Posting Requirement for Dental Offices Disclosing Fees

These days, it’s difficult to find health insurances and dental plans that cover the number of services at the reasonable fees they used to. Because of less coverage and higher deductibles, consumers have been pushing for more transparency from their healthcare providers, including their dentists. This year, the Colorado state legislature has passed Senate Bill 65. This bill will require all healthcare providers to make available a list of cash pay fees for their top 15 services and procedures. Not only are dentists specifically mentioned, but dental hygienists are as well. Starting January 1st, 2018, all Colorado dental offices must comply with the new fee disclosure requirements.

These requirements include providing your patients with a single document listing the fees for at least the 15 most common dental services provided in your office. This information needs to be accessible electronically or on your website and should be updated at least once every year. If your dental practice consists of less than six identical licensed providers (including both dentists and dental hygienists), you have the option of posting the fee list in the patient waiting room instead of electronically. As long as fees do not vary substantially between providers in a dental practice who practice under a single tax ID number, fees may be posted in aggregate for the practice as a whole.

Senate Bill 65 - What Colorado Dentists Need to Do

Below are a few things that you need to do to begin to comply with Senate Bill 65:

• Identify the 15 most common codes that your office bills for. Use the past 12 months as a reference and utilize your practice management software or a review of your billing statements for the last year to find these codes.
• Once you’ve identified your top 15 codes, calculate the cash-pay and non-discounted fees for each one.
• Put together a single document that plainly lists each of the 15 codes and the associated cash-pay fee for each one. Please make sure that a code description is required in plain-English so that your patients understand.
• Post the document in a prominent place on your website or have it available in your patient waiting room, depending on how many licensed providers are in your dental office.
• Lastly, make sure the document is updated at least once yearly.

Determining Cash-Pay Prices

The cash pay fee that you’ll need to determine includes all of your services that are exclusively self-pay, as well as those procedures that insurance will not cover. Cash-pay fees are to include the amount that your office charges to patients who have insurance that won’t cover the services they need.

If your office is one that already regularly maintains a schedule of usual and customary billing rates (also known as UCR), and tracks the top 15 codes used frequently in your office, it won’t be difficult for you to comply with the new requirements. All you’ll need to do is make a list of the 15 codes, use plain-English to describe each code, and list the fees associated with each. If your office provides self-pay discounts or promotions, make sure to exclude these reductions from the fees list. This is because the law is intended to disclose the fees prior to the appliance of discounts.

If your office does not already maintain the above schedule of usual and customary billing rates, you may need to start from scratch. First, sort your data to identify the top 15 codes. Once this is done, narrow this list down to include cash-pay patients by eliminating any procedures covered by a third-party or reduced because of a discount. This should leave you with a list of the cash-pay services provided by your dental office. Sort your list by using the CDT code and identify the exact fee for each of the 15 procedures. You can sort these by using any of the following methods:

• Determine which fee has been charged most frequently during the prior 12 months.
• Pick the highest fee from the lower half of all fees during the prior 12 months.
• List the range including the middle 50% of all fees during the prior 12 months (25-75th percentile range).
  (*Note: Using a range of fees is the recommended methodology if you are in a dental practice where fees among providers vary substantially enough that posting a single fee might be considered misleading to a patient.)

Keep in mind that your office isn’t required to disclose how the disclosed fee was calculated. You are not obligated to report fees for review and there is no agency that can approve, disapprove, or limit the fees you set. Insurers cannot use the information required in Senate Bill 65 to their financial advantage when contracting negotiations.

If your dental office offers less than 15 services, you only need to disclose the fees for the number of services that you do offer in your dental practice.

Language Used in the Disclosure

As a part of the fee disclosure list, certain langue is required in order to indicate that the fees listed on the document are not a guarantee of cost to any individual. We recommend writing the following statement, or one quite similar to your fee list:

“These health care prices are estimates. Actual charges for the dental treatment you receive depend upon your individual circumstances, including any complications that may arise, or exceptional treatment at the time of service.

If you are covered by health insurance or a dental plan, we encourage you to consult with your insurer to discover the accurate information regarding your financial responsibility for a particular dental service provided by a health care provider at our office. If you do not have health insurance or a dental plan, please contact our billing office [insert telephone number] to discuss your payment options before you receive your dental treatment. Again, the posted health care prices may not reflect the actual amount of your individual financial responsibilities.”

Because there is currently no regulatory or enforcement agency that is responsible for the interpretation of Senate Bill 65, this complicates the implementation of the law.