Orthotown September 2023 - 62

Take inventory, then take action
Providers frequently make hasty
decisions to start or end contracts
with insurance carriers, driven by factors
like the practice's current state,
signifi cant discounts and sometimes
team frustrations with the processes.
While some practices believe team
development is the only answer, I
fi nd that positive transformation
frequently indicates a need to address
internal processes and contracting,
whether it's the initial engagement or
revisiting participation.
Ask yourself the following actionable
questions to determine revenue
drain in your practice:
For in-network practices:
* " Have I contracted with a fee
schedule that allows for the
highest allowable charges? " Many
carriers, except for a few major
ones, can be contracted through
another carrier or a third-party
administrator's network.
* " Am I using all available coding
and claims submission methods
for my treatments? " Th is strategy
could potentially reduce
discounts under specifi c plans
and provide greater allowances.
Offi ces often fail to set up systems
to assess discounts by individual
carriers. Consider making
changes to your system to make
informed decisions.
For out-of-network practices:
* " Am I losing patients to nearby
offi ces that are in-network with
specifi c plans? " Assess your metrics
to understand the situation.
I have observed this happening
in numerous offi ces I've worked
with, especially now that carriers
are signifi cantly reducing benefi ts
paid to out-of-network providers.
* " Should I consider contracting
with PPOs if I can maximize
my allowances by itemizing the
codes in my treatment plan? " If
being a noncontracted provider
is negatively impacting your
practice, it would be wise to take
a strategic approach and explore
your options.
From an operations standpoint,
visit the following areas that can be
improved upon:
* Reports. Begin by conducting an
audit to evaluate the accuracy of
your insurance receivables. If this
hasn't been a standard protocol
in the past, it's important to do
so now. Often, offi ces discover
signifi cant credit balances on
their insurance ledgers. Reviewing
your insurance reports will
give you a clear understanding
of the situation and help identify
any inaccuracies.
* Th e end-to-end process. It's crucial
to revisit your entire process
for handling insurance benefi ts.
Th is area tends to be one where
the doctor has the least knowledge.
Seek feedback from your
team. Assess whether you have
enough benefi t information from
your verifi cation process. Identify
any recurring issues that could be
minimized by making necessary
changes to your procedures.
* Th e team's comprehension.
Assess the level of knowledge
and expertise your team possesses
regarding insurance and
the execution of the insurance
process. Unless your staff members
are seasoned and resourceful
individuals, chances are they may
not be well-versed in this area.
Consider providing additional
training and resources to ensure
that your team is well-informed
and capable of effi ciently handling
insurance matters.
To enhance the overall operations
and effi ciency of your practice while
minimizing revenue loss from insurance,
focus on addressing key areas
for improvement. OT
With more than 40 years of experience working and consulting in the field of
orthodontics, Tina Byrne has gained success and recognition for her proficiencies
in clinical, business and administrative functions. She has extensive knowledge and
understanding of systems innovation and eff iciency, data analysis, strategic business
planning and marketing implementation. Byrne, who has lectured and helped guide
the success of leading practices throughout North America and abroad, is the only
industry consultant who has extensively trained and lectured on orthodontic insurance.
Email: tinabyrne@byrne-consulting.com
SEPTEMBER 2023 | 62 | ORTHOTOWN.COM
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Orthotown September 2023

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