Your fee schedule is the foundation of your practice's revenue, yet most dental practices haven't audited theirs in three years. Stale fees and un-negotiated PPO contracts can quietly cost you 8–15% of collections—a six-figure leak in a $1.5M+ practice. The good news: a structured audit can recover that revenue without seeing a single new patient.
Which of the following is a key step in auditing your dental fee schedule?
Select one answer.
Why fee schedules go stale
Fee schedules drift out of date for several reasons. Practices add new procedures without setting appropriate fees, obsolete CDT codes linger, and procedure code revisions change the scope of work without a corresponding fee adjustment. Meanwhile, inflation, staffing, and supply costs rise. If your fees haven't changed in years, you're effectively earning less for the same work.
Outdated fees result in an estimated 5–12% loss in gross revenue, according to Next Level Consultants. That's money you've already earned but never collect.
Step 1: Pull your current fee schedule and contracts
Start by exporting your full fee schedule from your practice management software. Then gather every signed PPO contract and the negotiated fee schedule for each carrier. You need these documents to know what each payer agreed to pay. Save both the contract and the fee schedule for each in-network carrier, as recommended by Dental Insurance Guy.
Step 2: Benchmark against UCR and market rates
Compare your office fees to Usual, Customary, and Reasonable (UCR) rates for your zip code and specialty. UCR is the fee schedule insurance companies apply to out-of-network claims, and it's often derived from an average of submitted fees. If your office fees equal UCR, you're likely below market average—raise them. Use resources like Fair Health Consumer for unbiased fee comparisons.
Step 3: Audit EOBs against contracted rates
A payment audit compares three data points for every claim: your submitted fee, your contracted rate, and the actual payment received. When the payment is less than the contracted rate, that's an underpayment. Pull last month's EOBs for each carrier, match each procedure code to your contracted fee schedule, and flag any discrepancies, as outlined in this guide from SPS Dental Academy.
Underpayments are insidious because the claim appears closed. In a beta validation across 2,399 real claims, Elite Dental Force found $59,000 in underpayments at a single practice, with 27% of all audited claims underpaid.
Step 4: Identify write-offs vs. adjustments
Most practices conflate adjustments and write-offs. An adjustment is a contractual discount; a write-off is money you'll never collect. Mislabeling adjustments as write-offs hides the true cost of your PPO contracts. Separate them to see where you're giving away free dentistry.
Step 5: Renegotiate or drop underperforming PPO contracts
Most PPO contracts auto-renew with the same reimbursement schedule for years. Carriers expect you not to push back. Practices that do negotiate routinely see 6–12% reimbursement improvements, according to Practice Management Systems.
Request a fee review 60–90 days before your contract renewal date. Build a case with your claims data showing volume and the gap between your fees and the carrier's rates. If a plan represents less than 2% of your revenue and demands deep discounts, consider dropping it.
Step 6: Update your fee schedule and set a review cadence
Remove deleted CDT codes, add new ones, and adjust fees for procedure revisions. Benchmark against market surveys. Then set a reminder to audit your fee schedule every 18–24 months at minimum—not every five years.
Your fee audit checklist
- Export current fee schedule from PMS
- Gather all PPO contracts and negotiated fee schedules
- Benchmark office fees against UCR for your zip code
- Pull last month's EOBs for each carrier
- Match each procedure code to contracted rates
- Flag and pursue underpayments
- Separate adjustments from write-offs
- Identify PPO contracts to renegotiate or drop
- Update fees for new, deleted, and revised CDT codes
- Schedule next audit in 18–24 months
Quiz: Test your knowledge
Which of the following is a key step in auditing your dental fee schedule?
- A. Comparing actual insurance payments to contracted rates
- B. Increasing fees for all procedures by 20%
- C. Dropping all PPO contracts immediately
Correct answer: A. Comparing actual payments to contracted rates is the core of a payment audit, as it reveals underpayments.
How the Featured Expert Can Help
Tonya Brock, a fractional dental operations partner, helps practice owners reclaim time and improve efficiency. Her focus on unscheduled treatment and practice management solutions can streamline your operations, including fee schedule audits. Visit About Tonya Brock | Fractional Dental Operations Expert to learn more.