Step-by-Step Instructions to Adjust Your Fee Schedule
Are you considering adjusting your fee schedule?
I always recommend creating an insurance analysis.
This data gives you a starting point to work with.
It’s best to run multiple reports in your dental software to get data on the number of patients per insurance contract and most frequently used procedure codes.
I use an excel spreadsheet with approximately 15-25 codes, then enter all current fee schedules and list how many active patients are assigned to each of the contracts.
Be sure to include data like:
- Starting standard fees
- Fees per insurance contract
- Average fees for your area
Note: As you inactivate patients, remove their insurance to make your numbers more accurate (and helpful if/when your office decides to drop an insurance contract).
5 steps to adjust your fee schedule
1. Correct and update all UCR fees in your system.
Collect appropriate data and update to 80%-90% UCR or increase by 10% if your system fees are extremely low.
The percentage you increase to should depend on your area.
Your fees should be updated every year.
2. Print your UCR fees 1x for every insurance contract, along with attaching the UCR average of your area.
Contact your sales representatives and ask if they can help you obtain a copy. If you work closely with certain companies, they will provide it to you and save you about $300!
3. Send the data collected with a firm letter.
Your letter should not only requests a change in fees but also explains who you are and what you are looking to accomplish.
Be thorough and direct.
The letter should state that you want a response in writing within 30 days. If you do not get the response you are looking for or no response at all, you must follow up.
4. In the process of obtaining fees, evaluate what you’re looking to accomplish.
Are you wanting more money for the work you’re already doing?
Wanting additional/fewer new patients, and why?
By doing so, you can determine if you need to combine insurance contracts to achieve a higher fee schedule (working smarter, not harder).
If you want more new patients:
I wouldn’t always suggest combining contracts because this could isolate some employer-specific plans to a lower based payment and some patients may not stay with your practice.
You have to determine if these are the patients you “want” or if you are ok with having higher fees and patients willing to pay more out of pocket.
5. Evaluate how many active patients you have per insurance contract.
You may find getting rid of a bad contract will be beneficial to the office.
Thoroughly explain why you chose to cancel your contract with those patients. Send each patient a personal letter explaining that your care for them is more important than what their insurance company is expecting your office to accept.
Work smarter, not harder
Depending on the size of your office, the analysis, coaching, and negotiations can take 5-20 hours total.
Sound like a lot?
If you personally do not have the time or do not feel you can successfully negotiate fees for your office, speak with your doctor(s) about hiring an insurance coach to do so for you.
There are even coaches out there to teach, work with, and guide you in the right direction.
Meet the Author
Sandy McGrew, FAADOM, is a busy dental practice manager, wife, and mom.
She serves as the office manager at Podvia and Stanford Family Dentistry… This text opens a new tab to the Podvia and Stanford Family Dentistry website… in Florida. She began her career working for Aetna Dental Insurance and is also a certified dental assistant.
Today, Sandy works with 40+ practices throughout Florida and Georgia, helping staff through education related to insurance, marketing, and more.
In her free time, she stays busy by shuffling kids to soccer, dance, and swim meets. Otherwise, you’ll be sure to find her at the pool or beach!