A fee-for-service dentist may request payment one of two ways: having the patient pay for their services in full at the time of treatment to be reimbursed directly by their insurance carrier or paying the copayment then any remaining balances not included in their insurance benefits after the claims have been processed. Either method, the patient is paying the same amount. Some insurance companies prefer to reimburse the patient directly, making it more cost-effective and efficient for all parties involved to pay for the dental treatment at the time of the appointment.
Once it arrives, the payment should be made and mailed directly to your home address. Fee-for-service dentistry is a deterrent for some individuals when seeking out a new dentist. Not all Kois Center dentists are fee-for-service, but many are. For example, the dental practice can call to check the status of a claim, but the insurance may not give any information regarding whether a claim was paid, or how much was paid on the claim to the patient. In this third and final scenario, a fee-for-service dental practice can submit claims for their patients.
The dental practice is going to estimate the patient-owed amount based on insurance verification, or a Pre-Determination , before sending the claim to the insurance. The patient may only be required to pay their copay or patient portion at the time of service. When the practice is FFS, the insurance payer cannot dictate the fee charged to the patient. The dental practice is taking the responsibility for filing and checking up on any outstanding dental claims in order to receive reimbursement from the dental insurance companies.
Even when an office is out-of-network with all insurance payers, if they are filing claims, there are important steps Dental ClaimSupport can still take to eliminate insurance strain. For example: claims still need to be filed, and filed correctly. Dental ClaimSupport will handle filing claims for your practice to make sure the claims go out as clean claims and pay as quickly as possible.
Along those lines, if claims are denied, we will complete the appeals process for you. Unfortunately, an outsourced dental billing, like Dental ClaimSupport, cannot help a practice that does not file insurance claims at all , like scenario 1 above.
If there are no claims, this type of practice would not need insurance and dental billing support. Claims are being created and then need to be closed. Some offices may want to wait to close claims and oftentimes, never close claims. Failing to close claims creates major problems in your dental software in the long run. Instead of EOBs coming to the office to be worked, all EOBs are going to the patients instead, thus the follow-up required would double, if not triple the amount of work required to follow up on claims.
Outsourced dental billing companies could help with this scenario, but be prepared for a higher price tag in most instances due to the extra amount of research and work required. The office is fee-for-service but still wants to be reimbursed for their services by the insurance company.
Delta Dental has decided that if you go out-of-network with them, they will send the reimbursement check directly to the patient when allowed by state law, no matter what you do on the claim form in item Collecting from patients in this scenario can be very difficult because the patient is not prepared to pay for their services in full at their time of service, while they also tend to cash their checks from Delta Dental and decide not to reimburse the office which happens more than you think.
Delta Dental is creating more work for the office Scenario 2 while the office is trying to operate normally by reimbursing the office Scenario 3. This tends to be a difficult decision to make for most providers, and as much as providers dislike the low PPO reimbursement rates, they also want to be reimbursed for their services. Note: Delta Dental is used as an example in this article for illustration purposes only because Delta Dental brand is well known as one of the largest payers and third party administrators for dental plans.
Instead, they could charge their normal fees and spend that 30 percent on marketing to bring in a volume of patients. Or perhaps discount fees by 10 percent and spend 20 percent on marketing, essentially doing the same thing the PPO insurance is doing for them, but having better control.
The benefits, he says, are that the contract is now between the patient and the dentist. If a dentist has been working with 10 PPOs and decides to cut that number in half, he could lose 50 percent of his patient population. There are very few guys who are courageous enough to drop everything at one time.
Garg sees the opportunity for significant benefits for practices shifting to fee-for-service. For starters, he points to time and productivity. In the case of an extensive treatment plan, insurance requires everything be itemized—a 3- to 4-page detailed form where staff may need to look up codes for everything.
The important first step in transitioning to a fee-for-service practice is recognizing it as a new culture, Garg says.
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