The Lost Fortune in Your Dental Practice: The Cost of Fee Schedule Neglect
June 8, 2023
Maximizing Your Dental Practice's Revenue
Have you ever thought about how much money your dental practice might be missing out on due to outdated or neglected fee schedules? We recently worked with a client who was unknowingly undercharging $500 per denture code. The result was a missed income opportunity of approximately $26,000. Sounds unbelievable, right? But it's more common than you might think.
Why Fee Schedule Maintenance Matters
Fee schedule maintenance is a crucial yet often overlooked aspect of managing a dental practice. If you aren’t regularly checking your office and insurance fee schedules, you can miss out on fee increases from your in-network relationships. Not managing your fee schedules can cause you to lose money. If you don’t look at your Usual and Customary Rates (UCRs) compared to your Fee schedules, your office fees might not be high enough to get the maximum reimbursement on every code.
Case Study: The Cost of Neglected Fee Schedules
Allow us to illustrate the importance of fee schedule maintenance with a recent case study. We conducted a fee schedule review for a client and discovered they had been undercharging an average of $500 per denture code through their Careington fee schedule. Our analysis of their coding history over the past year revealed that they had billed for over 50prosthetics. This undercharging equated to a missed income opportunity of roughly $26,000.
Further examination showed that their Usual and Customary Rates (UCRs) were set more than $1,500 lower than the lease network fees for implant abutments and crowns. This discrepancy resulted in an additional lost revenue opportunity of around $15,000. In total, we identified a revenue loss exceeding $40,000 from just 8 billable codes. Unfortunately, such scenarios are not uncommon.
So how do you prevent something like this from happening in your practice? The answer is simple: manage your fee schedule through yearly fee schedule maintenance.
Once a year, we recommend calling each company that you have a contract with to obtain current fee schedules. The best time of year to do this is typically in January, as this is when insurance companies usually update their fee schedules. For lease networks, you can also double-check unlisted codes through the individual carriers that you access from said lease networks.
If you are using Careington, Zelis or Connection, we recommend using the www.metdental.com portal. Here, you can obtain your network fees through their individual code groups.
The Time Investment vs. The Payoff
We know what you might be thinking: "I have other priorities, and my front office can better spend their time on other projects." But let us assure you, the average amount of time spent on this annual project is around 8-10 hours of one front office team member’s time. This is a small investment when compared to the amount of lost revenue we consistently find as part of our Revenue Cycle Management Optimization Strategy.
In conclusion, regularly checking and updating your fees schedules is an essential part of managing a successful dental practice. It may seem like a small task, but as the case study above shows, it can significantly impact your bottom line. Don't let your practice lose out on potential revenue due to overlooked fee schedules. Make fee schedule maintenance a priority in your practice, starting today. If you need support or further advice, please don't hesitate to book a consultation with us.