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2022 Q4 Practice Health Check: Dental Benefit Plans

October 05, 2022 451

Are your practice fees updated?

Dentists are encouraged to review and analyze their procedure fees annually to ensure their usual, customary and reasonable fees will keep pace with several factors, including the state of the economy. The material, laboratory, technology and labor costs for the provision of some dental procedures can change over time and should be factored into consideration.

Keep in mind, patients are more sensitive to some fee increases than others, including for preventive services. Tools you can use to update your fees include: ADA Survey of Dental Fees, Fair Health Consumer and National Dental Advisory Service Report.

How do I evaluate the true cost of dental plan network participation to my practice?

Begin by submitting your full practice fee or UCR (usual, customary and reasonable) on the dental claim form. Submitting the full practice fee is extremely important for several reasons. First, if a plan allows a higher fee for a procedure than you are submitting on the claim form, the plan will pay at the lower rate. Second, by submitting the full practice fee, you are reporting to the dental plans the actual cost of doing that procedure. Finally, it gives you the ability to determine the true cost of contracting with that plan by comparing the full practice fee with the reduced contracted rate and analyzing the write-offs for each plan.

For more information on submitting claim forms or evaluating dental benefit plans, refer to the following CDA resources:

What tools are helpful to ensure proper billing in 2023?

  • 2023 CDT Codes: Each year the American Dental Association publishes an updated/revised set of current dental codes. To avoid claim denials in the upcoming year, it is important to know what codes have changed. Submitting claim forms with outdated or obsolete CDT codes will delay auto adjudication and payment. Prior to submitting claims on Jan. 1, ensure your practice management software has been updated to include new codes.
  • Updated dental plan handbooks: As the ADA releases updated/revised CDT codes, dental benefit plans must establish payment processing guidelines for new procedure codes and determine if there will be any changes to existing guidelines for revised codes. Having a current and updated dental benefit plan handbook is another way to ensure you are adhering to proper billing procedures.
  • Current contact information in dental plan portals: Dental benefit plans may also send electronic communication regarding changes to claim filing address and payment processing guidelines, as well as general notifications. Ensure that the dental benefit plan portal has your office’s most current contact information, including email, fax number and mailing address.
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