network participation: is it working for you? · teresa duncan, ms • odyssey management, inc. •...
Post on 10-Jul-2020
0 Views
Preview:
TRANSCRIPT
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Presented by Teresa Duncan, MS
Network Participation: Is it Working for You?
OdysseyManagement
teresaduncan
treeduncan
Speaker Disclosure
Teresa Duncan has been paid an honorarium by Henry Schein One to teach a continuing dental education session at this conference.
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
3
How Much Is Participation Costing You?
• Silent cost
o Use of fee schedules
• Overhead cost
o Labor
o Phone
4
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
• Adjustment report by type (courtesies given)
• Collection (monthly numbers)
• Production (monthly number)
• Your standard fee schedule
• PPO fee schedules if you have them
• Production by carrier (a summary is fine – you may need to do some addition of several reports)
• Procedure code summary (ex: how many PAs & the average fee charged)
• Referral report (who sent you patients and how many)
Today’s Reports
5
Adjustment Reports
Not PPO and full fee difference
• Production Adjustments:o Courtesies
o Fee schedule differences
o Some carrier refunds (most are appealable) **
• Collection adjustments:o Lost appeals
o Patient refunds
o Bad debt6
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
What’s Your Biggest Adjustment?
1.
2.
3.
7
Production & Collection
• Identify your busy months
• Marketing efforts will need to target
2-3 months prior to the slower
months
8
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Look for Low UCR Plans
9
Look for Low UCR Plans
10
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Collection Types
11
Most Common Payment Type
1.
2.
3.
The average for dental practices with patient financing: 14 percent
The average for dental practices without patient financing: 28 percent
Courtesy of eAssist
12
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Production By Carrier
Who is your biggest carrier?
1.
2.
3.
Source: Sikka Software & DPR, 2015 13
14
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Production By Carrier
• Who is your biggest carrier?
• Which carrier could you chop off? o Least profitable
o Most time-consuming
• What is your biggest write-off percentage?
15
16
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Procedure Code Summary
(# of procedures) x (full fee) = potential production
(# of procedures) x (PPO fee) = actual production
Difference is your true write-off
AP X
--- = ---
PP 100
17
Delta PPO FFS %
Metlife PPO FFS %
18
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
19
What’s the difference in PPO vs. FFS?
o Largest discounted codes
o Loss in production:
Amount of discount X procedure count
Has it affected your doctor’s decisions?
o Lab choice
o Use of technology
o Avoidance of financial discussions
20
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
21
Referral Report
Your top 10 referrals should include at least 3 non-insurance names
Your non-carrier top referrers:- Massage those names
- Target names from the next ten
22
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Network Participation
23
Participation Considerations
o Administrative mood
o Are you working harder? Smarter?
o Space
o Schedule
24
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Your Practice
STRENGTHSSTRENGTHS
WEAKNESSESWEAKNESSES
OPPORTUNITIESOPPORTUNITIES
!!!
25
Your Practice
STRENGTHSSTRENGTHS
WEAKNESSESWEAKNESSES
OPPORTUNITIESOPPORTUNITIES
!!!• Team• New patients• Good area
• Closing businesses
• Groups• PPO pressure
• Team• Outdated• Low cash
• Associate• Expansion
26
Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • Teresa@OdysseyMgmt.com
Nobody Told Me That!
iTunes, Google Play and on the web!
nobodytoldmethat.libsyn.com
• Coding discussions• Management• Leadership• Industry happenings
27
Teresa@OdysseyMgmt.com
www.OdysseyMgmt.com
Thank You!
OdysseyManagement
teresaduncan
treeduncan
28
top related