Maximizing Reimbursements While Minimizing Hassle

Key Takeaways:
  • Outdated fee schedules can quietly erode your profits by lowering reimbursements.
  • Regular reviews and renegotiations help you secure fair rates and protect your bottom line.
  • If a plan isn’t paying enough or serving many patients, consider leaving it behind and focusing on higher-value options.

 

For many dental practices, insurance reimbursements play an important role in profitability. Yet, too often, offices leave money on the table by failing to regularly update their fee schedules. Many insurance companies allow practices to renegotiate their rates every one to two years, and failing to do so could mean missing out on higher reimbursements.

If you’re still working off an outdated fee schedule, you may be accepting lower reimbursements than necessary, which directly impacts your bottom line.

Why Fee Schedule Optimization Matters

  • Protecting your Profitability: Every dollar left on the table adds up over time. If your practice is not proactively renegotiating its in-network insurance fee schedules, you may be receiving less than what’s available to you. Filing claims with full fees ensures that you’re maximizing your reimbursements whenever a renegotiation opportunity arises.
  • Understanding Insurance Negotiation Challenges: Negotiating with insurance providers can be frustrating and time-consuming. Insurance companies will push for the lowest reimbursement possible, and some may even refuse to negotiate entirely, basing their rates solely on geographic averages. That’s why being prepared and persistent is key.
  • Identifying Hidden Fee Structures: Some insurance plans operate under umbrella agreements, meaning you may unknowingly be contracted under multiple plans. Reviewing your participation agreements can reveal opportunities to restructure or exit agreements that no longer serve your practice.

3 Steps to Optimize your Fee Schedules

Step 1: Run a Patient Report for Each Plan

Before negotiating, know where your revenue is coming from. Use your practice management system to generate a report showing how many patients are on each insurance plan.

  • Look for patterns—are certain plans dominating your patient base?
  • Are you spending too much time on a plan that serves very few patients?
  • Do some plans include umbrella contracts that impact reimbursement rates?

This insight will help you prioritize which fee schedules to negotiate first and which plans may not be worth the effort.

Step 2: Compare Fee Schedules for Key Procedure Codes

Once you have a clear picture of your patient demographics, review all your in-network fee schedules and compare them against your top 10-20 procedure codes.

  • Identify which plans reimburse at the lowest rates.
  • Determine if certain codes are significantly underpaid.
  • Assess whether your fee schedule aligns with industry standards for your area.

If a plan has low reimbursements and few patients, it may not be worth renegotiating. Instead, consider phasing it out in favor of higher-paying plans.

Step 3: Initiate Negotiation or Plan an Exit Strategy

After identifying which plans need adjustment, reach out to the insurance provider to begin the renegotiation process.

  • Be patient. Insurance carriers often delay negotiations as a tactic to maintain lower fees.
  • Track negotiation windows. If a provider says, “We’re not reviewing fee schedules right now,” make a note in your appointment book or calendar to follow up when their next review period begins.
  • Be prepared. Arm yourself with data from competing insurance plans—showing that other carriers are reimbursing higher for the same procedures.
  • Don’t be afraid to exit. If a fee schedule is too low to justify participation, begin planning your exit strategy while ensuring patient communication is handled appropriately.

Overcoming Common Challenges

  • Don’t Let a “No” Stop You: Many providers initially refuse to negotiate. However, persistence is key. If an insurance carrier denies your request, follow up regularly and be ready with comparative data.
  • Track Re-Negotiation Deadlines: Some offices miss negotiation windows simply because they don’t track them. Keep a record of when each carrier allows fee schedule reviews and follow up as soon as the window opens.
  • Use Data to Strengthen your Position: When negotiating, leverage fee schedule data from other insurers to support your case. If one provider pays significantly more for the same procedure, use that as a benchmark.
  • Plan for a Strategic Exit: If an insurance plan no longer serves your practice, don’t be afraid to leave. Communicate changes proactively with affected patients and offer alternative payment options if necessary.

Dental practices work hard to provide top-quality care, but failing to optimize fee schedules means you’re leaving money on the table every single day. The reality is, insurance companies aren’t going to remind you to renegotiate—they count on practices staying complacent.

If you don’t have the time or resources to manage this process alone, Adams Brown Technology Specialists can help. Contact us today.