Did you know you can negotiate fee reimbursement rates with an insurance company as a dental service provider? You can and you should! Negotiated fees are fees a dentist who is “in-network” agrees to accept as payment for services provided to the patient, less co-payments, deductibles, cost sharing and benefit maximums.
Insurance companies do not pay all dentists the same for the same exact services they each provide. Every extra dollar your dental practice negotiates with an insurance company for services rendered is another dollar in your pocket. Negotiated fees are subject to change, as they can be re-negotiated once the contract with the insurance company for reimbursement has ended. This generally occurs every 18-24 months. It is very important to remember the terms and period of your contract with insurance providers to be in a position to re-negotiate, and hopefully, receive fee increases. A good practice to get in the habit of is reviewing your fee schedules on an annual basis, as it is usually the dentist that initiates the re-negotiating process.
Negotiating fees has dramatically changed recently and is a lot of work. It is truly a difficult process. For instance, many costs have increased recently due to the COVID-19 pandemic. There are added costs for PPE, plexiglas shielding and air purifying systems. Let’s look into what is involved with negotiating fees with insurance companies.
Know Where You Stand
You must have accurate information to begin choosing what and how to negotiate with insurance companies. First, review your current office fee schedule. Examine them to find out how you compare with other dental practices in your local area. Maintain your bargaining power by making sure your fee schedule is not too low. Make sure your UCR fees are in the 80th percentile with other practices in your zip code.
You must be organized when negotiating fee schedule offers and remain politely persistent. Keep negotiating until all offers have been exhausted. Once you have agreed upon fees with an insurance provider, make sure to audit your insurance claims over the next three months to confirm the insurance provider is honoring the agreed-upon fee schedule. As a matter of fact, healthy protocol says to audit a dozen claims every six months to maintain the honor of the fee schedule.
Know Your Insurance Providers
Next is to determine the number of insurance companies with which you actually have a contract. You should have contracts with at least 10-plus insurance companies. Also, if you are contracted by one insurance company, it may turn out you are contracted with several companies. A lot of insurance companies contract with each other to share patients and fees. Always read the fine print when signing contracts with insurance providers, and remember to only sign with insurance companies you feel are necessary for your dental practice.
A good way to begin researching local insurance providers is to call the Human Resources Departments of businesses in your area to ask which company holds the contract for their dental benefits. Find out what plans are offered by the local major employers in your patient area. Don’t forget to consider schools, hospitals, federal and state offices and large nationally-owned companies. You may discover new opportunities to update your current plans with other plan agreements that will benefit your practice.
Know Your Leverage
When negotiating with insurance providers, be sure to make the provider aware of the ways it could benefit from entering a contract with your dental practice. To represent your leverage as a service provider, be knowledgeable about the following:
- Added per patient cost due to COVID-19 related changes
- Saturation of dentists in your area
- Specialty services offered
- Appointment availability for new patients and current subscribers
- Your philosophy of care regarding preventive services
- Availability of teledentistry
- Your patient satisfaction rate
- Electronic claim processing capacity
- EFT-enabled for receipt of claims payments
- Use of online portals for eligibility and pre-authorizations
- Date of last contract increase compared to cost of living increase for same time
Know Your Dental Office Production
Based on your dental office production, determine which CDT codes are at the top of the list for your dental practice. Ninety percent of your practice’s billable production is usually covered by approximately 30 codes. Dental offices use these Current Dental Terminology codes to identify dental procedures which cover oral health. A procedural code has an alphanumeric code beginning with the letter “D” followed by four numbers. These codes are maintained by the American Dental Association (ADA).
Contact the Carriers
The final step is to contact the insurance carrier to speak to an agent, retention specialist or provider relations
manager/specialist to initiate the negotiations. Plan to discuss your decrease in revenue under your current contract along with all the advantages to the carrier your dental practice can provide. Ask for a review and increase in fee reimbursement for your top 30 codes. Inquire about receiving an additional per-visit fee to cover the addition of PPE expenses.
Ask the carrier if they have a co-lease agreement or network share agreement with any other carriers. Review the fees offered to you by the carrier and do not be afraid to make counter-proposals. Finally, when you accept fees, keep a detailed list of the contracts accepted, terms and all final fee schedules.
After consideration of all the steps involved in the negotiation of fees with insurance providers for your dental practice, you may decide negotiating with insurance companies appears to be too time consuming and too difficult. There are companies specifically designed to help you. These companies represent hundreds of dental offices and are familiar with negotiating with insurance companies. PPO Negotiation Solutions is there to help you! Contact them for your complimentary assessment and schedule a consultation today!