network participation: is it working for you? · teresa duncan, ms • odyssey management, inc. •...

Teresa Duncan, MS • Odyssey Management, Inc. • www.OdysseyMgmt.comPhone: 703‐201‐1845 • [email protected]

Presented by Teresa Duncan, MS

Network Participation: Is it Working for You?

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Speaker Disclosure

Teresa Duncan has been paid an honorarium by Henry Schein One to teach a continuing dental education session at this conference.


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How Much Is Participation Costing You?

• Silent cost

o Use of fee schedules

• Overhead cost

o Labor

o Phone

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• 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

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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


What’s Your Biggest Adjustment?

1.

2.

3.

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Production & Collection

• Identify your busy months

• Marketing efforts will need to target

2-3 months prior to the slower

months

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Look for Low UCR Plans

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Look for Low UCR Plans

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Collection Types

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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

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Production By Carrier

Who is your biggest carrier?

1.

2.

3.

Source: Sikka Software & DPR, 2015 13

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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?

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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

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Delta PPO FFS %

Metlife PPO FFS %

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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

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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

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Network Participation

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Participation Considerations

o Administrative mood

o Are you working harder? Smarter?

o Space

o Schedule

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Your Practice

STRENGTHSSTRENGTHS

WEAKNESSESWEAKNESSES

OPPORTUNITIESOPPORTUNITIES

!!!

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Your Practice

STRENGTHSSTRENGTHS

WEAKNESSESWEAKNESSES

OPPORTUNITIESOPPORTUNITIES

!!!• Team• New patients• Good area

• Closing businesses

• Groups• PPO pressure

• Team• Outdated• Low cash

• Associate• Expansion

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Nobody Told Me That!

iTunes, Google Play and on the web!

nobodytoldmethat.libsyn.com

• Coding discussions• Management• Leadership• Industry happenings

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[email protected]

www.OdysseyMgmt.com

Thank You!

OdysseyManagement

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network participation: is it working for you? · teresa duncan, ms • odyssey management, inc. •...

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