PAGD Keystone Explorer Summer 2021

20 www.pagd.org Q dentistry issues The examples show some simple contract differences, and hopefully you can see from our example that treating the same patients’ reimbursements can vary $44 versus $37. As shown in our example, this simple change is a difference of $7 or a 19% increase of payment. Imagine if you had a 19% increase of payment across 80% of your total procedure codes without changing anything else? Form good PPO habits. The insurance landscape is constantly shifting, so what may be true today, may not be tomorrow. Carriers come on and off participating Payor Lists without notice which may significantly affect your reimbursements. Here are some good habits to form when working with PPO’s: » Update your full-fees and codes regularly – Focus on the top 25/50 and related codes. Fee analysis reports and services are helpful in this process. » Find a reliable contact within a carrier – Though there is always turnover, once you can find a good contact within a carrier, work with them going forward. » Submit your full-fee schedules to carriers when updated – One of the reasons insurances request the office’s UCR is to help them determine the reasonable and customary fees for the area. Don’t use or submit your contracted fees as your full-fees since this will bring those numbers down. » Review your reimbursements and call when incorrect – Set up a system to randomly review code reimbursements throughout the year to make sure things have not changed and to make sure you are getting reimbursed at your contracted rates. » Leverage an advocate and resource like the Dental Cooperative – Whether it’s a Messenger Model like the Cooperative, an IPA (independent practice association), or a consultant, sometimes you may need some help. The Dental Cooperative is unique in our approach and can provide resources to help you evaluate and enhance your relationships and fees that other resources like a consultant may not. Maximize for you and your patients. As Dr. Buehner learned in this process, PPO plans and relationships can get complex, but starting with a little knowledge and a resource like the Cooperative at your back can get you much farther and reimbursed at your optimal rates. As a practice owner, you have a lot on your plate, but keeping tabs on how you get reimbursed should always be a priority for profitability. Ryan Buehner DMD, FAGD, AIAOMT owns Hershey Dental Associates, LLC and has been a member of the PAGD since 2005 and a member of the Dental Cooperative since 2015. Erica Gordon is the Director of Insurance Fee Maximization for the Dental Cooperative. For more information about the Dental Cooperative and our Insurance Fee Maximization program, please contact your local Pennsylvania Area Director, Justin Minton at justin.m@dentalcooperative.com or (484) 367-5955.