Orthotown September 2023 - 60

inaccurate. To ensure the utmost accuracy
and reliability, it is crucial to consistently
review and update the aging
of insurance accounts. As payments
are received, the date(s) for upcoming
payments should be placed into ledgers
accordingly. If your report indicates
carriers have paid ahead (you'll see a
negative number in the aging column),
it's not being aged properly, because
insurance never pays ahead for benefits.
The frequency of benefits could
also be a factor for the inaccuracy.
This proactive approach is essential for
maintaining competence in managing
insurance payments and benefits.
If your office heavily relies on the
bottom-line numbers provided by
insurance aging reports, I strongly recommend
conducting regular audits to
assess their accuracy. By doing so, you
can ensure that your financial data
remains trustworthy and dependable.
Contracting
An informed and calculated approach
to insurance contracting plays a
significant role in ensuring a practice's
profitability. This involves evaluating
and negotiating contracts with insurance
companies to achieve favorable
reimbursement rates, contract terms
and patient coverage. By thoroughly
understanding the financial implications
of different insurance contracts,
a practice can make informed decisions
about participating in specific
networks or negotiating alternative
reimbursement models. Additionally,
staying informed about industry
trends, regulatory changes and market
dynamics allows a practice to adapt
its contracting strategies accordingly.
While these factors are discussed
separately, it is important
to note that their order of priority
may vary depending on the unique
Fig. 1: 2022 averages
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$0
$4,939
$5,341
 In-network
 Out-of-network
$981
Average case fee
Fig. 2: Conversion rates
100%
90%
80%
70%
60%
50%
40%
30%
64%
20%
10%
2020
 Without insurance
benefits
2021
 With insurance
benefits, without
in-network discount
circumstances of each practice. Some
practices might prioritize team
education as the initial step to build
a knowledgeable workforce, while
others might focus on implementing
efficient processes first to optimize
revenue cycle management. The key is
to recognize the interdependencies of
these factors and tailor their implementation
to the specific needs and
goals of the practice.
Within our organizations, we
are able to maintain full autonomy
over team training and the ongoing
improvement of our systems.
We should proactively identify any
areas in need of improvement and
consistently assess their effectiveness
SEPTEMBER 2023 | 60 | ORTHOTOWN.COM
2022
 With insurance
benefits and
in-network discount
and efficiency. Conversely, external
factors lie outside our sphere of
influence and are often nonnegotiable.
Nevertheless, there are situations
where we have limited power to alter
these external factors, so it becomes
imperative for us to embrace a
strategic approach that enables us to
harness any advantages presented
by these external factors for our
own advantage.
Comparing benefits and fees
Based on statistical data, 60%-70%
of the population has dental benefits,
and out of those benefits, around 96%
are classified as some form of managed
care, with the majority consisting
$776
Average insurance benefit
83% 83%
80% 81%
73% 74%
62%
55%
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Orthotown September 2023

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