toothmagic

2+ Year Member
Oct 1, 2017
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Okay, I am going to try to make this post short, thank you for answering...

To make a story short, I have a friend. He is an international dentist and got his license last year. So he is not very familiar with payments and stuff. So he started working as an associate, The contract says VERBATIM, "3000 for the first 3 months, biweekly... then 25% of the collection". I told him to get a lawyer, but he said it was too expensive. OKAY... So he made the 3k, and then COVID happened just when he started to collect, He got paid during the quarantined these amount, which wasn't as much like ~2800 So after COVID, the owner was like, okay 3k until you start collecting again, b/c he moved him to a new practice. At first, they praised him "oh the first time this practice has produced that much bla bla.." He works alone w/ 1 hygienist.
He kept asking when he would start collecting. So almost 4 months later. NOW is that he was starting to collect. His production daily is no less than 3500 a day, somedays even 6k. His paycheck from the collection came out clean 2800k or something. The owner says he is not making enough! Even saying the hygienist produces more...And, he asked how much he had to do daily to see more money, they told him 8k daily! He was shocked. Also, he is just given a simple paycheck, the collection amount x % no included, and he asked for it, it was given to him in a piece of white paper like just a simple word doc, his name, the collection amount x the % - lab fees, divide by 2, so paying biweekly. I told him to check the amount on the computer but he doesn't know-how.
The office is not open FRIDAY AND sees many Medicaid patients though, so he might be not getting paid for it... I dunno.
 

dentistrydmd

5+ Year Member
May 18, 2014
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With medicaid I don't see how he could be billing that much. What kind of procedures is he doing? Also keep in mind Medicaid doesn't pay well, so with PPE and overhead costs the profit margins are small for the procedures, so maybe that's why the owner is saying 8k.
 
Jul 22, 2020
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Hello toothmagic,

The short answer to your question- Yes, he's being ripped off...No associate dentist should be subjected to such unethical business practices.

Few things to ponder over:

1. Daily production of $8K should compensate the associate around $16-18K (depending on the office's collection rate 90-100%; and assuming 10% lab expense)

- $3500 production on the dentist's side is not bad at all in a Medicaid setting. With another 30-40% hygiene production, the owner dentist has enough to cherish above and beyond good things in life.

- In reality, a Medicaid practice generating $8K/day on the dentist's side (General Dentist) is most likely engaged in upcoding and/or overtreatment. I think even specialists will find that number very hard to reach.

- The worst-case scenario is that the associate gets entangled in making his personal-financial ends meet by upcoding/overtreating.

- Medicaid fraud gets you jail time, (unlike private insurances where you will be likely debarred but not put behind bars).

2. 25% collection is too low. Associate dentists are the work-horses in any dental office and not donkeys. Workhorses should be compensated fairly- and the carrot stick tactic should be frowned upon.

- Minimum fair compensation is 28-30% production or 33-35% collections in the US and should be non-negotiable. 4-5% tuition increase every year, inflation, and stagnant dental patient fee increase will push new dentists to financial misery.

- If you find a great super GP mentor that is academically & clinically very strong and humble (highly unlikely these days), I would even take a 20% compensation on collection but chances are that mentor will likely offer a 33% collection instead.

3. Good practice in a good running practice is to print or view the end of day report and cross-check billing codes, procedures, patients seen, etc. This report also has a daily production and collections $$$ on it.

Dentistry has become the epitome of bad, bad business practices- high staff overheads, high fancy overheads, sub-par marketing, sub-par dental care...None of the above should be compensated by low associate compensation.


DrDentMP
 
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Molar Whisperer

Formerly drcobad
Apr 13, 2020
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- $3500 production on the dentist's side is not bad at all in a Medicaid setting. With another 30-40% hygiene production, the owner dentist has enough to cherish above and beyond good things in life.

- In reality, a Medicaid practice generating $8K/day on the dentist's side (General Dentist) is most likely engaged in upcoding and/or overtreatment. I think even specialists will find that number very hard to reach.

- The worst-case scenario is that the associate gets entangled in making his personal-financial ends meet by upcoding/overtreating.

- Medicaid fraud gets you jail time, (unlike private insurances where you will be likely debarred but not put behind bars).

I worked on an attorney who prosecuted Medicaid Fraud about 12 yrs ago. I had to do multiple RCTs on him because I was doing referral endos. I was prepared for Murphy's law such as broken files, perforation, missed canals, severe post-op pain, etc. He asked me my take on the difference between simple vs surgical extractions. Medicaid Fraud is very real with resources to investigate.

My DMO clinics would do State Medicaid capitation. The DMO will get paid by number of recipients as opposed to procedures. Molar RCTs aren't covered unless the patient is under 19 y/o. The Medicaid fee for a covered molar endo was $176...woohoo!!! Because of the capitation system, we were still getting paid during the Covid closures.
 

Molar Whisperer

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Many private offices don't accept Medicaid. Only the big DMOs have the capacity to take capitation. For capitation to be somewhat lucrative, it must be high volume. I don't know the exact no show rates but capitation pays regardless if the member shows up or not. I think it can be more profitable than discounted PPOs where the ins carrier will only pay you about 40% of the fees. Capitation usually leads to undertreatment. For big DMOs, they usually find someone like me to do those undesirable molar RCTs and pay me more obviously.
 
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