HSPA Health Check

Question 1

How does the HSPA work?

Answer 1

-Uses data from your practice management software and understanding your standards of care, we uncover opportunities for your practice with the HSPA

Question 2

What is the Average PPO percent discount of a docs full-fee schedule?

Answer 2

25-30%

Question 3

What is the HSPA?

Answer 3

• Standard of care vs. actual
• Benchmarking
• Opportunity Action Plan

Question 4

what are the 3 main parts of the HSPA Pitch?

Answer 4

• Fees
• Coding
• Hygiene

Question 5

What do I need for a HSPA?

Answer 5

• Fee Schedule (Print or Excel file)
• Active Patient Count - Last 2 years (don’t print just need #)
• Quantity by procedure report last 12 months (AKA procedure count)
• Need to ask: How often should your patients receive a PAN or FMX

Question 6

Before trying to provide a solution during the practice analysis ask these questions

Answer 6

1. What do you think is going on?
2. Has it always been this way?
3. What would you do to fix it?

Question 7

What is the 5 step process to present the Fee Comparision?

Answer 7

1. Make doctor aware this is the most robust fee analysis on the planet (Dentrix clearinghouse processes 1 billion claims/year)
2. Ask doctor percentage of each type of insurance they accept
3. Make it clear that despite being a largely insurance-based practice, balancing fees is extremely important for both automatic increases and negotiating with PPOsEven if they’re mostly fee-for-service,
4. Point out the docs numbers and compare them
5. 62% of their patients should still have some form of dental insurance Recommend a consultation with Unitas to negotiate for higher reimbursement with PPO contracts (can also set up an in-office dental plan)
   For Fee-for-service practices, raising preventative fees to the 70th percentile is a no-brainer since most PPOs cover preventative 100% up to the 70th percentile of the fee schedule•Recommend raising fees to 60th percentile at minimum, 70thpercentile is ideal•If they have a lot of fee-for-service patients, advise them not to raise any individual fee more than 10% or make an in-office dental plan•If they’re insurance-based, there’s no reason not to raise up to 70th percentile (allows them to negotiate)

Question 8

How to calculate Average patient value?

Answer 8

Total gross production / #active patients = ave. patient value

Question 9

The average patient value should be?

Answer 9

$750 annually

Question 10

For every dollar produced in hygiene how much is produced in restorative

Answer 10

$3

Question 11

How do you calculate Hygiene Retention Rate

Answer 11

1. Adult Prophy (D1110) + Child Prophy (D1120) = X
2. X / 2 = # of Hygiene Patients
3. Perio Maintenance (D4910) / 4 = Perio Patients
4. # of hygiene patents + # of Perio patients = Active hygiene patients
5. # hygiene patients / # active patient count = hygiene retention rate.

Question 12

What is the ideal hygiene retention rate

Answer 12

80%

Question 13

What are the 5 steps to increase the hygiene retention rate?

Answer 13

1. The hygienist should make all recare appointments in the operatory before the doctor comes in for the exam
2. The office should have an automated appointment reminder system that sends out reminders and confirmations one month, one week, and one day, and one hour before the appointment
3. The hygienist should track their re-booking rate. What gets measured gets results. Having the hygienist collect data on their success rate will hold them accountable and keep them aware of opportunities for improvement
4. The office should have a change of appointment policy that is clearly expressed and enforced with each patient
5. Have verbiage ready for patients who call to cancel appointments

Question 14

New Patient Exam D0150 vs. D0120

Answer 14

healthy offices see 25-30 monthly new patients per doctor to combat attrition. If your D0150 counts are low, you may be coding D0120 too often. Comprehensive exams on new patients or existing patients with a significant health change or who have been absent from the office for at least three years should be coded as D0150.

Question 15

Emergency Visits D0140 vs. D9110

Answer 15

Do you have high emergency evaluation (D0140) counts while your palliative (D9110) are low? While D0140 can always be reported at an ER visit, it remains subject to the “two evaluations per year” rule, meaning it’s using up an exam. Using the D9110 doesn’t use up an exam and typically has a higher UCR than D0140

Question 16

What 3 things must occur to use D9110

Answer 16

1. The patient must be in pain or discomfort
2. Some form of wet finger dentistry bust be done
3. The dentistry done cannot be the final treatment or the start of final treatment

Question 17

Info on Pallative-D9110

Answer 17

• One of the least reported codes
• Can’t report any other treatment on same visit date with most plans besides X-Rays
• Some plans limit the frequency of D9110 to 2 or 3 times per year
• Always use the narrative
• Auto Rejection of this code if you do not provide a narrative (50% of the time)

Question 18

Info on Single Fim Bitewings D0270

Answer 18

Bitewing-sing film (D0270) counts, it should be close to zero. If the count is high, you might be using D0270 for ER visits, which uses up the annual 4BWX coverage! Instead, consider two PAs at the ER visit, which are almost always clinically justified and paid! Or, when a patient comes in for an ER visit, check if they’re due for their 4 bitewings and take them at that time.

Question 19

What is the most miscoded dental treatment?

Answer 19

Perio

Question 20

Info on Periodontal New patient D0180

Answer 20

Higher UCR than D0150 and D0120. Using D0180 the first time you see a new perio patient introduces them into your perio program. Also, you’re entitled to bill a D0150 on their next eligible exam.