Access Insider Tips


Whether you are an Ascent Member or an Ascent Elite Member you’ll want your staff to always be at the forefront of PPO news and Negotiation tips and resources.

Are my UCR Fees where they need to be?

Full Fees in the Office: Where should mine be? “Are my fees too high? Are they too low? How can I be sure?” You can be sure of this: these are the right questions to ask and those who aren’t asking may be on pace to lose thousands of dollars this year (and in coming years) for their practice. Full Fee Maximization matters, and it matters for more reasons than at first glance. Follow these 3 tips to see more profits and keep your practice’s full fees on pace for success: 1. Perform an Annual UCR Review: Industry standards for annual UCR reviews suggest an evaluation every 1-2 years; however, your Ascent Membership affords you twice the minimum standard with semiannual reviews. (If you haven’t already requested your review, click this link.) Please note that our custom analysis contains data that is not found elsewhere, such as valuable code utilization data for your specific area! 2. Avoid “Price Sensitivity” Myths: If you have talked with your colleagues about adjusting your fees, you may have been […]

Your Fee for Service Rates can Influence your PPO Negotiations for better or for Worse

Did You Know Your Fee for Service Rates can Influence your PPO Negotiations for better or for Worse? Were you aware that many national PPO insurance companies base their reimbursement schedule on your office’s full fees? While this is simply one of many factors that impact reimbursements, it’s critical that you’ve taken the advice herein to review your fees and make your game plan according to the data you discover. Remember, your office fees can also have an impact on out of network patients and the revenue collected from this portion of your patient base. Many national PPO companies pay up to the 80th percentile of your regions full fees when an out of patient network is seen; this is often based on Fair Health Benchmarks. Make no mistake about it: insurance companies closely correlate their maximum fee increases with no uncertain relation to your in house fees, and this can impact your negotiations for better or for worse.

7 Steps to the PPO Negotiation Process (Part 1)

This featured article will serve as the blue print and reference point to Ascent Members as they strive to increase their PPO insurance revenue by communicating directly with the Insurance Companies—or by asking their staff to do the same. For this purpose, you’ll notice this article’s length will be greater than subsequent featured articles. Below, in Part 1 of “7 Steps to Negotiate Improved PPO Reimbursements” we will outline steps 1-3. Be sure to check back next month for steps 4-7 (Part 2). It’s encouraged that you follow these steps verbatim and adhere to the additional articles and training within our membership suite to achieve maximum success in your practice. Step 1 - Build Your Personal Insurance Profile (SWOT Analysis of Your Insurance Operation) The first step in negotiating is to outline your operation. Have your answer clearly defined before you attempt to open a "negotiating dialogue" with your negotiating challenger. You’ll want to conduct a SWOT (Strength, Weaknesses, Opportunities, and Threats) analysis on your entire insurance operation. Here's a brief outline of a SWOT analysis: Identify all insurance plans you […]

CDT Code Changes 2014

The purpose of the CDT Code is to achieve uniformity, consistency and specificity in accurately reporting dental treatment.  One use of the CDT Code is to provide for efficient processing of dental claims.  These codes are reviewed and updated yearly.  2014’s CDT Dental Procedure Code changes include: 29 new procedure codes, 18 revised procedure codes and 4 deleted procedure codes. CDT 2014 Code Change Summary New codes effective 1/1/2014 CODE NOMENCLATURE D0393 Treatment simulation using 3D image volume D0394 Digital subtraction of two or more images or image volumes of the same modality D0395 Fusion of two or more 3D image volumes of the same modality D0601 Caries risk assessment and documentation, with a finding of low risk D0602 Caries risk assessment and documentation, with a finding of moderate risk D0603 Caries risk assessment and documentation, with a finding of high risk D1999 Unspecified preventive procedure, by report D2921 Reattachment of tooth fragment, incisal edge or cusp D2941 Interim therapeutic restoration – primary dentition D2949 Restorative foundation for an indirect restoration D3355 Pulpal regeneration - […]

Shared Network Breakdown

PPO SPOTLIGHT: SHARED NETWORKS Shared networks or third party administrators are companies that a dentist can contract with but are not insurance companies themselves.  If you sign on with one of these shared networks, you are agreeing to be in-network under a fee schedule for any insurance company who has an agreement to use that shared network’s fees.  Some insurance companies have an agreement with more than one shared network.  It is necessary to pay attention to which shared network offers the best fee schedule for each insurance company.  If you choose to contract with two shared networks that offer one or more of the same insurance companies, you may have the option to opt out of a specific insurance company with one of the shared networks. Maverest and Connection Dental are two of the biggest shared networks.  Dental Health Alliance/Assurant is also a large shared network but they are also an insurance company.  Shared networks can be a good option if you understand the exposure and fee schedules you will have with various companies. […]

Susan Klyber

Each month Ascent shares a success story of one of their members who was successful in increasing their PPO reimbursements, whether by the sweat of their own brow, or by hiring the experts (us!) “I just completed the 120-day PPO Optimization process with Ascent. My participation throughout the process was very minimal compared to the immense load of paperwork that Kristan (my own personal “Ascent”) took care of on my behalf. Once Ascent had completed my PPO Optimization process, the fee increases they were able to obtain for me ranged from a humble 3% increase all the way up to my highest increase, which was a whopping 76% increase!! Ascent was able to increase my abutment-supported porcelain ceramic crown fee to a point where I am now earning an additional $599.00!! for that one procedure—while doing the same amount of work that I have been doing for years. I had tried (and miserably failed) in the past to negotiate fees on my own with insurance companies. It went nowhere and was extremely frustrating so I […]

Aetna Plans at a Glance

PPO SPOTLIGHT: AETNA Aetna is one of the nation’s leading, diversified health care benefits companies, serving an estimated 44 million people. Aetna offers stand-alone dental plans in select states only, as well as through some employer plans. There are around 130,000 in network dentists around the country. Aetna PPO plans cover both basic and major dental care. PPO plans at a glance: Aetna PPO dental plans Networks Plan options Funding PCD required Plan maximum PPO Members can visit any licensed dentist. They may pay less if they choose a dentist from our large PPO network. PPO, Aetna Dental PPO II (vendor-based) Deductible and/or coinsurance Fully or self-insured No Yes Aetna Dental Care Reward Rewards members the next plan year for visiting a dentist for preventive care during the current plan year. PPO, Aetna Dental PPO II (vendor-based) Deductible and/or coinsurance Fully or self-insured No Yes Aetna Dental Preventive Care Members get preventive care and some diagnostic services covered at 100% in one cost-saving plan when they visit a network dentist. PPO, Aetna Dental PPO II […]

Down to Earth Dental

Each month Ascent shares a success story of one of their members who was successful in increasing their PPO reimbursements, whether by the sweat of their own brow, or by hiring the experts (us!)“ “Three and a half years ago, I bought a small 4-operatory practice in western Washington state.  My team and I put a great deal of effort into turning it around by focusing on marketing, improving internal process and reducing overhead.  The hard work paid off in that we increased annual revenue by 73% and more than doubled gross profit.  Despite our hard work, we seemed to have plateaued. My practice revenue is heavy PPO - about 80%.  We knew the biggest "low-hanging fruit" left was to address PPO reimbursements.  We also knew that we lacked the time and skill to get the most we could from the insurance companies.  That's where Ascent came to the rescue. After getting over the initial sticker shock of their fees, we signed on with them in early December.  In less than three months, our team […]

When a Patient Loses their Plan...

When a Patient loses their Insurance Plan, don’t lose the Uninsured Patient!  Have you recently caught wind of the money that the MBA’s of the world are making through the offering of Dental Discount Plan’s? Plans are popping up at record speed, but why? They are in high demand from consumers! Which begs the question; why not see some of this revenue run through your deserving office as well? Recently, my wife took our 1.5 year old to a pediatric dentist. Our youngest had fallen while playing and chipped her tooth. She was taken to a new practice we had never gone to before. Ironically, we currently hold no dental insurance and my wife explained this to the staff member upon checking out at the front desk. The staff member went on to explain that she never expects her patients to have dental insurance and went on to introduce the office’s solution for that. She introduced their dental discount plan and the reasonable cost, but my wife held her own by saying she’d think about […]

Do’s and Don'ts of Dropping a Plan

Do’s and Don’ts of Dropping a Plan You may have had countless reasons, for dropping an insurance plan, flood your mind as you glanced at this article’s title. Perhaps they included low fees, a brutal claims process or the loss of a major employer in your area. This article will help you decide if dropping a specific plan is beneficial for your practice. Several years ago we assisted a doctor who had roughly $300k in related claims to a particular insurance company. However, before he came to us, he was so upset that the exam and prophy combo was less than half of his fee for service charge, he decided to drop the plan without crunching the numbers. Because of his decision to drop the plan, this doctor had essentially lost most of his take home income. Dropping a plan is not a whimsical decision that can be made by throwing a dart at the board and you cannot make this decision in anger.  Commit now to remove as much emotion as possible when you […]

 

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