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Key Points
- The major sources of patient
care revenue for clinics are public programs, private pay, and
commercial insurance.
- The two key pieces of information
needed to predict patient care revenue for each payer source are
(1) number of patient visits and (2) average reimbursement per patient
visit.
- Several factors affect patient
care revenue, including patient scheduling, broken appointments, efficiency
of the dental team, the billing and collection system, fees, and the
payer mix.
- The two steps to determining
patient charges are (1) establishing a non-discounted (full) fee
schedule and (2) developing a sliding fee schedule of percentage
discounts.
- Clinics can increase patient
revenue by increasing the proportion of patients for whom they receive
higher reimbursement. However, some clinics consider this type of
practice inconsistent with their mission.
- There are at least two approaches
to using sliding fee schedules: (1) totaling the full fees, multiplying
by the discount factor, and subtracting to determine charges to the
patient and (2) establishing multiple lists of fees-per-service and
determining patient charges by adding the services provided from the
appropriate fee schedule.
- The Internet is the best source of information
about states’ Medicaid and SCHIP programs. Ohio
Safety Net Dental Clinics provides
direct links to information about the Ohio Medicaid/SCHIP program.
- A clinic looking at entering into a contract
must consider the impact of a contract on its payer mix and revenue projections
as well as how entering into the contract relates to the clinic’s
mission and goals.
- The two major sources of non-patient
care revenue are grants and fundraising.
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