Over the past few years, dental payers have added in new hurdles, forcing dental practices to adapt, according to one dentist.
Downgrading payments for certain procedures and network leasing are two of the challenges that dentists have had to navigate.
Samson Liu, DDS, CEO of SOHDental in St. Louis, recently connected with Becker’s to talk about how dental payers have changed and how dentists have adapted.
Note: This response was lightly edited for clarity and length.
Question: How has dental payer behavior changed within the past year, and how have you adapted?
Dr. Samson Liu: Many practices are often frustrated with third-party dental payers putting in perceived roadblocks throughout the entire claims process to slow down or deny payments. In recent years, we have encountered several payers adding new policies to make the overall process more cumbersome.
A recent example is the downgrade of payment of two surface restorations to single surface restorations on posterior teeth by certain payers. Another common example is network leasing or sharing. Payers are forcing practices who signed up to automatically enroll in other networks without asking for permission. This forces practices who are already participating in these other networks at a higher reimbursement rate already, to now unknowingly accept a new lower reimbursement rate.
As a result, we have taken several measures to proactively address these issues. For example, when we credential a new provider, we will proactively include letters notifying them to opt out of all other networks. We have also developed an internal audit process to review EOB’s (explanation of benefits) for fee discrepancies. Lastly, regular cadence in negotiating higher fees with payers is also key to maximizing reimbursement rates.
