11.11.16 Issue #766 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Ready to Raise Your Fees? Follow These Tips
By Sally McKenzie, CEO

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You’ve finally decided it’s time to adjust your fees. It’s been awhile, and you know the extra money will boost your bottom line so you can finally invest in the new technology you’ve been eyeing or take the CE courses you need to expand your skills. Yes, you’re ready…but not only are you still afraid of losing patients when they find out about the higher prices, you’re not sure where to start.

Don’t worry. That’s where I come in. Establishing fees can be tricky, but it’s vital to practice success and profitability. It also helps you improve the level of care you offer, which is more important to most patients than saving a few dollars on a procedure. Still, I know the thought of raising fees makes most dentists uneasy. That’s why I’ve put together a few tips to help you establish a solid fee schedule that will be fair to both you and your patients while turning your struggling practice into a thriving practice.

1. Do a little research. Before you adjust your fees, find out what other dentists in your community charge. Make sure your fees aren’t too far below (or above) the local marketplace. Your fees should also reflect the level of care and overall patient experience your practice offers.

2. Establish a solid fee for each service you offer. Don’t guess when establishing or adjusting your fees; determine how much it actually costs for you to perform the dentistry. From there, base your fees on patient base, debt, overhead, expenses and your experience level.

3. Monitor your overhead expenses. Make sure your overhead expenses line up with industry benchmarks. Not sure what those benchmarks are? Here’s the breakdown: Laboratory: 10%, Dental and office supplies: 7%, Rent: 5%, Employee salaries: 19-22%, Payroll taxes and benefits: 3-5% of collections.

4. Plan for fee increases. Establish a solid fee for each service you provide and then plan to adjust those fees twice a year. I suggest you raise fees 2% the first time and 3% the second time for a 5% yearly increase. It might not seem like a lot, but this slight increase will significantly boost your bottom line.

5. Focus on building a rapport with your patients. Most patients want to feel some kind of connection to the practice they call their dental home. They want to know you care about them as people and aren’t just worried about selling dentistry. To build these connections, talk with your patients about their jobs, their families and their oral health goals. Educate them about their condition and the services you provide, and train your team members to offer exceptional customer service during every patient interaction.

When you show patients you care, they’ll be much more likely to become loyal patients who don’t even flinch when your fees go up.

6. Create goals. Figure out what kind of lifestyle you want to live, and then determine how much you need to make each year to get there. Factor in how many weeks you want to work each year, how many hours per week and how many patients you want to see each day. Use these numbers to determine daily production goals, which should serve as a guide as you establish or adjust your fees.

7. Avoid the fee ceiling trap. Don’t trap yourself by attempting to establish your office fee schedule based on what some third-party payer reimburses at 65% of the 85th percentile.

If you want to own a successful, thriving dental practice, you have to consider adjusting your fees from time to time. It’s an important part of owning a dental practice and is something your patients expect. If you take the time to create connections and show patients the value of dentistry and the services you provide, raising your fees won’t send them to the practice down the street. Fee increases will enable you to provide patients with a better overall experience and enhanced care, which will make them want to stay loyal to your practice and even refer you to family and friends.

Need more guidance? Feel free to give my office a call at 877-777-6151. I’ll conduct a Fee Analysis to help get you on the right track toward true success and profitability.

For additional information on this topic and more, visit my blog: The Lighter Side

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
Interested in having McKenzie Management Seminars speak to your dental society or study club? Click here.
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Carol Tekavec, RDH
Hygiene Consultant
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New Hygiene Codes for 2017
By Carol Tekavec RDH

As everyone in the profession knows, the ADA revises the codes that dentists and dental insurance carriers must use on an annual basis. Several codes have been added or deleted for the 2017 Code on Dental Procedures and Nomenclature (CDT) Manual. The existence of a code does not mean that any insurance plan will pay for it. However, services without specific codes are typically relegated to the “99” codes that are notoriously underpaid or simply denied (for example; D4999-Unspecified Periodontal Procedure, by report). Even so, the development of a code is the first step in recognition and possible future payment or inclusion for a procedure in an insurance plan.

In 1995 the ADA deleted a code that was very useful to dentists and hygienists after it was deemed “over-utilized” by insurance carriers paying on claims. The code was D4345-Periodontal Scaling Performed in the Presence of Gingival Inflammation. There were several keys to applying this former code to a dental service. Of importance was the use of the descriptor “periodontal scaling”, implying scaling into an actual periodontal pocket, as opposed to a pseudo, or inflamed supra-bony pocket.

Insurance carriers decided that the code was being inappropriately used for a so-called “difficult” prophy, or a prophy that requires extra time, but not necessarily a different service. It must be noted that a D1110-Adult Prophy is performed in a healthy mouth, removes plaque, calculus and stains, and is intended to control local irritational factors. If the service takes longer than average, it is assumed that extra time will be allotted and the fee will be adjusted, which is always problematic when insurance payment is requested.

Prior to 1995, the D4345 was used frequently because many of our patients are not just simple adult prophys, and no other code was available. Since its deletion, no code considering inflammation has existed, until now.

The new code for scaling in patients with inflammation is D4346-Scaling in the Presence of Generalized Moderate or Severe Gingival Inflammation-Full Mouth, after Oral Evaluation. It is described as: “The removal of plaque, calculus, and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized supra-bony pockets, and moderate to severe bleeding on probing. It should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.”

It is expected to be used after an exam (Code D0120, D0150, D0180) and in cases where inflammation involves soft tissue only, with no loss of attachment or bone loss. The ADA also cautions that the procedure is “based on the diagnosis rather than the intensity of treatment required.”  So yet again, this code does not apply to a “difficult prophy”. 

Code D4346 is also different from D4355-Full Mouth Debridement to Enable Comprehensive Evaluation and Diagnosis in that D4355 applies when an exam and diagnosis are not possible prior to the removal of the large deposits the patient is presenting. D4346 is a therapeutic service performed after an exam and a diagnosis of gingivitis. It is further thought the ADA intends that an exam and a D4346 may be appropriate on the same day, and therefore, on the same claim form.

Since a diagnosis of “generalized inflammation” is essential for use of the code, the American Academy of Periodontology provides some guidance.

• 30% or more of the patient’s teeth at one or more sites are involved.
• Moderate inflammation means redness, edema, glazing of tissues, and bleeding on probing.
• Severe inflammation means marked redness and edema, and ulcerations with a tendency to spontaneous bleeding.

These conditions should be noted on the insurance claim form and in the patient record. Pseudo pocket depths and bleeding on probing, as well as the inclusion of photo attachments if possible, are also important. If a patient has only localized inflammation, as opposed to generalized inflammation, D1110 is still appropriate.

Subsequent hygiene recall appointments will be for standard D1110 services, not D4910. D4910 is a procedure that is only appropriate after a patient has received periodontal scaling and root planing (D4341-Periodontal Scaling and Root Planing-Four or more Contiguous Teeth per Quadrant, or D4342-Periodontal Scaling and Root Planing-One to Three Teeth, Per Quadrant) or periodontal surgery.

Another new code is D6081-Scaling and Debridement in the Presence of Inflammation or Mucositis of a Single Implant, Including Cleaning of the Implant Surfaces, Without Flap. The description of this procedure states that it is not performed in conjunction with D1110 or D4910, so D6081 is a separate procedure which may be reported with the same date of service as either of these two other codes. It is also considered to be appropriate on the same date of service as D4346.

Payment for either of these two new codes will be paid as determined by a patient’s individual dental plan. Since these codes are new for 2017 there is no track record yet, however, it is likely that both will be followed closely by carriers to see how the utilization by dental offices unfolds. Until more is known, it will probably be advantageous to alert patients to the fact that the services may or may not be covered by their carriers, or they may be down coded to what is paid for a standard D1110.

Carol Tekavec RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department?  Email hygiene@mckenziemgmt.com.

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