Tom Limoli Jr.
What write–off are you talking about? Is your practice–man age ment software working for you or against you? Are you at least getting basic information to make sound business decisions, or is your computer nothing more than a glorified pegboard?
Have you ever heard your contemporaries make one of the following statements?
- "If we were not a participating provider for ABC Dental Plan, we would not have had to write off the difference for all those crowns!"
- "Our office lost $$$ because we participated with ABC Dental Plan."
- "Look at all the money you are losing by participating with ABC Dental Plan! Those write–offs should be going into your pocket, not the insurance company's."
Let me go on record as saying, "Never join or participate in any managed–care plan that reduces your usual fee, unless you need additional patients to fill empty chairs."
Write–offs most often occur when your usual fee in the open unrestricted marketplace is $800. and the plan's maximum is only $600. Did you lose $200 doing the procedure ... or did you never really have it in the first place? A write–off is an amount of money you intended to collect, but were unable to do so. You cannot lose that which you never had!
Here is my point: Do not rely solely on the total dollar amount of financial adjustment to determine the stability and vulnerability of your participation with any specific benefit plan. Closely scrutinize your data for the following ...
Utilization reports
By frequency – How many patients has the plan directly reimbursed you for?
By total dollar – Of those patients/plans that pay you, how much are they paying?
These reports will tell you which plan is sending you the most patients and which one is paying you the most.
New–patient data
By plan – Are these patients coming to you because of the plan and your willingness to wait on the check?
By frequency – How many new patients are plan–dependent?
In analyzing this data, remember that new patients are the lifeblood and lifeline of your practice.
Contract considerations
Look for exit clauses at 30–, 60–and 90–day–as well as 180–day–intervals.
Don't write patients a blanket letter telling them you are dropping a plan, because it always makes your office look selfish and greedy. Have the courtesy to tell the patient face to face.
Your automated practice–management system must be able to track multiple participatory fee schedules. Of utmost importance is the confirmation that your computer submits the right dollar amount to the right plan at the right time.
Right amount
Does the benefit plan require you to submit the patient's claim with your usual unrestricted fee or some variation of a participatory reduced–dollar amount? If you are submitting your usual fee, do you have to individually adjust the patient's account, or does your system automatically account for the discrepancy in dollar amounts?
Right plan
Does your automated practice–management system know which plan is assigned to which patient? Remember that plan specifics are based on indexing the employer, not the insurance company. An individual employer may have several benefit plans, but insurance companies have thousands. The individual patient record is assigned an individual benefit plan. Don't fall into the trap of indexing and linking individual patient records by "family" or "responsible party." You can't apply
Dad's overpayment to Mom's out–of–pocket obligation.
Right time
Does your automated practice–management system know when to generate the claim? Can you submit the claim for the crown on the date of preparation or do you have to wait until cementation? This is a plan–specific issue and has nothing to do with the revised ADA claim form.
With participatory plans, you never have open patient accounts receivable. These patients pay their dedicated portions prior to or at the time of service. No statements or invoices are ever issued to patients with reduced– dollar participatory plans. Remember, you agreed contractually to accept a reduced–dollar amount for the completed procedure in exchange for the reduction and/or elimination of administrative aggravation.
Your point of control for the accountability and overall profitability of any and all participatory plans must be limited to your automated practice– management system, and never the operatory.
Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third–party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252–7808. Visit his Web site at www.LIMOLI.com.
