The overall goal of this organizational effectiveness study was to identify areas that were limiting the FQHC’s capacity, and to use the findings to discover capacity-building strategies that would potentially increase profitability. The study’s three objectives were to 1) identify the dental codes most frequently used by the dental entities of the League, 2) highlight best practices, trends, and common coding errors, and 3) offer recommendations based on best practices that the League can use to benchmark dental billing across its centers.
According to the Health Resources and Services Administration, about 108 million people in the U.S. have no dental insurance. Even those who are covered may have trouble getting care. Safety-net oral health programs such as those in federally qualified health center (FQHC) settings have sought to address these access issues. However, fulfilling this mission comes with a unique set of internal and external challenges. To build organizational capacity, FQHC dental sites need both adequate resources and efficient systems to enable them to deliver care.
Established in 1972, the Massachusetts League of Community Health Centers ("the League") is a non-profit, statewide association representing and serving the needs of the state's 49 community health center organizations. The League addresses common concerns of medically underserved areas across the state. Thirty-one of these centers provide dental care. Issues affecting the financial success of safety-net dental sites are multi-faceted, and the League identified its billing and coding discrepancies as its area of focus for this study.
The study had both quantitative and qualitative components. For the quantitative
segment, 135 CDT billing codes used by the League were inputted into a Microsoft Excel spreadsheet template and sent to dental directors. Third quarter billing data for 2014 were reported for each code. Responses were obtained from all 31 of the dental sites providing a response rate of 100%. In addition, a dental director survey was created based on the data reported to assess the insurance and billing training needs of the sites. Qualitatively, an interview and facility tour were later conducted with a site director to get a first-hand explanation of billing practices.
Received data were reviewed and interpreted, and observations were recorded. Outliers were identified. After the initial data review, the League requested that the 20 most billed codes be identified and data for each of these 20 codes be graphically depicted for reporting. Variations in billing and coding within the League were identified, and an anonymized report detailing these variations along with a recommendation of best practices was sent to each dental director. The report also provided the League with an instrument to benchmark dental billing across its centers.
It is anticipated that the results of this study may ultimately affect the internal policy within the organization and lead to a more standardized billing practice, which could yield increased capacity and profitability. From the findings, the League may also seek to advocate for higher reimbursements from Mass Health, the state’s Medicaid program.
Shannon Wells, Oral Health Affairs Manager
Massachusetts League of Community Health Centers