Make Hay While The Snow Flies!

Tuesday, January 17, 2012

Since I grew up as a farm kid, I’m big on being aware of the seasonable variations.*

For example, most of you already know that August is the single, biggest new patient month of the year (big on kiddie prophies with the back to school rush). May and September are typically lighter months in our area. Doctors, that’s a good time to plan your Continuing Ed or vacations. Beats sweating about the schedule.

We’re now coming up on the biggest crown and bridge months of the year: December, January and February. It’s the “Insurance Effect.” Anyone that’s putting off treatment now should be committed to an appointment next year. Don’t let it dangle with, “We’ll get back in touch with you later…” Some people use the Year End Insurance/Flex Letter. If you don’t mail these, these can at least be used as a handout. Some practices have good success with this and others not so much. If you haven’t tried it before, it’s worth a shot. Call our office for a copy, 952 921 3360.

Since more and more offices are using automatic confirmation, you can use the same service to blast out a notice about year-end benefits. I saw a practice do this with Demand Force. For very little cost, they stirred up some business.

So, light up those intra-oral cameras, get out the visual aids and get the staff and yourself psyched up! This is the time of year where more of your patients will choose to upgrade their dental health if you are on your game.

“Non-Covered” Services:

We still get a lot of questions on this topic so here are some key points.

Non-Covered Services such as cosmetic services: If an office places an anterior crown (such as all porcelain) for aesthetic/cosmetic purposes, this is a non-covered service and should not be submitted to the insurance company. Submitting it could imply that it is not cosmetic and is likely that you would be required to reduce your fee to the allowable amount by the insurance plan. Not submitting to the insurance company allows you to bill and collect your whole fee.

Maximums: Anything submitted beyond the maximum is still subject to the “allowable amount.” For example,

The Dentist completes two restorative crowns at $1,000 each. The patient’s maximum is $1,000. The allowable amount is $900 per crown. Even though the insurance plan only covers $1,000 of the $2,000 treatment plan, the dentist is still required to reduce the fee on both crowns after the maximum is reached. In this situation the Doctor would write off $100 per crown.

This logic also holds true for things like “waiting periods,” “prior conditions” and “frequency limitations.”

Alternate Benefit (Covered Services): This is when the insurance plan alternates a “covered service” to support the lowest reimbursement or another similar service. For example, The dentist completes a Posterior Composite at $250. The insurance plan alternates the benefit to an amalgam with an “allowable amount” of $120. The dentist collects the difference of $130 from the patient.
Posted by Bill Rossi at 2:03 PM
Labels: Advanced Practice Management, Bill Rossi, Dental Consultant, Insurance, Non-Covered Services