Increasing overhead and operating expenses, including employee salaries, supply costs, and inflation, are forcing many practices to evaluate their managed care plans.
It’s no secret that prices continue to climb. For one, the Consumer Price Index (CPI) rose 5.4% for the 12 months ending June 2021 — the largest increase in 13 years. Not to mention, inflation at a wholesale level climbed 8.3% from August 2020 to August 2021. Dental benefit plans, however, have remained static in their reimbursement rates.
In response, dental practices are closely evaluating their participation levels because there are both pros and cons of becoming a participating provider with contracted plans:
- Access to a greater pool of new patients
- Contracted fee schedules that help provide more accurate estimates
- Happy patients who appreciate the savings they receive when using an in-network provider
- High adjustments with plans that are not responding to renegotiation requests
- Remapping and downgrading of treatment, resulting in additional write-offs
- Complicated policies that are difficult for the patient and practice to fully comprehend
- The need for a higher-level understanding of coding protocols and how those protocols impact potential reimbursement, increasing staff salary overhead
For many practices, the pros outweigh the cons. On the other hand, a practice may not feel empowered to make any participation changes because the fear of losing patients can be overwhelming. Dropping a plan requires excellent communication skills to maintain patient loyalty, and some practices aren’t sure they can pull it off.
The truth is that dropping a plan isn’t always the best solution, at least not immediately. In fact, careful analysis must take place to understand the potential implications of dropping a dental plan contract, including investigating the number of patients impacted and the average adjustment required. Likewise, it would be a good idea to have a strong foundation that incorporates long-range treatment planning, excellent coding protocols, target marketing, and verbal scripting for the team. There is something you can do to take back a bit of that lost power!
So before dropping a plan, take a closer look at your coding protocols to make sure you’re maximizing reimbursements inside the often-confusing world of managed care.
We suggest you:
- Make a small shift in the timing of procedures
- Review your fluoride usage and how it aligns with your philosophy of care
- Evaluate your higher profit procedural mixture
- Dive deeper into the hygiene contribution to production
- Study how your fees compare to the fee percentile in your zip code
- Examine your preventative care protocols
Another option is conducting a PPO and Practice Analysis, which can help uncover potential profit inside the practice. In fact, the average annual lost opportunity totals an estimated $131,282 per year in added reimbursements.
To receive a customized practice analysis, simply contact us. We’ll dive deep into your coding protocols and managed care reimbursement levels to identify lost opportunities, or help you move through a successful network status change while ensuring maximum patient retention.
The best part? We provide strategies to recoup lost production at no cost to our valued Burkhart clients. Request an analysis through your Burkhart Account Manager or the Practice Support Team today.
What will your report find? Schedule an appointment today.
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