Author Archives: vlm

Did your practice receive a Cigna Fee Reduction letter? Dental practices that participate with Cigna PPO in certain market areas (Northern Virginia, Washington DC, Maryland and Pennsylvania) have been receiving a letter from the Plan with a copy of a new reduced plan fee schedule. Cigna Dental is working to reduce “the cost of care” by decreasing fee schedules for targeted practices, sometimes as much as 25%. The trend of the mailings so far suggests that the majority of practices with any custom or enhanced Cigna fee schedules are at risk to receive the Cigna fee reduction notice.

We Received a Cigna Fee Reduction Letter – Now What?

Cigna Dental is a large insurance carrier and we expect that many patients will be affected by this change. We recommend seven points to consider when developing your response to this targeted Cost Reduction process:

• Review your practice software and determine the number or active Cigna patients in your practice. These are your patients with Cigna Dental coverage.

• Communicate with your Cigna patients. Ask the patients to reach out to their Human Resources department and tell the company that they still want to access their doctor.

• Review potential participation alternatives. At the time of this post, Cigna representatives have indicated that the plan will NOT allow access through any existing network lease arrangements.

• Offer alternatives to Cigna Dental coverage, including a low-cost in-house discount plan. The Plan should include an exam and cleaning each year with a 20 to 25% discount on the remainder of your practice’s fees.

• An accessible list of other Dental Plans accepted by the practice can also be offered as an alternative option to your patients. Reducing the practice’s dependency on the plans with the lowest fees will make the practice stronger. Market to your patients and aggressively work to keep them under your care.

• Cigna will most likely not accept a request to increase the new reduced fee schedule included in this 30-day notice. If there is any room for negotiation, it will be minimal and move the practice to the “DPPO” network. The DPPO network is a smaller portion of the overall “Advantage” network and also increases patient copays.

• Although you will receive a 30-day notice from Cigna to reduce your fees, the Cigna contract requires a 90-day notice from the practice to terminate. This will be important in coordinating care and benefits.

Did your practice receive a Cigna Fee Reduction letter and you are not sure how to react? Contact Us! We can help. Please call our office at 856-235-0020. We will work with you to develop the best response strategy for your practice.

Register for our free Practice Evaluation Today!

At Dynamic Dental Support, we specialize in the business end of dental practices. We offer administrative support and use financial analysis and strategies to assist dental practices in their operations. As a Dental Support Organization (DSO) we provide increased leverage in dealing with the Dental Insurance Plans. For over 25 years, we’ve been developing strategic growth plans for practices like yours.

You may be accepting Medicare  at your dental practice without knowing it. In recent years, most Commercial Dental Plans have added a Medicare component to their existing network. This is driving patients with Medicare coverage into otherwise commercial-only practices. The result is that the related federal requirements, as is consistent under all CMS programs, will now be imposed on your practice. These patients are coming into your practice under your commercial contracts thus subject your practice to these related federal requirements.

Participation With Medicare Through Dental Insurance Plans

Cigna Dental is now utilizing a new strategy for putting Medicare patients in to your practice. Cigna is administering a Medicare supplement under the Dental Care Access Plan. The Plan will require the practice to collect the patient copay and bill the plan for the balance. This Medicare supplement administered by Cigna will still need to follow all CMS compliancy requirements.

Participation with federal plans, such as Medicare and Medicaid, is substantially different than participation with commercial plans. We recommend considering three notable differences in network participation before accepting Medicare in your practice:

• Medicare participation has the same regulatory requirements as Medicaid. This includes Fraud, Waste and Abuse (FWA) training annually for all staff, including the dentist.

• Since federal funds are part of the payment that the practice is receiving from the Dental Plans, the processing of claims, resolution of patient issues (complaints) and chart audit requests will become routine and a standard participation requirement.

• The current plans utilize the contracted fee structure, with the majority of payments from the patients. This is different from your existing commercial plan coverages.

Medicare and Medicaid participation requires a more intensive verification of benefits. The practice administration should be adapted when accepting payments with federal funds. It is important to make sure that your practice meets the federal CMS requirements before signing an attestation that legally confirms compliance.

What if I Don’t Want To Accept Medicare In My Dental Practice?

If the dentists at your practice have completed a Federal Medicare Opt-Out, this should be honored by the Dental Plans. The commercial plans should not add the practice to its Medicare component if providers have a Federal Opt-Out in place. We recommend checking patient benefits in advance of care to confirm that Medicare coverages are not involved.

Do you have questions about your commercial contracts, CMS regulatory compliance issues, or about pursuing the Federal Medicare Opt-Out process? Please contact us at 856-235-0020 today.

Register for our free Practice Evaluation Today!

At Dynamic Dental Support, we specialize in the business end of dental practices. We offer administrative support and use financial analysis and strategies to assist dental practices in their operations. As a Dental Support Organization (DSO) we provide increased leverage in dealing with the Dental Insurance Plans. For over 25 years, we’ve been developing strategic growth plans for practices like yours.

Dental practices should avoid virtual credit card payments. Virtual Credit Cards (VCC/VCP) are another form of payment being offered to the Dental Practices by Insurance plans. Some Dental Plans have even gone as far as making it the preferred method of payment. Other Plans are using outside vendors to process payments for your practice. The payment process can be changed to VCC for practices that are not contracted with the Plans.

Here are three reasons to avoid using Virtual Credit Card payments:

1. The dental practice increases its operating costs by paying the Merchant Service fees to process payment. This cost can range from 2% to 5% depending on your Merchant Service costs.

2. Payments received as Virtual Credit Cards are not easily posted to most practice software systems.

3. Virtual Credit Card payments do not have adequate documentation for claims resolution. Determination of related patient data is not easily detailed on the VCC payment documentation.

At this point of the market rollout, a VCC payment can be easily converted to a paper check by contacting the Vendor. We do not recommend processing any payments through VCC if you want paper checks. Checks are typically promised in seven to ten days. A follow-up letter to the Dental Plan is recommended to complete the process.

We do not recommend the use of Virtual Credit Cards. The practice can always decline participation. Call us if we can help.

Let’s examine how dental plans are reducing their costs in 2018. The Dental Insurance Plans have shifted their marketing position with the stated goal of “reducing the cost of dental care”. Here are five Plan behaviors to consider in the current Dental Market:

The FIRST way dental plans are reducing their costs
Dental Plans are limiting or eliminating participation with the higher paid components of their Plans. Some of the Delta Dental arrangements are specifically limiting access to their Delta Premier network, requiring participation with the PPO plans.

The SECOND way dental plans are reducing their costs
Leased Network Arrangements create the opportunity for the Dental Plan to pay patient claims at the lowest fees possible.

The THIRD way dental plans are reducing their costs
The Dental Plans are demanding more money to be refunded, and, in some cases, are reducing future payments to the practice. The Dental Plan policies are national and may conflict with the State Dental Regulations. Dispute the refund in writing and contact your state Dental Association.

The FOURTH way dental plans are reducing their costs
The Dental Plans are reducing costs by implying that the practices must accept electronic payments, either by Electronic Funds Transfers (EFT) or Virtual Credit Cards (VCC). Please note that you do not have to participate and can decline electronic payments. If you are paid by VCC, contact the Plan or Third Party Vendor and request a paper check. Do not process the credit card payment if you do not want future VCC payments received.

The FIFTH way dental plans are reducing their costs
Medicare components are being added to most commercial Dental Plan contracts. These payments are partially governmental and therefore require additional training and policies, such as Fraud, Waste, and Abuse. Minimal payments come from the Plans. The practice can decline participation with the majority of the Medicare components of the Dental Plans. An opt-out letter can also be submitted to the Centers for Medicare and Medicaid Services (CMS).

The market changes will impact your ability to acquire a practice while maintaining the existing Dental Plan fees schedules. The practice may be required to add associates to the lower paid component of the Dental Plan. Remember that the practice has a contracted fee schedule and the doctor should be paid for patient care.

Are you impacted by the Leased Network Arrangements contained in your Dental Plan contracts? Have you contracted with the major Dental Plans that are primarily network lease arrangements? Is the practice losing credibility with patients because you cannot determine how you will be paid?

Here are some of the indicators of your practice’s participation with Dental Leased Network Arrangements:

1. The practice never contracted directly with a dental plan but the claim is paid as in-network.
2. The primary plan will confirm benefit levels but the actual fees to be paid are based on another Dental Plan’s fee schedule.
3. Claims are paid at different fee levels or randomly paid as both in and out of network.
4. Participation status varies from doctor to doctor in the same practice.
5. Patients tell your front desk that the practice is listed on their Plan’s website and you do not recognize the plan.

The impact of joining the major plans is further complicated by Leased Network Arrangements contained in your participation agreement. We will explore some ways to eliminate participation or utilize the network leases to your advantage in our next post.

Let’s look at some strategies for dealing with leased network arrangements in your dental practice. Dental Network Lease Arrangements are allowed through the practice agreements with each of the Dental Plans. Just about every Dental Plan has the ability to put the practice into another Dental network. This causes confusion in your discussion of costs with patients and can reduce your claims payment levels.

Here are three strategies for dealing with leased network arrangements:

1. The “Addition by Subtraction” Strategy: The practice can actually increase reimbursements by strategically terminating dental contracts and utilizing a lease arrangement with higher fees.

2. The practice has the ability to decline participation with network lease arrangements that are not ideal for the practice.

3. Negotiate the leased network partner’s fee schedule and decline participation with the primary Dental Plan.

Do you need help dealing with leased network arrangements in your dental practice? We are here to help. Our team will develop a plan for reducing low reimbursements by accepting smarter and more profitable Insurance Plans. Our goal is to reduce the number of plans you contract with while maximizing your collections by this selective use of the Dental Plans in your practice. That’s what we call “Addition by Subtraction”.