www.LIMOLI.com
800-344-2633
1924-2006
National Association of
Dental Plans © 2013
“The size of the dental
benefits market can be
reliably estimated at 176
milli...
What Kind Of Coverage
Do They Have?
176 Million Lives
By Plan Type
PPO
HMO
Traditional
Discount
Where’s The Money?
Usual Fee
The fee that an individual dentist
most frequently charges for a
given dental service
Customary Fee
The fee level determined by the
administrator of a dental benefit plan
from actual submitted fees for a
spec...
Reasonable Fee
The fee charged by a dentist for a
specific dental procedure that has
been modified by the nature and
sever...
It’s The Individual Plan,
Not The Insurance Company
Coding and
Reimbursement
Management is Simple
Follow Tom’s
Seven Keys to
Reimbursement Success
Rule 1
Diagnose and document
prior to initiating any
treatment
Evaluations
The codes in this section have been revised
to recognize the cognitive skills necessary
for patient evaluation...
Evaluations
As with all ADA procedure codes, there is no
distinction made between the evaluations
provided by general prac...
Evaluations
• D0120 periodic
• D0140 limited
• D0145 under 3 years of age
• D0150 comprehensive
• D0160 detailed and exten...
Periodic Oral Evaluation
An evaluation performed on a patient of
record to determine any changes in
the patient’s dental a...
with CDT-7 was added
This includes an oral cancer
evaluation and periodontal
screening where indicated, and
may require in...
Limited Oral Evaluation
An evaluation limited to a specific oral
health problem. This may require
interpretation of inform...
Problem Focused
Typically, patients receiving this type of
evaluation have been referred for a
specific problem and/or pre...
Comprehensive Oral
Evaluation
Used by a general dentist and/or a
specialist when evaluating a patient
comprehensively. It ...
Comprehensive
This includes an evaluation for oral
cancer where indicated, the
evaluation and recording of the
patient’s d...
Comprehensive
It may include the evaluation and
recording of dental caries, missing or
unerupted teeth, restorations, exis...
Detailed and Extensive
A detailed and extensive problem-
focused evaluation entails extensive
diagnostic and cognitive mod...
Detailed and Extensive
Integration of more extensive
diagnostic modalities to develop a
treatment plan for a specific prob...
Problem focused, by report
Examples of conditions requiring this type of
evaluation may include dentofacial
anomalies, com...
Comprehensive Periodontal
Evaluation
New or established patients
showing signs or symptoms of
periodontal disease and for ...
D0180
It includes evaluation of periodontal
conditions, probing and charting,
evaluation and recording of the
patient’s de...
D0180
It may include the evaluation and
recording of dental
caries, missing or unerupted
teeth, restorations, occlusal
rel...
How Often Can I Charge
For A New
Comprehensive
Evaluation?
How about the new or established
patient?
To Reach A Documented
Conclusion or Diagnosis
Limoli’s Trilogy of Reimbursement
Limoli’s
6 R’s
of Record-Keeping
1. Reason
• Why is the patient here today?
2. Review
• What is the patient’s overall
health status today?
• Evaluation of the patient’s dental
needs and description ...
3. Radiographs
• Are radiographs needed?
• Why are they being taken?
• Document what they show.
4. Recommended Treatment
• Based upon the evaluation and
diagnosis, what treatment is
recommended by the dentist?
5. Rendered Treatment
• What procedures were
performed?
• What anesthesia was used?
• Other materials used?
6. Response to Treatment
• How did the patient’s condition
respond to treatment?
• What are the next steps or
follow-up pr...
Rule 2
Establish a written
treatment plan for the
patient as well as
yourself
Report of findings
• What is the patient’s chief
concern?
• What is good?
• What needs to be improved?
• What needs to be ...
Peter E. Dawson, DDS
“The prime requirement of
good treatment planning
is to do the minimum
required to achieve
optimum or...
Slow Down
Four phases
• Allow for a triage of patient needs
• Initiate saving as many teeth as
possible
• Begin when the demand for
...
Phase 1
• Emergency relief of pain (D9110), routine
extractions (D7140)
• Comprehensive evaluation, radiographs
and diagno...
Phase 2
• Periodontal, osseous, and mucogingival
surgery, per tooth, as prerequisite for
restorative care
• Restorative de...
Phase 3
• Space maintainers for children;
preventive orthodontics
• Single crowns, inlays, inlays w/
onlays
• New full den...
Phase 4
• Periodontal, osseous and
mucogingival surgery, per
quadrant
• New partial dentures
• New fixed partial dentures
...
With All Patients
A maintenance level is
achieved first, with
shared patient
responsibility, before
EXPENSIVE and
EXTENSIV...
Peter E. Dawson, DDS
“Any dentist who makes mouths
healthy and keeps them that way is
practicing complete dentistry.
Furth...
Rule 3
Secure financial
arrangements prior to
treatment
Who Pays What Amount To
Whom
Follow the money and you enforce
the accountability
Assignment of Benefit is
a two edged sword
What is a write off?
“You cannot lose that which you
never had”
In other words
• If your usual fee is $800
• And, the plans maximum allowance is only
$600
• You did not lose $200 doing t...
Schedule by production
• Production is a measurement in
dollars of the actual services
performed.
• Current production fig...
Schedule by collection
• This figure is the total of all monies
received by the practice during a
specific period.
• Colle...
Rule 4
Patient must acknowledge
and agree to pay the
total fee prior to
insurance consideration
Financial Arrangements
(Total Cost of Care)
vs
Benefits Assessment
(Insurance)
It’s the patient’s plan
Plan Provisions
• Reimbursement Percentile
• Alternate Benefit
• Coordination of Benefit
• Maintenance of Benefit
• Non du...
Benefit Plan Provisions
Must Be Confirmed With
Each New Series Of
Visits
Your office must follow the
benefit plan provisions.
Providership is not a
consideration or excuse.
Secure Specifics In
Writing From The Plan
Or Make Other Financial
Arrangements.
Get The Benefit Booklet From
The Patient –...
Always Confirm Eligibility With
Each Appointment
If you file the claim,
it’s your responsibility
Eligibility
• Benefit Card
• Call the day of the patient visit
• Reference #
• Name of contact
• Don’t forget the employer...
But what fee goes
on the claim form?
Your full “USUAL” fee
We will talk about
discounts later
Alternate Benefit
A provision in a dental plan contract
that allows the third-party payer to
determine the benefits based ...
with alternate benefit
The plan is not dictating
treatment, they are only
determining coverage based
upon that plans speci...
Why the plan does not
pay?
Exclusions, limitations and
carve outs of coverage
Coordination of Benefits
• A method of integrating benefits
payable under more than one plan
• The benefit plans work toge...
Maintenance of Benefits
• A method of restricting benefits
payable under more than one plan
• Secondary plan pays no more ...
Nonduplication of Benefits
• A method of restricting benefits
payable under more than one plan
• If primary plan pays, sec...
The Problem
Elimination and/or reduction of
secondary coverage's
although premiums paid by
both primary and secondary
bene...
The Solution
• Don’t accept authorization for
payment on secondary coverage
• Have the plan reimburse the patient
• Financ...
Rules of Primacy
• The plan covering the patient as
anything other than a dependent is
primary
• The plan without a COB pr...
What is the date of
incurred liability
Limoli says to always:
“Wait to Generate the
Claim Until the
Treatment Procedure
is Completed”
Assignment of Benefits
A procedure whereby a beneficiary
authorizes the administrator of the
program to forward payment fo...
Assignment of
Benefits is not an
Authorization for
Payment
Preauthorization
Precertification
Predetermination
Prior Authorization
simply defined as:
an indication of the dollar
amount to be paid for covered
services contingent upon
continuing eligibili...
First Instance
Important for the patient to know
approximately how much their dental
benefit plan may pay.
Determines full...
Second Instance
Since we have no record of having
received a predetermination…
Treatment plan exceeded $250
Benefits are p...
Third Instance
Uncooperative patient with no printed
benefit information
“I have insurance and my husband has
insurance. E...
Never a guarantee of
reimbursement
You can’t take it to the
bank
Discounts
• Total Fee Charged (Question 53) must be
the fee you intend to collect.
• It is illegal to discount based on th...
Rule 5
Bill and code for exactly
what dated services are
rendered
Current Dental
Terminology
The Code on Dental
Procedures and
Nomenclature
We Have More Code
Changes on the Way
Let’s Do Some Claims
Doctor
Diagnosis
Clinical
Findings
Narrative /
Attachment
Code
•No attachment loss
•No bone loss
•Abundance of
plaque, calculus and
stain
“Last professional
cleaning was 24
months ago”
...
Prophylaxis - Adult
A dental prophylaxis performed on
transitional or permanent dentition
which includes scaling and
polis...
with CDT-2005
Descriptor changed to removal
of plaque, calculus and stain
from the tooth structure…
As well as local irrit...
Non-Surgical
Periodontal Service
• D4355 full mouth debridement to
enable comprehensive evaluation
and diagnosis
D4355
• The gross removal of plaque
and calculus that interfere with
the ability of the dentist to
perform a comprehensive...
D4355
When an
evaluation, diagnosis
and radiographs are not
possible.
Not a routine procedure
Other Periodontal
Services
• D4910 periodontal maintenance
procedures (following active therapy)
This procedure is for pat...
D4910
This procedure is instituted following
periodontal therapy and continues at
varying intervals, determined by the
cli...
D4910 Includes
• Removal of the bacterial plaque and
calculus from supragingival and
subgingival regions
• Site specific s...
•What about the
evaluation?
•Is it charged out
separately?
• Can the hygienist do the
evaluation?
“Periodic maintenance
treatment following
periodontal therapy is
not synonymous with a
prophylaxis”
Never alternate
D4910 with D1110
Sequential Order of
Treatment
• Diagnose First
• Treat based on diagnosis
• Evaluate treatment
• Continue treatment
• Cont...
Rule 6
What the insurance does
not pay - the patient
must pay
Dental Benefit Plan
Any plan is simply a device
which those individuals in
the work force are using to
help offset the cos...
Fee For Service
Dentistry
With A Managed
Care Component
“If you are thinking a year
ahead, sow seed. If you
are thinking ten years
ahead, plant a tree. If
you are thinking one
hu...
Managed care will not
solve the
inadequacies of a
low-
profit, mismanaged
dental practice.
Look closely at your
existing patient base and
bank deposit, then
determine:
How insurance dependent
is your dental practi...
Track the third-party
portion of your bank
deposit by payer
and employer.
If a major employer in
your area is involved
with a substantial
portion of your
practice
revenues, monitor that
employer b...
Don’t Speak Poorly Of The
Employer and Benefit Plan
“Fee For Service”
selling procedures for a
fee
“Service For A Fee”
managed care selling
time
We must maintain
our posture of
serving the needs
(both clinical and
financial) of our
patient base.
“I would never
have guessed in
a million years
that my patients
would leave me
for a dollar”
What’s good for
Managed Care can
be great in
Fee-For-Service
Limoli & Associates
But if its not for you, simply get out
of the plan
You Must Stop Accepting
Assignments of Benefits
The Patient Must Be Accountable
For The Strengths And
Weaknesses Of Their Own
Benefit Plan
Rule 7
If the patient does not pay
- hunt them down like
you would a rabid dog
7 keys 2013 webinar only
7 keys 2013 webinar only
7 keys 2013 webinar only
7 keys 2013 webinar only
7 keys 2013 webinar only
7 keys 2013 webinar only
7 keys 2013 webinar only
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7 keys 2013 webinar only

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The very short version of my 7 basic keys to reimbursement success.

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7 keys 2013 webinar only

  1. 1. www.LIMOLI.com 800-344-2633
  2. 2. 1924-2006
  3. 3. National Association of Dental Plans © 2013 “The size of the dental benefits market can be reliably estimated at 176 million lives – or 57% of the US population”
  4. 4. What Kind Of Coverage Do They Have?
  5. 5. 176 Million Lives By Plan Type PPO HMO Traditional Discount
  6. 6. Where’s The Money?
  7. 7. Usual Fee The fee that an individual dentist most frequently charges for a given dental service
  8. 8. Customary Fee The fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefits payable under a given plan for that specific procedure.
  9. 9. Reasonable Fee The fee charged by a dentist for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complication or unusual circumstances.
  10. 10. It’s The Individual Plan, Not The Insurance Company
  11. 11. Coding and Reimbursement Management is Simple Follow Tom’s Seven Keys to Reimbursement Success
  12. 12. Rule 1 Diagnose and document prior to initiating any treatment
  13. 13. Evaluations The codes in this section have been revised to recognize the cognitive skills necessary for patient evaluation. The collection and recording of some data and components of the dental examination may be delegated; however, the evaluation, diagnosis and treatment planning are the responsibility of the dentist.
  14. 14. Evaluations As with all ADA procedure codes, there is no distinction made between the evaluations provided by general practitioners and specialists. Report additional diagnostic and/or definitive procedures separately.
  15. 15. Evaluations • D0120 periodic • D0140 limited • D0145 under 3 years of age • D0150 comprehensive • D0160 detailed and extensive, –by report • D0170 re-evaluation – limited • D0180 comprehensive periodontal
  16. 16. Periodic Oral Evaluation An evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health status since a previous comprehensive or periodic evaluation.
  17. 17. with CDT-7 was added This includes an oral cancer evaluation and periodontal screening where indicated, and may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately.
  18. 18. Limited Oral Evaluation An evaluation limited to a specific oral health problem. This may require interpretation of information acquired through additional diagnostic procedures.
  19. 19. Problem Focused Typically, patients receiving this type of evaluation have been referred for a specific problem and/or present with dental emergencies, trauma, acute infections, etc..
  20. 20. Comprehensive Oral Evaluation Used by a general dentist and/or a specialist when evaluating a patient comprehensively. It is a thorough evaluation and recording of the extraoral and intraoral hard and soft tissues.
  21. 21. Comprehensive This includes an evaluation for oral cancer where indicated, the evaluation and recording of the patient’s dental and medical history and a general health assessment.
  22. 22. Comprehensive It may include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, existing prostheses, occlusal relationships, periodontal conditions (including periodontal charting), hard and soft tissue anomalies, etc.
  23. 23. Detailed and Extensive A detailed and extensive problem- focused evaluation entails extensive diagnostic and cognitive modalities based on the findings of a comprehensive oral evaluation.
  24. 24. Detailed and Extensive Integration of more extensive diagnostic modalities to develop a treatment plan for a specific problem is required. The condition requiring this type of evaluation should be described and documented.
  25. 25. Problem focused, by report Examples of conditions requiring this type of evaluation may include dentofacial anomalies, complicated perio-prosthetic conditions, complex temporomandibular dysfunction, facial pain of unknown origin, severe systemic diseases requiring multi-disciplinary consultation, etc..
  26. 26. Comprehensive Periodontal Evaluation New or established patients showing signs or symptoms of periodontal disease and for the patients with risk factors such as smoking or diabetes.
  27. 27. D0180 It includes evaluation of periodontal conditions, probing and charting, evaluation and recording of the patient’s dental and medical history and general health assessment.
  28. 28. D0180 It may include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships and oral cancer evaluation.
  29. 29. How Often Can I Charge For A New Comprehensive Evaluation? How about the new or established patient?
  30. 30. To Reach A Documented Conclusion or Diagnosis
  31. 31. Limoli’s Trilogy of Reimbursement
  32. 32. Limoli’s 6 R’s of Record-Keeping
  33. 33. 1. Reason • Why is the patient here today?
  34. 34. 2. Review • What is the patient’s overall health status today? • Evaluation of the patient’s dental needs and description of condition
  35. 35. 3. Radiographs • Are radiographs needed? • Why are they being taken? • Document what they show.
  36. 36. 4. Recommended Treatment • Based upon the evaluation and diagnosis, what treatment is recommended by the dentist?
  37. 37. 5. Rendered Treatment • What procedures were performed? • What anesthesia was used? • Other materials used?
  38. 38. 6. Response to Treatment • How did the patient’s condition respond to treatment? • What are the next steps or follow-up procedures?
  39. 39. Rule 2 Establish a written treatment plan for the patient as well as yourself
  40. 40. Report of findings • What is the patient’s chief concern? • What is good? • What needs to be improved? • What needs to be replaced?
  41. 41. Peter E. Dawson, DDS “The prime requirement of good treatment planning is to do the minimum required to achieve optimum oral health”
  42. 42. Slow Down
  43. 43. Four phases • Allow for a triage of patient needs • Initiate saving as many teeth as possible • Begin when the demand for restorative dentistry tapers off • Only be practiced when the patient can demonstrate meticulous home care
  44. 44. Phase 1 • Emergency relief of pain (D9110), routine extractions (D7140) • Comprehensive evaluation, radiographs and diagnostic casts as needed • Home care instructions (D1330) demonstrated and evaluated • Initial perio therapy (D4341 D4342) • Periodontal maintenance (D4910)
  45. 45. Phase 2 • Periodontal, osseous, and mucogingival surgery, per tooth, as prerequisite for restorative care • Restorative dentistry – amalgams / resins • Endodontic • Complicated, non-emergency extractions (D7210 to D7241) • Relines and repairs to existing dentures and removable partials
  46. 46. Phase 3 • Space maintainers for children; preventive orthodontics • Single crowns, inlays, inlays w/ onlays • New full dentures
  47. 47. Phase 4 • Periodontal, osseous and mucogingival surgery, per quadrant • New partial dentures • New fixed partial dentures • Orthodontic care
  48. 48. With All Patients A maintenance level is achieved first, with shared patient responsibility, before EXPENSIVE and EXTENSIVE restorative care is undertaken
  49. 49. Peter E. Dawson, DDS “Any dentist who makes mouths healthy and keeps them that way is practicing complete dentistry. Furthermore, in providing optimum maintainability, the bonus side effects of better comfort, function, and even esthetics are more easily achieved.”
  50. 50. Rule 3 Secure financial arrangements prior to treatment
  51. 51. Who Pays What Amount To Whom Follow the money and you enforce the accountability
  52. 52. Assignment of Benefit is a two edged sword
  53. 53. What is a write off?
  54. 54. “You cannot lose that which you never had”
  55. 55. In other words • If your usual fee is $800 • And, the plans maximum allowance is only $600 • You did not lose $200 doing the procedures? • You cannot lose that which you never had in the first place
  56. 56. Schedule by production • Production is a measurement in dollars of the actual services performed. • Current production figures gain meaning as they are compared to those of the same period last year • Not a financial number because it only represents a potential number
  57. 57. Schedule by collection • This figure is the total of all monies received by the practice during a specific period. • Collections are a measurement of the effectiveness of the practice’s credit policy and those responsible for its execution.
  58. 58. Rule 4 Patient must acknowledge and agree to pay the total fee prior to insurance consideration
  59. 59. Financial Arrangements (Total Cost of Care) vs Benefits Assessment (Insurance)
  60. 60. It’s the patient’s plan
  61. 61. Plan Provisions • Reimbursement Percentile • Alternate Benefit • Coordination of Benefit • Maintenance of Benefit • Non duplication of Benefit • Date of Incurred Liability • Birthday Rule • Predetermination
  62. 62. Benefit Plan Provisions Must Be Confirmed With Each New Series Of Visits
  63. 63. Your office must follow the benefit plan provisions. Providership is not a consideration or excuse.
  64. 64. Secure Specifics In Writing From The Plan Or Make Other Financial Arrangements. Get The Benefit Booklet From The Patient – The www or Fax Back
  65. 65. Always Confirm Eligibility With Each Appointment If you file the claim, it’s your responsibility
  66. 66. Eligibility • Benefit Card • Call the day of the patient visit • Reference # • Name of contact • Don’t forget the employer • Web based plan access
  67. 67. But what fee goes on the claim form? Your full “USUAL” fee We will talk about discounts later
  68. 68. Alternate Benefit A provision in a dental plan contract that allows the third-party payer to determine the benefits based on an alternate procedure that is generally less expensive than the one provided or proposed
  69. 69. with alternate benefit The plan is not dictating treatment, they are only determining coverage based upon that plans specific contract language
  70. 70. Why the plan does not pay? Exclusions, limitations and carve outs of coverage
  71. 71. Coordination of Benefits • A method of integrating benefits payable under more than one plan • The benefit plans work together • Benefits from all sources do not exceed 100% of the total charge
  72. 72. Maintenance of Benefits • A method of restricting benefits payable under more than one plan • Secondary plan pays no more than if it were primary • If primary plan pays, secondary plan does not
  73. 73. Nonduplication of Benefits • A method of restricting benefits payable under more than one plan • If primary plan pays, secondary plan does not • If primary plan does not pay, secondary plan may/may not
  74. 74. The Problem Elimination and/or reduction of secondary coverage's although premiums paid by both primary and secondary beneficiaries
  75. 75. The Solution • Don’t accept authorization for payment on secondary coverage • Have the plan reimburse the patient • Financial arrangements based on primary coverage
  76. 76. Rules of Primacy • The plan covering the patient as anything other than a dependent is primary • The plan without a COB provision is primary • Lowest dollar threshold is primary
  77. 77. What is the date of incurred liability
  78. 78. Limoli says to always: “Wait to Generate the Claim Until the Treatment Procedure is Completed”
  79. 79. Assignment of Benefits A procedure whereby a beneficiary authorizes the administrator of the program to forward payment for covered procedures directly to the treating dentist.
  80. 80. Assignment of Benefits is not an Authorization for Payment
  81. 81. Preauthorization Precertification Predetermination Prior Authorization
  82. 82. simply defined as: an indication of the dollar amount to be paid for covered services contingent upon continuing eligibility
  83. 83. First Instance Important for the patient to know approximately how much their dental benefit plan may pay. Determines full cost of treatment before treatment is actually started.
  84. 84. Second Instance Since we have no record of having received a predetermination… Treatment plan exceeded $250 Benefits are payable for only diagnostic, preventive and palliative services
  85. 85. Third Instance Uncooperative patient with no printed benefit information “I have insurance and my husband has insurance. Everything is paid at 100% in full”
  86. 86. Never a guarantee of reimbursement You can’t take it to the bank
  87. 87. Discounts • Total Fee Charged (Question 53) must be the fee you intend to collect. • It is illegal to discount based on the patients co-payment. • Discount must be disclosed when the claim is filed.
  88. 88. Rule 5 Bill and code for exactly what dated services are rendered
  89. 89. Current Dental Terminology The Code on Dental Procedures and Nomenclature
  90. 90. We Have More Code Changes on the Way
  91. 91. Let’s Do Some Claims
  92. 92. Doctor Diagnosis Clinical Findings Narrative / Attachment Code
  93. 93. •No attachment loss •No bone loss •Abundance of plaque, calculus and stain “Last professional cleaning was 24 months ago” D1110 Prophylaxis
  94. 94. Prophylaxis - Adult A dental prophylaxis performed on transitional or permanent dentition which includes scaling and polishing procedures to remove plaque, calculus and stains. “coronal” deleted with CDT-2005
  95. 95. with CDT-2005 Descriptor changed to removal of plaque, calculus and stain from the tooth structure… As well as local irritational factors…
  96. 96. Non-Surgical Periodontal Service • D4355 full mouth debridement to enable comprehensive evaluation and diagnosis
  97. 97. D4355 • The gross removal of plaque and calculus that interfere with the ability of the dentist to perform a comprehensive oral evaluation. • This preliminary procedure does not preclude the need for additional procedures.
  98. 98. D4355 When an evaluation, diagnosis and radiographs are not possible. Not a routine procedure
  99. 99. Other Periodontal Services • D4910 periodontal maintenance procedures (following active therapy) This procedure is for patients who have previously been treated for periodontal disease.
  100. 100. D4910 This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacement.
  101. 101. D4910 Includes • Removal of the bacterial plaque and calculus from supragingival and subgingival regions • Site specific scaling and root planing where indicated (D4341 or D4342) and • polishing of the teeth (D1110).
  102. 102. •What about the evaluation? •Is it charged out separately? • Can the hygienist do the evaluation?
  103. 103. “Periodic maintenance treatment following periodontal therapy is not synonymous with a prophylaxis”
  104. 104. Never alternate D4910 with D1110
  105. 105. Sequential Order of Treatment • Diagnose First • Treat based on diagnosis • Evaluate treatment • Continue treatment • Continue evaluation
  106. 106. Rule 6 What the insurance does not pay - the patient must pay
  107. 107. Dental Benefit Plan Any plan is simply a device which those individuals in the work force are using to help offset the cost of dental care
  108. 108. Fee For Service Dentistry With A Managed Care Component
  109. 109. “If you are thinking a year ahead, sow seed. If you are thinking ten years ahead, plant a tree. If you are thinking one hundred years ahead, educate the people.”
  110. 110. Managed care will not solve the inadequacies of a low- profit, mismanaged dental practice.
  111. 111. Look closely at your existing patient base and bank deposit, then determine: How insurance dependent is your dental practice?
  112. 112. Track the third-party portion of your bank deposit by payer and employer.
  113. 113. If a major employer in your area is involved with a substantial portion of your practice revenues, monitor that employer base closely.
  114. 114. Don’t Speak Poorly Of The Employer and Benefit Plan
  115. 115. “Fee For Service” selling procedures for a fee “Service For A Fee” managed care selling time
  116. 116. We must maintain our posture of serving the needs (both clinical and financial) of our patient base.
  117. 117. “I would never have guessed in a million years that my patients would leave me for a dollar”
  118. 118. What’s good for Managed Care can be great in Fee-For-Service Limoli & Associates
  119. 119. But if its not for you, simply get out of the plan
  120. 120. You Must Stop Accepting Assignments of Benefits
  121. 121. The Patient Must Be Accountable For The Strengths And Weaknesses Of Their Own Benefit Plan
  122. 122. Rule 7 If the patient does not pay - hunt them down like you would a rabid dog

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