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Holly Hoffpauir

Director of Accounting

5 Fee Schedule Tips to Increase Your Practice’s Management & Efficiency

What is a fee schedule for dental insurance?

Efficient fee schedules allow you to set proper pricing options based on the services you provide. These are based primarily on the “Usual, Customary, and Reasonable” (UCR) fees close to your practice location. Of course, there are a few other factors that will help you maximize your fee schedule and profits, the first of which is understanding the differences between various fee schedules.

Standard fee schedule

Your standard fee schedule is your bread-and-butter compilation of fees for services provided, and what you will charge your patients. Most standard fee schedules correlate treatments with their respective dental or medical codes, making it simple to find and determine the cost of a procedure. However, monthly and annual updates to procedural codes vary for each insurance company, making it more difficult to set a standard price on multiple services without access to these data points.

Insurance fee schedule

By providing dental services through certain insurance companies, you are required to adhere to their fee schedules, which can vary widely. While having more in-network companies means you have higher visibility, you should choose your partnerships based on your clients and practice specialization, if any. As well as this, it’s important to reiterate to your patients that their insurance being “in-network” indicates the maximum allowable fee you may charge them for treatment, and that if they are outside of it, they must instead pay what your standard fee schedule dictates.

Five fee schedule efficiencies and management tips

Keeping your personal fee schedule current and consistent is as easy as following these five steps:

  1. Review the customary fees for services provided in your area
  2. Perform a yearly checkup to update price points to stay competitive and cash flow positive
  3. Know the procedural codes, fees, and annual ROI for the top 5 treatments you provide
  4. Ensure your fees are at or above the allowable coinsurance deductible rates reported by insurance companies
  5. If necessary, outsource your fee scheduling to a company with efficient ROI reports and access to regularly updated coding changes

Your fee schedule is how you present your practice to your community. Are you charging too much? Too little? Not sure? By knowing and keeping your price points competitive, you’re taking care of your patients as well as your bottom line.

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