02 Oct Is your Office charging above average, median, or low UCR fees?
K M McBain eAssist Ambassador & Credentialing Coach
Nearly half of 2018 is already over, have you raised your UCR fees this year? Are you wondering how you stack up to the other practices in your area? Could you be profiting larger margins from insurances who capitalize on and impose harsh write offs? What is a UCR fee anyway? If you’ve had to call an insurance company for any reason, insurance verifications, claim status or with explanation of benefits questions or even just read through an insurance policy you will run across the term “UCR” fee.
I remember 18 years ago as a young front desk gal asking insurance representatives numerous questions about dental lingo that seemed so foreign to me then. UCR stands for the words “Usual, Customary, and Reasonable.” Insurance companies use and implement “UCR fee schedules” as a way of helping to control their expenses and cap how much they will pay per procedure per provider per area. The insurance companies can act enigmatic about revealing these lists of procedures that dictate how much the insurance has determined each procedure should cost and in turn they process claim benefits based on these UCR fee amounts. This can make it tough for dental office administrators to determine an exact treatment estimate. Since insurances seem to set the standard for most employer contracts and how much you can make shouldn’t you equip yourself in every way possible to make sure you are profiting from insurance as much as possible?
One of the many questions I receive from dental industry practitioners is how they can figure out if they are charging the right amount to their patients for services rendered. Running a dental practice is synonymous with running a business. Successful businesses do not guess what to charge their clients and customers they do the research for their area and products or in this instance procedures to find an appropriate range and then they set their target price smartly. Most dental practices try to negotiate an increase in their contracted fees with insurances each year, but are they also looking at their UCR fees and making the proper increases? Feeling confident in making the necessary changes in your fee structures to keep up with local or regional trends in your geographic region is necessary to be a top business in this industry. If your UCR fee for a crown is less than your contracted fee for some of your insurance carriers that should be a red flag that you may be in the 10th percentile for UCR fee in your area and losing out on money you could be billing and collecting from insurance companies let alone patients.
The dental industry is ever evolving, and it is better to be on the cutting edge than to be left in the dark. Fair Health Consumer has a website where anyone can see where they stand (even your patients can check fair dental costs) for out-of-network- UCR fees per procedure for their area code. This site can be found at www.fairhealthconsumer.org and is a completely free resource! Take advantage of this wonderful resource to see where you stand.
The pros are you can customize your results by percentile range, choose your specialty, and narrow down your exact procedure type. For instance, you can search a general practitioner vs a prosthodontist for a D2740 crown to replace tooth structure vs replacing a missing tooth etc.
The cons are you can only enter one zip code at a time and research one procedure code at a time which can become cumbersome. With that being said, there is another option! if you do want to optimize your fees, Sikka Software has a simple solution for you! Using data compiled from 13,000 dental practices across the U.S. of the most 20 frequently used insurance codes and their fees they’ve created a product called Fee Survey for Dentistry. It has been rated 4 out of 4 stars from 6 verified users of your colleagues.
For under $150 (half yearly subscription) you can enter 3 postal codes in your area to gauge the ideal fees you want to charge to be on target and competitively priced with insurances. Each fee report offers 600+ procedure codes along with fee recommendations and a PDF report will be emailed to you instead of needing to create a report from the data yourself. You may also cancel at any time!
You can find this Fee Survey for Dentists online at www.sikkasoft.com/FeeSurveyforDentistry . I hope you decide to update your fees appropriately using whichever method you prefer to be a contender in today’s insurance-based world of dentistry!
Dental Billing Tips and News for Pros; Edition #128