Maximizing Reimbursement Rates through Optimization Efforts

In their May 2018 study, Morgan Stanley revealed that solo general practices had experienced an average decrease of 6.7% in payer reimbursement rates over the previous 12 months. They also predicted an additional 2.0% drop over the next 12 months. On the other hand, the same research forecasted that group practices would see an average increase of 1.6%. This trend held true for Mortenson Dental Partners, an employee-owned DSO — we garnered a significant increase in reimbursement rates for our doctors in 2019. 

How DSOs Are Different

An individual practitioner, or even a small dental group, often does not have the resources to dedicate to the evolving landscape of dental insurance markets. On the other hand, MDP’s National Support Center features a team of industry experts who manage our relationships with insurance companies. This team handles the end-to-end contracting, participation and fee schedule negotiations with payers on behalf of our practices. They continually adapt to the ever-changing processes imposed by insurance carriers as part of our revenue optimization efforts. Through direct contracting, MDP evaluates and selects the carrier networks that generate the best reimbursement rates. Having a team who is completely dedicated to optimizing our payer relationships not only helps us achieve better reimbursement rates, but it also removes the administrative burden from our doctors, allowing them more time with their patients.

Evaluating New Payers

Before enrolling with a new payer or plan, our team evaluates several pieces of information to determine whether or not to accept it. These include:

  • Network affiliation.
  • Differentials between in-network and out-of-network benefits.
  • Fee schedules.
  • Administrative ease.

Once we are working with a payer, we regularly revisit our rates to ensure we don’t miss any opportunities to increase our fee schedules to benefit our providers. We certainly do not mandate which payers or plans our groups participate with; however, we highly encourage consistency among practices to strengthen our ability to negotiate better rates and make things easier to manage. We want all of our practices to benefit from a good plan!

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Along with better payer reimbursements, our practices enjoy a number of other benefits, including lower costs on supplies and labs, quicker insurance processing and regular maintenance and technology updates. Contact our development team to learn more.