either share their fee schedules with other insurances, or have access to umbrella PPOS, and many have both. When one insurance plan shares their rights with another, we call these network sharing arrangements. These negatively impact the practice as it gives the insurance plans multiple fee schedules to use for payment and as you would expect, they’re always going to use that lowest rate to pay the claim. We call this payment downgrading, and it further depresses revenue from these shared contracts.
Once you have a good understanding of your fee schedules and revenue, and have identified the overlapping and shared contracts, you can then formulate a strategy to address these issues. There are various strategies and tactics that can be utilized to increase revenue and profitability, while remaining in network with all the best plans. This may include things like eliminating overlapping contracts, canceling contracts with low fees, or consolidating to a PPO.
We will provide you with a roadmap that includes all the analysis information, along with specific practice recommendations. Our ultimate goal is to maximize revenue, maximizing in network participation, while minimizing the overall number of contracts held by the practice. If you’d like to start on the road to increase revenue and profitability, please take our no obligation assessment. Once we have the assessment, we’ll contact you to set up a time to review your options, and discuss how to proceed. Thank you for your interest in Dental Advocacy Group.
I have been working with Dental Advocacy Group for just over three years now and could not be more pleased. In network providership allows for a razors edge margin for error and profitability. With that said, DAG is constantly working to negotiate fee schedules that allow maximum payment under the headings of a massive variety of PPO plans. Cornelia, Michael and their team take all the guess work out of credentialing and recredentialing that can be tedious to say the least. The fee schedules that are achieved are significantly greater than any I have been able to negotiate in the past on my own dealing with companies as a single practitioner. Whether you are in a 10 operatory, 2 doctor practice like mine, or a 3 op practice just beginning to swim in the PPO pool, constant fee negotiations are absolutely necessary. Without DAG I would not be able to achieve the results in PPO profitability that I now have. A Class A organization all around. I couldn’t be happier.
JAKE R. NOEL DMD
When our practice was looking for new ways to increase revenue, we hired a consultant that suggested we speak with Dental Advocacy Group regarding their program. We had tried to get fee increases from of our insurance companies and always hit a brick wall. Our fees were consistently being cut. When we met with DAG we were a little skeptical to say the least. We decided partner with DAG in hopes of seeing our revenue increase. Jaime, our account manager, has been wonderful in walking us through a somewhat complicated process. She is knowledgeable, well organized, patient and responds promptly to our questions. She kept track of our network participation status with the insurance companies while we waited for our fee schedules to switch over to the higher schedule. This process does take time, but we are already seeing significant changes in our reimbursements.