Limoli & Associates | P.O. Box 420505 | Atlanta, GA 30342 1-800-344-2633
Fix this Fee Schedule and Call me in the Morning!

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.

Three Parts to Consider — You Can’t Have One Without the Others

No greater dichotomy exists in all the professions of healthcare than that of the love/hate relationship between doctors and the fiduciary responsibilities of today’s Insurance Benefit industry. One provides the loving compassion, while the other coldly enforces contractual financial provisions. How much time and effort do you spend fighting with the patient’s insurance? …

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What Puts the Patient in the Chair — Delta’s “Premier” is not “PPO”

The reality of today’s uncertain healthcare marketplace is fueling consumers to rethink the significance of the once sovereign doctor / patient relationship. Let’s break down the transaction into its various evolutionary phases so as to better grasp the root of this growing issue.

Let’s begin to solve the ethical issue of medical/dental cross coding by simply introducing the challenge as it most often presents itself to the administrative team.

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Submitting to the Medical Plan: It’s Not About Hiding the Truth!

The lies and fallacies being taught by so-called “experts out standing in the field” continue to confuse and mislead those who unknowingly accept them as truth but are nothing more than smoke and mirrors.

Let’s begin to solve the ethical issue of medical/dental cross coding by simply introducing the challenge as it most often presents itself to the administrative team.

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Basics of Myth-Busting Practice Management – November 2016

My father jokingly commented that if you wanted loyal patrons at the door each morning as well as disappointed customers when you were closed in the evening – that business was not a dental office but rather a liquor store. You see, in any type or retail establishment where widgets are marketed and sold, we face two separate and very distinct realities…

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When Coding Has Nothing to Do with Code Numbers, Part 3 – Sept 2016

So exactly WHAT procedure code number do we use? One would think this would be the easiest part of the equation. However, this is not always the case if the first two parts of the previously discussed equation are not followed. The application of Rule #5 is always to be paramount. You have to act accordingly, and code for exactly the specific procedure that is completed. Completed when? Completed today. In other words, the patient walked out the door with (having received) WHAT procedural treatment?

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When Coding Has Nothing to Do with Code Numbers, Part 2 – Sept 2016

So WHEN does the actual coding of a clinical procedure take place in your office? Pretreatment is an issue unto itself for a later discussion. However, at this time, I want to address the actual delivery of dental services. That’s right, I’m talking about the patient in the chair. This is not an orthodontic case, as that too is another discussion. Let’s address at what point in the treatment you encounter the use of a procedure code…

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When Coding Has Nothing to Do with Code Numbers – Sept 2016

Here we go again. The American Dental Association has yet another revision to Code on Dental Procedures and Nomenclature. Is it going to make your life any better? Will it bring you any additional revenues? Was the word “surgical” really that offensive thus requiring the redefinition of over three dozen procedure codes? Let’s move beyond the scope of NDR and address the real heart of the reimbursement challenge…

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D7465: It’s a Laser, Now What? – August 2016

The laser has continually evolved into becoming one of the most powerful operative tools available to dentistry. Its many variations and flexibilities allow for today’s clinician to not only simplify, but also streamline most facets of specialty and general dentistry. It’s a hot topic of late as more dentists are considering the purchasing of lasers but yet are wondering, “Where do I go from here?” This is a broad question that when broken down really asks, “What is the best way to bill and see a return on my investment, AKA the laser?”

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D4346 Advanced Prophy Difficult? – July 2016

How is changing a bunch of definitions going to simplify and streamline the overall reimbursement process? Answer – it won’t. We have got to understand that insurance companies and third party administrators pay, by contract, toward the overall costs for completed procedures.

Now why is the reincarnation of D4346 merely a symptom of a greater problem? Let’s look at the actual sub components of its ancestors and see if the solution does not automatically appear…

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