At APEX Reimbursement Specialists, we work with many dental practices to complete audits and identify areas for improvement. Some of the most common errors we find involve UCR fees and insurance provider fees. If you’re like many dental practices, your UCR fee confusion might be leading to a lower bottom line and lost income.
What Fee Should You Submit?
Take a look at the fees you are submitting to insurance providers for reimbursement. Are you always utilizing the UCR fee? Are you submitting the maximum fee for your insurance provider? Or, are you submitting a mixture of both? Many practices accidentally submit fees to their insurance provider partners that are lower than the insurance fees. Because the maximum that any dental practice can receive from an insurance company or patient is the submitted fee, you should always submit the highest of the two, whether that’s the UCR fee or the insurance fee.
Why UCR Fees Are Critical
Another common error we encounter is dental practices who fail to update their UCR fees. Some insurance providers will automatically pay a practice their office fee or the maximum allowable fee for the procedure based on which is lower. In most cases, offices have higher UCR fees than provider fees, and not updating yours with the provider could result in your getting paid less.
Has it been a while since you updated your UCR fees? APEX Reimbursement Specialists can help you to determine which fees are appropriate for your practice. If your fees are 10% lower on only 10% of the top procedures that your practice performs, you could easily be missing $50,000 of revenue in a year. Remember that your UCR fees being higher than an insurance provider’s fees does not mean that you’re charging too much or gouging patients. Instead, it simply means that the fee for that insurance provider for that specific procedure does not cover your charge. In general, your fees should be in line with market rates for your area and not necessarily what insurance providers are reimbursing or what patients would prefer to pay.
Master Your Fees and Avoid Confusion With APEX Reimbursement Specialists
The experts at APEX Reimbursement Specialists can help you to explore the best fee schedule options and demystify UCR fees at your practice for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.