Example 1. If a single crown is priced at an example fee of $1600 for an out-of-network provider or $705 when contracted with the example dental insurance payer MetLife, and 50% of what your office expects to be reimbursed by the insurance provider for treatment that meets medical necessity and clinical criteria for benefits, you would need to see a return of $800 as an out-of-network provider, or $352 as an in-network provider. This means when following FCG’s techniques including FCG’s 4 Steps to Build Better Benefits Success and using FCG’s Suggested Clinical Procedure Notes Templates, once 4 crowns are reimbursed for out-of-network providers or 10 for in-network, you have made your initial investment money back.
That means that the treatment you bill in less than 1 month (possibly even 1 week!) will give you a return on your investment.
Even investment in FCG’s Suggested Clinical Procedure Notes Templates alone, without any instruction or professional coaching, will result in a return on your investment.
Example 2. If we review isolated scaling procedures; scaling and root planing limited to 1-3 teeth per quad (D4342) we see a similar trend.
Using an example fee of $240/quad for out-of-network providers or contracted fee example of $78/quad for a carrier like MetLife, 4 quadrants of scaling and root planing, 1-3 teeth per quad would be a fee of $960 for out-of-network coverage, $312 for in-network. Typical benefits packages offer 80% coverage for periodontal treatment such as D4342. This means you are expecting benefit reimbursement of $768 for a full mouth testament as an out-of-network provider, $249.60 in-network. Out-of-network offices will make your investment back with reimbursement from 4.5 patients, in-network with 14. If your office is seeing 200 hygiene patients a month, and the average presentation of periodontitis in the general population is estimated to be 40%, that means 80 patients would have periodontal therapies treatment planned.
You will be making your money back in less than a month again and FCG’s Suggested Clinical Procedure Notes Templates alone will pay for themselves.
You really cannot afford to not adopt the FCG techniques for a more successful claim reimbursement rate.
info@fufidioconsultinggroup.com dominique@fufidioconsultinggroup.com
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