Will the Affordable Care Act Impact Your Dental Practice?

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For the most part, the Affordable Care Act has flown under the radar of many dental professionals. Yet the reality is that “Obamacare” includes provisions that will impact the dental profession. Make time now to bone up on the ACA’s potential impact to your practice’s bottom line.

Anticipate More Coverage

Under the ACA, pediatric oral care benefits are considered to be “essential health benefits” that must be covered by all insurance policies, whether purchased through the insurance exchange or not.

Each state determines what will be covered as part of essential health benefits. In Colorado, for example, all children ages 0 to 18 years must have dental coverage through the purchase of a pediatric dental benefit, or by enrolling in Child Health Plan Plus (CHP+) or Medicaid. Currently, the Colorado health insurance exchange offers 14 dental plans through five carriers.

Note that dental benefits can be purchased as a “stand-alone” dental plan or through a dental plan that is “embedded” into the general medical coverage. This means that your office administrator and billing staff will need to learn how to file claims for dental coverage embedded within a general medical insurance policy.

Expect More Patients

Plain and simple, the Affordable Care Act will increase the number of patients who are eligible for dental services. According to the American Dental Association, expansion of dental benefits under the ACA (including Medicaid expansion) will generate some 11 million pediatric dental visits and 1.7 million adult dental visits.

This means you’ll need to gear up for two distinct challenges:

  1. An influx of younger patients.
  2. An influx of Medicaid patients.

Don’t fear Medicaid

Many dentists find that there are far fewer administrative issues and fewer disputes over payment when working with Medicaid than with private insurance providers. According to Colorado’s Cavity Free at Three initiative, the state is considered to be one of the best for doing business with the Medicaid population. The state is responsive to concerns, reimburses for services quickly, and doesn’t require a lot of wait time for prior authorizations.

Preparing for the Financial Impact

Dental practices would be well served to perform a financial analysis of the ACA’s impact on their bottom line. That would include determining if accepting this new crop of dental patients makes financial sense — as well as deciding how many new patients to accept if it does.

For example, dental practices that are used to collecting at the time of service will need to adjust to the often-lengthy claims process. They will also incur costs to hire or train staff who are experienced in filing medical claims. (Filing a “clean claim” can mean the difference between a profitable visit and one that drains the bottom line.)

Dentists also need to keep in mind that the new 2.3 percent medical device excise tax imposed by the ACA may well drive up their costs. The tax is imposed on the manufacturers of medical devices, yet many believe that these costs will be passed down to the dentist and eventually the patients they serve.

Hang on for the Ride

According to the ADA, the Affordable Care Act may increase dental spending by $4 billion, with the largest effect seen in the Medicaid population. Ultimately, practices that are prepared to handle these newly insured patients could benefit. Please feel free to contact our office for assistance with performing a financial forecast to understand how the Affordable Care Act could affect your practice.

SKR+CO Expert
DR Admin