Using the fee schedule to create sustainability and affordability in the dental practice

Safety net dental programs are the answer to many dilemmas for unisured patients

May 29th, 2014
Outside Shot Of Dental Office

In his last article, "How to create and manage a successful safety net dental program," Dr. Mark Doherty described what a safety net dental program is:The dental care safety net is where people go:
• When they don't have a regular dentist

• Because they know their Medicaid card will be accepted

• Because they won't be turned away when they are in pain and can't afford care

• Because the clinic is close to home and linked to their other health care providers

In this article Dr. Doherty describes how to use the fee schedule to create sustainability and affordability for the safety net dental program.

Safety net dental programs must work to find a balance between the need to maintain financial sustainability, and the need to make dental care as affordable as possible for patients without dental insurance.

The first step is to establish a schedule of dental fees that are in line with the usual and customary fees in the area where the practice is located. Setting fees below prevailing rates undervalues the contribution the safety net dental clinic provides to the community. It also may negatively impact revenue if fees are less than third party insurers are willing to pay.

There are a number of resources available to help determine prevailing rates, such as the National Dental Advisory Services (NDAS), Dental Economics, the UCR Dental Fees Report (www.dentalfees.com), and Udell Webb Leadership (webbdental.com). Most of these resources are available for a fee, which vary widely. It’s important to find a resource that is updated annually, contains the most recent usual and customary rates, and provides fees for the zip code in which the dental practice is located. The fee schedule should be reviewed annually to make sure it remains up-to-date. If third party insurers are reimbursing the safety net dental clinic the full amount of charges, it’s time to review and increase the fee schedule.

For low-income, uninsured, or underinsured patients, fees can be discounted based on income eligibility guidelines. Most safety net dental programs use Federal Poverty Level guidelines, which are provided annually by the U.S. Department of Health and Human Services, to establish eligibility.

Fees can be broken down into two categories using the prioritization system developed by the Bureau of Primary Health Care – Phase I, and Optional Services. Phase I services are defined as diagnostic, preventive, restorative, emergent, basic endodontic, periodontal and oral surgery (simple extractions), single unit crowns, and space maintenance. Phase I services are designed to diagnose, prevent, and eliminate disease and restore patients to a baseline of optimum oral health. Phase I services can offer multiple discount categories on the sliding fee scale based on the patient’s income eligibility status.

Optional services are more specialized, complex and time-consuming and often involve outside dental laboratory fees. Most safety net dental practices cannot afford to offer multiple discount categories for Optional services but should consider offering some kind of discount to make these services as affordable as possible for low-income, uninsured patients. Many practices require patients to pay the lab costs out of pocket before the procedure is scheduled, subtract the lab fees from the overall charge and offer a discount based on the remainder of the charge.

Mark Doherty, DMD, is the Director of Safety Net Solutions at the DentaQuest Institute.

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