Fee Schedules & Contracts
February 2023
February, much like October, is typically a slower month for dental and oral surgery practices. This makes it the perfect time to focus on key business functions that often take a backseat to daily operations. We recommend two priorities this month: review your fee schedules and renegotiate your contractual agreements.
February, much like October, is typically a slower month for dental and oral surgery practices. This makes it the perfect time to focus on key business functions that often take a backseat to daily operations. We recommend two priorities this month: review your fee schedules and renegotiate your contractual agreements.
First, before we dive in, ask yourself the following questions:
Do you have a copy of your fee schedule for each payer you participate with?
When was the last time you re-negotiated each fee schedule?
How do you currently use each fee schedule? Are these fees in your database software? Are they used in creating insurance estimates?
Fee Schedules
Having a current fee schedule for each payer you participate with is an essential tool for your practice. These up-to-date fees allow you to create accurate insurance estimates for your patients (in conjunction with insurance verification information), easily determine patient responsibly when posting insurance payments, and also help you determine the value of your contractual relationship with each payer.
Most practice management software allows you to import and regularly update fee schedules that can then be used for procedure codes, estimates, write-offs, and claims. Understanding how your software uses your fee schedules is really important – it is often referred to as “fee schedule logic” or “fee schedule hierarchy.” It can be very complex or very straightforward, depending on what you prefer. Review your software reference guides or contact a software representative to make sure your database is setup to use fee schedules in a way that is meaningful and helpful to you.
Contractual Agreements
Renegotiating contractual agreements with payers, including fee schedules, is time consuming and requires persistence. Which is why it’s a great task for a slower month!
We recommend setting a calendar reminder once a week and regularly following up with each payer until renegotiation is completed. Before signing a contract, make sure you review all aspects of the agreement, not just your fee schedules. For example, many payers now participate in multi-plan groups which can often extend your contractual obligations to other “affiliate” payers.
Key Resource: Your local ADA Association website offers a contract analysis service where you can submit a contract draft and receive a plain language explanation of contract terms. They also offer a helpful guide of what to know before you sign.
Learn more: https://www.ada.org/ada-for-dental-societies/contract-analysis-service
Dental Billing & Consulting Professionals is also always happy to be an additional resource. Our services are customized to each practice’s specific needs and goals. Call or text us at (860) 435-7344 any time for a free consultation on how we can support your practice.
P.S. With a lighter schedule this month, it’s also a great time to encourage staff vacation time!