Tiffany

Tiffany Wesley

Advisor, FAADOM

3 ways patient discounts impact your dental billing process

The quick and dirty truth is that giving discounts to patients is not recommended. Beyond having the potential to create distrust amongst your patient base — since  giving discounts to separate groups or certain people without giving discounts to others can be viewed as discrimination — it can  disrupt your dental billing process and revenue cycle management. Did you know? Patient discounts can also jeopardize your in-network participation with insurance carriers. This all undoubtedly sounds very concerning, so let’s dive into each of these a little deeper. 

Why patients should be responsible for a portion of dental treatment

What is the purpose of holding the patient responsible for their portion of their dental treatment? Each private insurance plan integrates some form of deductible, coinsurance, and/or copay for two major reasons: 

  1. It mitigates the total overall cost, and cushions against any potential unexpected financial burden caused by catastrophic loss or an accumulation of small losses paid by the payer. 
  2. The patient being partially responsible for the cost of their treatment ensures they have some “skin in the game.” 

 

While there are a few insurance plans with no patient copayments, those that exist typically come with a very high premium. Even many government sponsored plans — such as Medicare, Medicaid, and TRICARE — require copays from the plan beneficiaries.1

Once the remainder of the dental claim is processed

No matter how many preauthorizations you submit or insurance plan details you obtain, there will undoubtedly still be a few patients with a remaining balance  after a dental claim is processed. This patient copayment is part of the total charge for services rendered. That means, in order to collect 100% of what is rightfully owed on dental services provided, copayments must be collected. 

 

Did you know? Collecting patient balances is part of the dental billing process as well as a definitive component of your revenue cycle management. If you are not collecting on patient balances, or discounting them due to an inaccurate treatment estimation, you are leaving collectible revenue on the table. 

 

To keep your cash flow consistent and your dental practice revenue on track, best practice is to complete the following dental billing processes to collect patient copayments:

  • Obtain a complete breakdown of benefits for the patient’s insurance plan and input the details into your  practice management software
  • Take the time to thoroughly review the patient’s treatment plan with them and discuss all payment options available for copayments
  • Make the patient aware of any downgraded or non-covered services impacting their patient responsibility
  • Collect the estimated patient copayment on the day the services are rendered
  • Contact the patient by mail and phone if there is a balance remaining after the dental claim is processed
  • Have an electronic payment option for patients to easily settle remaining balances without needing to come into the office or send payment via standard mail

 

We have an entire list of the 22 dental billing processes for dental practice success, that we highly recommend you read next!

Patient discounts can put your network participation in jeopardy

Insurance payers are serious about requiring that beneficiaries take responsibility for their financial share of dental treatment. Typically, dental payers are clear in their plan documentation regarding the patient’s financial responsibility for copays. Consider this excerpt from a recent statement posted by Delta Dental Insurance for its providers:

 

“Copayment waiver is when a dentist enters a fee on a claim that includes a copayment that the dentist never intends to collect, which makes the reported fee artificially higher than the dentist’s actual fee charged. This causes the dental carrier to cover the patient’s share of the fee. Copayment waivers are a form of overbilling the dental carrier.

 

Waiving copayments violates the contracted dentist’s participation agreement with Delta Dental as well as the patient’s dental benefits contract. This can jeopardize the stability of the patient’s dental coverage by driving up costs, because we assume the overbilled fee to be accurate and then base our premiums on inflated dental costs. When premiums increase, groups may consider dropping dental benefits altogether. Delta Dental may also terminate the dentist’s participation agreement if a dentist regularly waives patient copayments.”

 

While this is a specific example of Delta’s contract wording — the entire statement from Delta Dental can be found here — similar language is found in nearly every payer provider processing manual and patient plan document. As an in-network provider, part of your agreement is to adhere to the payer’s processing policy manual in its entirety. This manual may be obtained via a download from the payer/provider portal or by contacting the insurance company’s  Provider Relations Department.1

How to discuss discounts with patients

Using the verbiage “that is our office policy” or “this is how we do things” can come across very rigidly, and does not make a positive impact on the trust patients place in your office and team. Likewise, offering discounts on patient copayments can actually swing the pendulum the other way and deliver the message that patients are not required to adhere to the office financial protocols. Nail down verbiage as a team that communicates to your patient how much you care while also setting reasonable expectations for patient copayments at the time of service. 

 

The ADA reports that 33.6% of Americans do not have dental insurance, so you may have in-office financial protocols that offer paid-in-full discounts on treatment plans over a specific dollar amount. These should be clearly defined and consistently communicated to patients, carefully curated so as not to feel discriminatory, and clearly documented in a financial agreement signed by the patient and administrative team member presenting the treatment plan.If you need a detailed financial agreement to use, great news, we have one for you!

Outsourcing patient accounts receivable

Are you finding it difficult to manage your patient accounts receivable and have the (sometimes tough) conversations with patients regarding their account balance? eAssist Dental Solutions can help. CLICK HERE to schedule a consultation with a Business Development Specialist, or you can call 1-844-327-7478 or email LearnMore@eassist.me

 

If you are interested in learning more administrative best practices on dental billing and statements, claim submission, coordination of benefits, embezzlement prevention, and more, grab the 2022 Edition of Administration with Confidence from Practice Booster today! The new 2022 edition is easy to understand and will support your team with the information, tools, and solutions to increase patient satisfaction and improve your bottom line. Plus, it is perfect for both the new and experienced team members!

 

1 Administration with Confidence 2022 Edition, eAssist Publishing

0 Comments

Post a comment

Get started with the eAssist platform today

    Dental Billing