How to Set A Dental Practice's Fee Schedule (In Arkansas)

November 18, 2014

How to Set A Dental Practice's Fee Schedule (In Arkansas)

The Problem:


Dental practice owners are losing money by not having a competitive fee schedule.

How the Problem Started: 


The most common "methods" that dental practices use to create their fee schedules are:

  • They were "inherited" when they took the practice over.
  • They created the fee schedule from educated guesses on fees.
  • They made the fee schedule based off of their staff's opinion.
  • They used an annual, survey-based fee schedule from a national publication, such as the ADA.

What if I told you that each of these options could be costing your practice tens of thousands of dollars a year? (or more)

I could tell you horror story after horror story.

Horror Story #1: Set it and Forget it


For example, one client set their fees eight years ago.

Each year, another opportunity came up for our client to "adjust" his fees, but every year he was either too afraid to scare fee-conscious patients away or too busy with his clinical duties to actually raise the fees.

His typical excuse was, "I get paid what the insurance company wants to pay me anyways, and 90% of my practice is insurance based."

When we looked at the reimbursement rates for their insurance companies, they were priced UNDERNEATH what the insurance company would reimburse.

The insurance companies had increased their rates and the practice wasn't even aware.

Horror Story #2: A Bad Starting Point


Another client had simply set their rates and, to their credit, had increased their fees every year by 3%.

Even so, when we looked at their schedule, we found $50,000 in missed production by simply bringing their fees to the market.

That original fee schedule had cost them way more than $100,000.

The practice had used a "regional" study that was published by the American Dental Association to set their fees.

The problem with these national "studies" are that they are extremely flawed in their statistical sampling. (They only use the schedules that are submitted, so if only one schedule is submitted from an area, guess which one gets posted as a "market" example)

I've described the wrong way to look at your fee schedule, what about the right way?

A Look at the Market:


The best way to create a fee schedule is to look at what your market is charging, and make a determination off of that.

So, when was the last time you compared yourself to your market?  Did you know that there is actually a way to do that, right now?

For reference, here is an analysis I prepared of the fee structure for six different dental codes from the lowest income areas in Arkansas to the wealthiest income areas in Arkansas.

(If you do nothing else, send this to your office manager to compare to your current fee schedule and see how you compare)

Important: These numbers are from the Fair Health Consumer organization, a company that was created for transparency from health insurance providers and derives their numbers from actual reimbursement requests from dental practices to insurance companies. In other words, these are numbers that the government tells the public to expect to pay.

02

Compare these six numbers to your practice's fee schedule.

What to Consider:

  • Are you average for your area?
  • Are you below the fees for the poorest areas in Arkansas, but pride yourself for being a "high-end" provider? (I've seen it more than once)
  • Are you in a middle-upper income area and charging the same as the "poorest" areas of Arkansas?

All important questions for you to consider when looking at your fee schedule for 2015.

Now, how many prophy’s and evals does your practice perform in a year? For example, a lot of the practices I work with do around 3,000 of each a year.

That means for every dollar their pricing for the D0120-D0150 and D1110 codes are off, they are losing $3,000 PER dental code.

Now how many dental codes does your practice bill out?  (If you are a general practice, it's probably over 100 codes)

It adds up fast.

Obviously, prophy’s and eval’s are the most common treatments delivered, but you’d be amazed at how much production can be added to a practice by simply bringing your fees to the market. I’m not talking about gouging prices. I’m talking about simply fixing your fee schedule to where you are charging a fair price for the services you are providing.

Limitations to this Approach:


The fee schedule I showed you in this analysis is a very generic schedule created from different regions of Arkansas and it:

  • Only shows the 80th percentile of the market.
  • Is a "regional" study.
  • It only shows 6 different dental codes.

Note: In Arkansas, a region can be a very large geographical area.  For example; Jacksonville, Benton, and Conway are all in the same "region" for these studies, that's a pretty wide breadth of areas that have some very different demographics. The problem with "only" having the 80th percentile is that you may be a practice structured to cater to the "high-end" or even the "low-end" of your market.

The "Better" Solution:


If you've followed along to this point, you'll make large strides in your practice towards being competitive.  But there is an additional step you can take to make sure your practice is operating at peak performance:

The absolute best way to look at your practice's fee schedule is to compare it to your zip code.  Can you think of a better way to judge if your fees are "fair" than to compare them to your peers and competitors?

Second, you need more than just the 80th percentile.  What if you aren't comfortable with the 80th percentile?  What if your practice's goals are to serve as many patients as possible and give better access to care?  What if you are wanting to be a high-end provider?

Third, you need all the dental codes, not just the six listed here.  (But the six listed here could help your practice out a lot)

Lastly, you'll need to come up with a game plan for your practice to implement the changes in the fee schedule.  You'll need a course of action.

I can give you this analysis.

This is a laser focused report for your practice’s location and can mean an increase by thousands of dollars a year in production.

A lot of practices are scared of increasing their fees. They are afraid that their patients will be angry.  This analysis enables you stay at a fair price, without over-charging your patients.

It will help you ensure that your practice remains profitable and that you can continue to provide the quality of care your patients want and deserve.

If you are like all the other practices I've worked with, and aren't sure about how to tackle your fee schedule, I've got you covered.

And I'm going to do it for free.

I charge a flat fee of $1,000 for this service.

So, how do I charge $1,000 for the service, but still give it to you for free?

I'll offer you a guarantee.

If you don't see at least a $10,000 increase in your projected production, I'll refund 100% of your money.  It's as simple as that.  That is a 1,000% ROI guarantee.

It's a crazy thing to do but I'm so confident in this analysis that I'm willing to take that risk, and if my analysis doesn't find any increases for you, you shouldn't have to pay for it.

If you have any questions, you can reply to the email I originally sent, or send an email to jonathan@toothandcoin.com and I'll answer any questions you may have.

P.S. Due to time restraints, I can only complete 10 of these a quarter.  I've already completed 6 this quarter, so if you are wanting one completed for your practice, time is of the essence.  Order Now.

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