Dental Sleep Medicine Insider September 2017 | Page 16

DON’T OVERLOOK
THE IMPORTANCE OF
SETTING YOUR FEES
I’m often asked, “What should I
charge for an oral appliance?”
It is a question your office has
probably contemplated and is
a very important decision that
should not go overlooked. Devel-
oping a random figure or asking
a friend may not be your best
bet. Avoid relying on your billing
company to set your fees as this
can be considered unethical and
lead to unexpected problems. So
then, how should you come up
with fees?
You’ve probably heard the term
“usual, customary and reason-
able (UCR)”. It is used in health-
care when providers set charges
for services and health plans
set their fees. The term lends
insight into how you should
consider establishing, applying,
and updating charges for each
dental sleep service your office
provides. I would recommend
adding the word “consistent” to
be mindful of insurance con-
tracts, Medicare policies, and
regulations from your state’s
Attorney General that apply to
your practice. Do I have your
attention now?
The fee schedule is an internal
office policy that dictates an
exact amount charged for each
service (defined by a unique CPT
code) and applied consistently
for every patient, unless there is
documented financial hardship.
Here are some factors that you
should consider:
Know the range of allow-
able amounts for each
specific CPT code(s) across all
the health plans to whom you
submit claims.
Use health plan fees only
as a reference and be sure
your fees are set above the in-
surer with the highest allowed
amount; It is particularly import-
ant to set your fees above the
Medicare allowed amount.
Be knowledgeable about
your geographic location
and what may be a customary
charge for a particular service;
an unreasonably low or high fee
may throw up a red flag with
payers.
JEFF BURTON
panorex).
Identify ALL expenses
(materials, lab, equipment),
labor (dentist & staff time) and
liability (malpractice premiums,
legal compliance, licensure/cer-
tifications) to account for your
total cost of providing a service.
Setting your fees is only the first
step. Applying them consistently
and evaluating them on a reg-
ular basis is just as important.
Taking these factors into consid-
eration may help minimize your
financial and legal risk while
ensuring practice profitability.
Don’t carry multiple
charges for a custom, ad-
justable oral appliance (E0486)
based on the type of device –
pick one fee (you are a medical
provider, not a retail clinic).
Put as much attention into
setting appropriate fees for
radiographs and exams as you
do the oral appliance, these are
billable services.
Consider fees that your of-
fice has already established
for a similar dental service (i.e.
JEFF BURTON
Owner of Lyon Dental Sleep
Services, a Michigan-based
company that provides crit-
ical resources and services
to dental sleep specialists
across the country.