Is your practice management software working for or against you? Are you getting at least basic information to make sound business decisions, or is your computer nothing more than a glorified pegboard?
Have you ever heard your contemporaries make one of the following statements?
"If we were not a participating provider for ABC Dental Plan, we would not have had to write off the difference for all those crowns."
"Our office lost $ because we participate with ABC Dental Plan."
"Look at all the money you are losing by participating with ABC Dental Plan. Those write-offs should be going into your pocket, not the insurance company's."
Let me go on record as saying, "Never join or participate in any managed-care plan that reduces your usual fee unless you need additional patients to fill empty chairs."
Write-offs are most often associated with that which occurs when your usual fee in the open unrestricted marketplace is $800 and the plan's maximum is only $600. Did you lose $200 doing the procedure or did you never have it in the first place? A write-off is that which you intended to collect but were unable to do so. You did not and cannot lose that which you never had.
My point being - do not rely solely on the total dollar amount of financial adjustment to determine the stability and vulnerability of your participation with any specific benefit plan. Look at and closely scrutinize your data with the following specifics:
By frequency - how many total patients have the plan directly reimburse you?
By total dollar - of those patients/plans that pay you, how much are they paying?
These reports will tell you from where your money is currently coming.
New Patient data
By plan - are these patients coming to you because of the plan and your willingness to wait on the check? By frequency - how many new patients are plan-dependent? In analyzing this data, remember that new patients are the lifeblood and lifeline of your practice.
Exit clauses at 30-, 60- and 90- as well as 180-day intervals.
Don't write patients a blanket letter because it will always make your office look selfish and greedy. Have the courtesy to tell the patient face to face.
Your automated practice management system must be able to track multiple participatory fee schedules. Of utmost importance is the confirmation that your computer submits the right dollar amount to the right plan at the right time.
Does the benefit plan want you to submit the patient's claim with your usual unrestricted fee or some variation of a participatory reduced dollar amount? If you are submitting your usual fee, do you have to individually adjust the patient's account, or does your system automatically account for the discrepancy in dollar amounts?
Does your automated practice management system know which plan is assigned to which patient? Remember that plan specifics are based on indexing the employer, not the insurance company. An individual employer may have several benefit plans, but insurance companies have thousands. The individual patient record is assigned an individual benefit plan. Don't fall into the trap of indexing and linking individual patient records by "family" or "responsible party." You can't apply dad's overpayment to mom's out-of-pocket obligation.
Does your automated practice management system know when to generate the claim? Can you submit the claim for the crown on the date of preparation or do you have to wait until cementation? This is a plan specific issue and has nothing to do with the revised ADA Claim Form.
With participatory plans you NEVER have open patient accounts receivable. These patients pay their dedicated portions prior to or at the time of service. No statements or invoices are ever issued to patients with reduced dollar participatory plans. Remember you agreed to contractually accept a reduced dollar amount for the completed procedure in exchange for the reduction and/or elimination of administrative aggravation.
Your point of control for the accountability and overall profitability of any and all participatory plans must be limited to your automated practice management system and never the operatory.
What write-off were you talking about?
Tom Limoli, Jr. is the author of the Dental Insurance & Reimbursement Coding and Claim Submission Manual. To order click here. Tom can be reached at 404-252-7808 or at http://www.limoli.com