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SIX WAYS A PPO PRACTICE CAN INCREASE INCOME

1) Increase your fees every year. Why? Because you will never receive an increased in reimbursement rate if you don’t increase your fees and bill at your own UCR. Practices that bill their UCR do receive an increase in reimbursement rates from time to time. It really does happen!

2) Bill your UCR and adjust off what is not allowed. Again, if you don’t bill your fee (UCR), you will never receive an increase in reimbursement. Also, this is the correct way to bill insurance. To do otherwise manipulates practice numbers and collection percentages.

Dental practices are losing tens of thousands of dollars per year by billing at the insurance reimbursement rate rather their own UCR

3) Stay on top of CDT Code changes. Thoroughly document treatment and use codes as directed.

4) Check EOB’S. Often, a simple correction in code, or a short narrative makes the difference in claim payment. It’s important to note; an over-whelmed administrator can easily miss the details. The person tasked with posting and following up on insurance claims must have time to focus, must be thoroughly trained and stay up to date on code changes. *This will require yearly training.

5) Negotiate fees – Insurance companies have divisions, and even the companies who “don’t negotiate” have divisions that do negotiate. Their policies change, and they won’t write you to say, “we are now open to negotiating your reimbursement rate.” If you have asked and were told no they don’t negotiate, you have nothing to lose by trying again. Try every year, with every insurance company for which you are a participating provider.

6) Always check the production by provider portion of the end of day sheet. You will be shocked at how often procedures or images are mistakenly not posted or billed out. If you catch it at the end of the day, it’s an easy fix.

This is another area in which Dental Practices lose tens of thousands of dollars per year.

Mary Fisher-Day is the founder and owner of Legacy Dental Coach; a wholly owned subsidiary of The Dental Business.

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