If you’re trying to maximize revenue as part of your COVID recovery process, evaluating insurance plan participation and payment is a great place to start. Around three-quarters of patients have dental insurance of some type, according to the latest ADA research, and most dentists are contracted with one or more carriers too. It’s a simple way to attract new patients without having to do much heavy lifting. However, it can also be a costly way, with some contracts requiring you to cut your fees by 30% or more. With rising care costs, PPE expenses, and diminished production, that’s simply not an option for many dentists today.
On this page, we’ll walk you through how to quickly identify which insurance carriers are creating major revenue leaks for your practice, run an analysis of your fees, and how to address any issues you find without leaving a network.
Start with Good Data
If you’re using Practice-Web, your practice management software can automatically calculate and track insurance write-offs for you. However, you’ll need to have your insurance plans and fee schedules set up properly in order for the functions to work correctly. Watch our video tutorials on Insurance Plans and Fee Schedules or check out the Help Guide to read information on Insurance Plans and Fee Schedules if you’re unsure if your practice is using these tools correctly or if the reports we cover later on this page don’t appear accurate.
Evaluate Carriers at a Glance
The best way to get an overall picture of how much you’re writing off for each insurance company is to look at your PPO Writeoffs Report. To obtain yours in Practice-Web, select “Reports” from the top menu, then choose “Standard Reports.” Within the “Monthly” section, you’ll see “PPO Writeoffs.” (Note: The “Writeoffs” Report in the “Daily” section will not return the same values, so be sure you’re choosing “PPO Writeoffs.”) Under normal circumstances, you’d want to look at the prior 12-month-period. However, practices heavily impacted by COVID may want to look at a larger span of 18 to 24 months. You’ll also want to select “Group by Carrier” to have your report tally all fees and write-offs for you. If you need help running the PPO Writeoffs Report, please visit the Help Guide.
With this report in hand, you can calculate the percent you’re writing off for each insurance company as a whole. You can use it to triage and decide which insurance carriers you want to tackle first.
Identify the Patient Impact of Any Changes
Before you make any decisions or apply manpower to making changes, it’s a good idea see to how many patients belong to carriers with high write-off amounts. To do this, you’ll select “Lists” from the top menu in Practice-Web, then select “Insurance Carriers.” Double-click the carrier you want to learn more about. The number of subscribers will appear near the bottom of the pop-up box.
If you’re an advanced Practice-Web user, you can also use Queries to get a full list of carriers with subscriber counts in one go. Just copy the code in the box below and paste it into the “Queries” section. Adjust the dates in red to suit your timeframe and click “Submit Query.” If you need additional assistance with queries, please visit the Guide.
/*69 Count of patients by Carrier with procedures completed in date range*/ SET @FromDate='2020-02-28' , @ToDate='2021-01-31'; /*Adjust above Dates AS needed*/ SELECT carrier.CarrierName, COUNT(DISTINCT claimproc.PatNum) AS 'Patients' FROM carrier INNER JOIN insplan ON carrier.CarrierNum=insplan.CarrierNum INNER JOIN claim ON insplan.PlanNum=claim.PlanNum INNER JOIN claimproc ON claim.ClaimNum=claimproc.ClaimNum INNER JOIN procedurelog ON claimproc.ProcNum=procedurelog.ProcNum INNER JOIN procedurecode ON procedurelog.CodeNum=procedurecode.CodeNum AND (procedurelog.ProcDate BETWEEN @FromDate AND @ToDate) AND ProcStatus=2 GROUP BY CarrierName ORDER BY CarrierName;
Become Familiar with Your Top Codes
All too often, practices only look at their top five or so procedure codes when evaluating insurance plan participation. However, you really want to look at the top 20 as a minimum. Some practice management experts will stretch this to 30 to give you a broader picture that encompasses 80-90% of your revenue sources. It’s also helpful to include codes that are commonly downgraded/ remapped/ downcoded. For example, you may do a fair amount of three-surface composites, but many insurance carriers will downgrade to the amalgam fee. You’ll need to make sure you’re being fairly compensated for the codes insurance companies actually pay on.
To identify your most performed procedures in Practice-Web, select “Reports” from the top menu, then choose “Standard Reports.” Within the “Daily” section, you’ll see the “Procedures” report. Just like with the Writeoffs Report, you’d want to select the prior year under most circumstances. However, you may want to extend it out to 18-24 months if your practice has been heavily impacted by COVID. Be sure to select “Grouped by Procedure Code” to have your report provide you with totals rather than a full list of all procedures. You can export the report to Excel if you want to sort it by quantity. Additional information on the Procedures Report is available in the Guide.
Examine Your Fee Schedules
You’re likely to see a wide variance in allowed amounts for each procedure when comparing fee schedules. Knowing what some of the higher-paying carriers allow is helpful if you decide to renegotiate fees with low-paying carriers.
It’s possible to pull a report of multiple fee schedules using queries, so you can compare them all in one go. However, this method is better for advanced query users, as it involves a high degree of customization.
If you’re not an advanced query user, you’ll want to pull your fee schedules one at a time. To do this, you’ll select “Reports” from the main menu in Practice-Web, then choose “Standard Reports” and locate the “List” section. There, you’ll find a report called “Procedure codes – Fee Schedules.” Choose the Fee Schedule you want to review and click “Ok.” You can export your report and save it as an Excel spreadsheet to build a workbook of all your Fee Schedules for comparison.
As an alternative, you can also visit “Lists” in the main menu of Practice-Web and then select “Procedure Codes.” From there, you can select up to three Fee Schedules to compare at once.
Plan Your Next Steps
At this stage, you’ll now know which insurance carriers are pay best, which ones don’t pay well, and can quickly identify what top-paying carriers allow for individual procedures. You may also wish to visit the Dental Insurance Contract Concerns section of the ADA website. If you’re an ADA member, you can access things like the Survey of Dental Fees to see how yours stack up, tips for handling contract negotiations, and more.
End Your Contract
It may go without saying, but you will likely lose some patients if you end your contract with a carrier. Departure rates increase with plans that have no out-of-network benefits and with certain demographics, such as low-income patients. You can help minimize the loss by creating your own membership plan that offers discounted rates of your choosing. To do the physical setup in Practice-Web, you’ll leverage Fee Schedules and Recurring Charges. Visit our guide to read more about Recurring Charges and Fee Schedules.
Many dentists don’t realize this, but you can renegotiate your fees with a carrier you’re contracted with when it’s time for renewal. Each company has a different process for this, but most have a department dedicated to provider relations. When you approach them, use the stats you’ve gathered to help make your case. It’s also beneficial to cite cost increases, like how much more you’re paying for PPE and other supplies.
If you have an active Practice-Web Support agreement and need help with any of the reports or setup steps outlined here, our team can help you get the data you need to make informed decisions, set Fee Schedules up properly in the system, and more. Visit our Contact page to get in touch.
Don’t have Support? Visit our Pricing page to renew.
Don’t have Practice-Web? Request a demo and we’ll give you a complimentary tour.