By Tom Limoli
Stop, look around. Are we alone? Is anyone looking? Now, close the door and dim the lights. We have to talk, just you and me, and it’s about your fees.
Limoli & Associates has tracked dental fees for the better part of the last quarter century. My father collected both international and domestic fees and fee schedules the same way some people accumulate postage stamps and coins. His detailed analysis of data was nothing less than a labor of love for his profession and how it functioned within the confines of differing world economies.
The tracking and reporting of dental fees is no different today. The sluggish economy complicated by rising unemployment and government intervention in the free market system is challenging capitalism as we know it. And guess what? All this shows up in the fees charged by doctors to their patients.
Not so long ago it was common for dentists to raise their fees annually by 2% to 5%. These fee raises were usually “across the board” where each and every procedure code was modified. But, those days have also gone by the wayside. The act of balancing fees is an art form pioneered by my father in his original 1984 textbook entitled The Dental Consultant Looks at Insurance with your Fee Schedule. He and I perfected the process of fee balancing and relative value with our original 1995 text Fee for Service Dentistry with a Managed Care Component. In short, Limoli & Associates is the most accurate source for a comprehensive fee schedule analysis.
What does your current fee data show?
In many parts of the country dental fees are stagnant. We are not seeing dental fees statistically drop but we are seeing areas where the data has reached a plateau and is no longer in a growth posture. I see this also occurring as fewer and fewer dentists are routinely jacking up their individual fees simply because the calendar says so.
In those few areas of the country where the fee data are consistently rising I see this as the effect of simple procedural reality. Artificially deflated fees simply and naturally rise as greater numbers of various procedures continually occur in that geographic area.
Three things must continue to painfully happen in order to maintain growth and establish economic stability.
- Banking and lending markets have to stabilize on their own without government intervention or other institutional manipulations.
- Service industries, including healthcare, have to fundamentally restructure how they do business in order to maintain a more competitive and cost effective posture in delivering their services.
- Corporate models must continue to trim the cost of goods sold while continuing to produce and develop newer market solutions to yesterday’s longstanding problems.
Old solutions are not going to fix the new economic problems.
What do all three phases have in common?
The answer is simply fair market pricing. Fair market pricing is the amount of money that a willing buyer pays to acquire something from a willing seller. What we are talking about is your unrestricted usual fee.
Where do your fees fit in? Where and by how much is your data higher/lower than that of your neighbor? Is it that way by design and intent or do you simply not know?
Stop basing the future of your practice and fee schedule on randomly generated statistical percentile calculations, which is not real data. Let Limoli & Associates professionally analyze your fees. Your potential and active patient base is shopping for quality, price and value. Unfortunately, not always in that order.
Each and every facet of the American healthcare system has been stretched beyond any previous conceptual limitation. Never in modern history has such upheaval touched (now go wash your hands) every individual, community, and industry…
In this issue, we will discuss when it’s (in)appropriate to not send a claim on behalf of the patient and their insurance. The ONLY reason to not send a claim is because you are hiding something that brings you shame. There – I said it – now prove me wrong…
How often does your office update radiographs? Is it based upon specific, doctor-diagnosed patient need or their individual benefit plan limitation? Do patients question radiographic frequency to the extent that they only want them if paid for by their insurance? Now here is the kicker — do you write off the fee if the plan doesn’t pay?
Insurance companies and plan administrators usually do not separately reimburse for temporary prosthetics or restorations, particularly if the overall completed procedure is in any way cosmetic in nature or considered to be non-covered. Provisionals and interims are another story. Let’s take a minute and draw a clearer distinction between the use of these terms…
Not so long ago, the claim payment parameter for a crown was pretty simple. The “dump to pay” rate for these claims were rarely if ever questioned. Crowns were easy to treatment plan and they were a vital part of the overall cornerstone to dental office profitability. Those were the good old days of yesteryear and the rules have definitely changed.
It is imperative that we as dental professionals, both clinical and administrative, have a sequential process by which the entire team can follow. All too often I find offices that have slipped out of focus by attempting to hold themselves out as being all-knowing as well as all-doing when it comes to the patient’s benefit plan.
(Yours truly worked on this case for over three years and provided expert testimony on behalf of the Plaintiff.)
A Cook County jury has awarded more than $500,000 to an Oak Park dentist who bought another dentist’s practice, then later learned that dentist defrauded patients and their insurance companies and inflated his revenue.
It is a sad state of affairs when I see procedure coding taken completely out of context for the betterment of one’s own political agenda or simple lack of knowledge. So is the case with the age-old discussion of “When does perio maintenance become a prophylaxis?” Believe me when I say it has nothing to do with simply the calendar or GPS. What’s the solution?
Coming soon to a dental office near you are newly revised procedure codes and definitions for 2018. Will they make more problems or solutions? The management, reimbursement and subsequent coding of non-surgical periodontal care has, for years, been a nightmare for all segments of the dental profession. So what is the real problem and where is the hidden solution? You got it… Where is the dentist?
Monitoring your practice profitability is becoming more and more important as patients’ dollars are squeezed and patients must be savvy by maximizing their plan benefits in the present economy. If you’ve ever participated with an insurance plan or are simply considering the option, it has crossed your mind before… Are you really making money by participating with XYZ plan, or are you losing your shirt? …