Improve your practice’s insurance reimbursement rates

March 27, 2018

By Adam Reisch, CPA, CFP®, CCA, CGMA,  Partner

    In the dental marketplace, insurance reimbursement rates are at the top of everyone’s minds. The changing and sometimes volatile world of dental insurance can be stressful for practitioners who desire a more predictable income stream. Fortunately, ways exist to improve your rate of return on insurance reimbursements. It starts with developing a strong understanding of the system.

Two practices in the same community, treating similar patients and offering virtually the same services can receive different rates of reimbursements from insurance providers. It comes down to the coding of your services, your buying power, and your pricing structure. While some practices may not be able to significantly improve their buying power due to marketplace restrictions, changes to coding, pricing and other procedures can significantly improve the rates of the return from insurance companies.

Ways to improve

Code correctly: The first way to vastly improve your insurance reimbursement rates is to code your procedures correctly for the insurance companies with whom you work the most. Understanding what reimbursement levels are available for which specific services and aligning your coding with the services for which they cover the most is a clear but often overlooked step to take in improving your rates. Research will be essential on your part to understand your most popular insurance companies’ ideal procedures and how you can align your practice’s coding with their methods. The payout in the long run can be significant.

Price for maximum return: Once you’ve established your coding structure, understand what insurance is willing to reimburse you at your rate, and establish your pricing structure to get the most from the rate available to you. If you underprice to what the insurance provider will reimburse, you leave money on the table. If you overprice slightly, you are guaranteed the full reimbursement but will need to account for the lost revenue. Determine what you are willing to live with and establish the pricing structure that works for you and your marketplace.

Increase number of visits per patient: Most insurance providers allow two covered checkups per year. If you’re not doing two, you’re leaving money on the table. You can improve your reimbursements by helping your patients improve their proactive dental care. This is a win-win for you and your patients as they are receiving consistent care to prevent any potential disease or issues down the road, and you are receiving the maximum reimbursement available per patient. Knowing your patients and establishing proactive care is an easy way to pick off that low-hanging fruit in your practice.

Evaluate scheduling policies: Scheduling your patient visits can be a significant hurdle for dentists, more so than any other health care provider, because patients are more likely to cancel a dentist appointment last-minute than a doctor appointment. Practices are then faced with the dilemma of overscheduling versus fill-in scheduling. What is right for each practice often depends on location and marketplace. In a smaller community, overscheduling may be the method of choice as the patient base from which to draw and fill in empty slots is smaller. In larger communities, practices may find the opposite to be true as they have a larger pool from which to draw. Review, test and measure your practice’s cancellation versus fill-in rates to see what makes the most sense in your specific situation.

Understand your patients: Obviously, a root canal is more expensive than a semi-annual checkup. Understand what your patient’s insurance covers and what they are willing to pay out-of-pocket before scheduling an expensive procedure. While the procedure may be necessary for their health, it is important you establish expectations for payment up-front. If their insurance only covers part of the procedure and they are expected to make up the rest of the cost, work with them to determine payment and stick to your agreed-upon method and timeline. While the reimbursement rate for complicated procedures is higher, if the patient is not able to fulfill any leftover expense, then the procedure becomes a loss. This step is more about understanding your people and less about the intricacies of insurance; but it is equally important in the reimbursement rate discussion. Don’t price your necessary procedures out of your market and establish a plan to make up the difference insurance doesn’t cover.

Insurance reimbursement is a game you can win. Do your research, code and price correctly, optimize your patient visits, and realize more success and peace of mind in your practice.

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