PAGD Keystone Explorer Summer 2021

Keystone Explorer | Summer 2021 15 dentistry issues Q For those of you considering joining or leaving networks, most practices should focus on four key areas of their practice financials. A practice which understands these key practice indicators (KPIs) will be better prepared to enter into conversations with insurance networks. These KPIs are also critical if you are considering hiring a third party to help with negotiations and contracts. Being an educated consumer about the financial status of your practice will ensure you choose the right company for you. Codes What are the top codes that account for about 90% of your yearly production? When reviewing possible contracts with insurance networks, providers should know which CDT codes account for 90% of their annual production. This should be a simple report to pull from your practice management software and exported to a data software like Excel for analysis. Most insurance companies will provide a fee schedule focusing on the top 20 codes used by dentists industry wide. This may not accurately reflect your own unique practice. How can you focus on the right codes for your practice if you are not familiar with your own diversified suite of services? If you prefer to do orthodontics or endodontics in your practice, do you really care about the reimbursement rate of overdentures? Know your top 90% of codes based on production value and you will be able to focus on negotiating fees for the procedures that really matter to you. Fees Review your current fee schedules to see who is paying the best reimbursements for top codes. Now that you understand which procedure codes make up 90% of your annual production, it is time to look at the fees associated with those procedures. Using your same spreadsheet, you can attach fees to each code broken down by each insurance provider. If you are already in-network with some companies, this is a great way to compare your reimbursement values from each company. This analysis will certainly aid in any decisions regarding your insurance participation. “Most insurance companies will provide a fee schedule focusing on the top 20 codes used by dentists industry wide. This may not accurately reflect your own unique practice.” Jennifer Bell, DDS, FAGD