Dental PPO Write-Offs by Plan: Which Plan Pays the Least per Chair Hour?

Why one write-off total hides the plan

A single write-off figure answers “how much did contracts cost us this month?” and nothing else. It cannot show that one plan’s fee schedule sits far below another’s, that one carrier’s patients fill long appointments while another’s fill short ones, or that part of the total is not contractual at all.

The setup inside the practice management system decides what can be seen later. In Open Dental, “write-offs are only tracked for insurance plans that use the PPO Percentage or PPO Fixed Benefit plan type.” A plan set up the simpler way — as a Category Percentage plan carrying the carrier’s fees — “doesn’t track write-offs,” and the manual marks that option “not recommended”: it bills the carrier’s fees directly, so the gap between the office fee and the contracted fee never appears on any report. Whatever the software, the questions are the same: is each plan’s fee schedule attached to the plan, and is each write-off posted under a type that says what it is?

• Every PPO plan uses a plan type that records write-offs, with the carrier’s current fee schedule attached.
• Adjustment types are separate for contractual write-offs, denials, downgrades, courtesies and small balances.
• Remittances that arrive short of the claims they list — a payer recovering an earlier payment from a later check — are traced to the remittance detail and posted as what they are.

How to run dental PPO write-offs by carrier

In Open Dental, the PPO Write-offs report sits in Standard Reports, in the Monthly section. It lists standard fees, PPO fees and write-off amounts, and it groups them two ways: Individual Claims, which includes patient names, or Group by Carrier, which shows totals by carrier. Its date range defaults to the last calendar month; for a decision about a contract, run twelve months.

Choose the write-off date setting on purpose. Posting write-offs on the procedure date puts each reduction in the month the dentistry was done; posting on the insurance payment date can move it months later. For a by-plan comparison over a year, either works, as long as the same setting is used every time the table is rebuilt. The manual also notes that this report’s standard-fee total “may not match” the Production and Income report when procedures are billed to more than one PPO plan — expected, not an error.

The carrier-level view carries no patient names, which keeps a first look — inside the practice or by anyone outside it — to aggregate numbers. HIPAA’s minimum-necessary standard, 45 CFR 164.502(b), asks for limiting protected health information to “the minimum necessary to accomplish the intended purpose.” Whether any outside reviewer needs a business associate agreement is a question for the practice’s compliance officer or attorney.

Set write-offs against chair hours

A write-off percentage ranks plans by how far their fees sit below the office fee. It does not rank them by what they pay for the practice’s scarcest resource: an hour in a chair. For that, each plan needs one more column — the chair hours its patients used.

In Open Dental, the Appointments report lists each appointment’s length in minutes. Joining appointment length to each patient’s primary carrier happens inside the practice, by the office manager or with a saved query; only the totals by carrier ever need to leave the building. Then, per plan: gross production, write-offs, net fee (gross minus write-offs), write-off percentage, chair hours, and net fee per chair hour.

• Illustrative example, twelve months. Plan A: $300,000 produced, $120,000 written off (40%), $180,000 net, 900 chair hours — $200 an hour.
• Plan B: $250,000 produced, $50,000 written off (20%), $200,000 net, 800 chair hours — $250 an hour.
• Plan C: $150,000 produced, $45,000 written off (30%), $105,000 net, 700 chair hours — $150 an hour.

Ranked by write-off percentage, Plan A looks worst. Ranked by what an hour of chair time earns, Plan C pays the least, because its patients use long appointments for modest fees. Set those rates beside the practice’s own cost per chair hour — total operating cost from the CPA’s statement divided by the chair hours the schedule offered — and the question for the owner becomes concrete.

What the table can decide, and what it cannot

The table shows which plan pays least per hour. It does not decide whether to leave that plan. A plan that pays less than the practice’s average cost per hour can still cover more than the extra cost of each visit if those hours would otherwise sit empty; a plan that fills hours other patients would take is a different case. Which one is true lives in the schedule — open hygiene and doctor time, and how far out the next opening is.

Contracts carry their own terms. A practice’s fee schedule can reach patients of plans it never signed with directly when a network leases access to its contracts. Virginia, for one, bars a contracting entity from leasing that access unless the provider contract “explicitly states” it is permitted and the affected dentists are notified; rules differ by state. Before acting on the table — renegotiating, declining a leased network, or leaving a plan — read the contract with the practice’s attorney. The arithmetic belongs to the owner; the contract language belongs to counsel.

How do I negotiate PPO fee schedules for my dental office?

Negotiate one plan at a time, and bring that plan’s own numbers: what it pays on the procedure codes that carry its volume, what the practice is asking for on those codes, the chair hours its patients use, and what the practice will do if the answer is no. The by-plan table above supplies the chair hours and the net fee per hour; the practice management system supplies the codes and fees. A request built that way gives the carrier specific numbers to answer instead of a general ask for higher fees.

Start from the codes, not the write-off percentage. In Open Dental, where the office’s UCR fees and each carrier’s fees sit in separate fee schedules, the Procedure Codes - Fee Schedules report prints or exports the fees on one selected schedule at a time; print the plan’s and the office’s. Then count the times each code was done under that plan in the last twelve months, with a saved query or a procedure report, and put the highest-volume codes in a short table. For example, a practice that did 1,200 adult cleanings under one plan last year and asks for $8 more per cleaning is asking for $9,600 a year on that code alone; every number in that example is hypothetical.

Set the walk-away before the call, using the test in the section above — whether the plan’s hours would otherwise fill or sit empty — and make that decision without other practices. The FTC’s price-fixing guidance says the antitrust laws generally require each company to “establish prices and other competitive terms on its own,” and it describes competing optometrists who agreed to stay out of a vision care network until it raised reimbursement rates, an agreement the FTC said was illegal price fixing. Before sending a counteroffer or a termination notice, have the practice’s attorney read the contract’s amendment, termination and notice terms. Not legal advice.

• The plan’s current fee schedule and the office’s own, printed or exported from the practice management system, plus the contract with its amendment and termination clauses.
• The highest-volume codes under that plan: office fee, current plan fee, fee asked for, twelve-month count and the dollar difference.
• That plan’s row from the by-plan table: net fee per chair hour beside the practice’s cost per chair hour, and the date of the next open hygiene and doctor hour.
• One owner’s decision on what to ask for and whether to leave, with no agreement or coordination with other practices.

When this is not worth anyone’s fee

A practice that is mostly fee-for-service, or in network with one or two plans, can build this table itself and needs no outside help. So can any office manager comfortable with the reports above. If the write-off report already runs by carrier, adjustment types are clean and the owner reviews the table once a year before contracts renew, the work is done.

Outside help earns its fee when the numbers will not reconcile — when write-offs, denials and courtesies sit in one adjustment type, when plans are set up so write-offs never record, or when the by-plan question is one of several leaks at once. The free Revenue Leak Calculator gives a rough first figure for the whole practice in a few minutes, with no email gate.

Where the Revenue Review fits

The Revenue Review builds this table for twelve months and puts it beside the rest of the practice’s money: production against collections, claims never sent, insurance aging, unscheduled treatment, recall and the phones. It takes two weeks and works from read-only access to the practice’s own reports, starting with aggregate reports that carry no patient names, and it ends in a written report the practice keeps: each leak with a monthly dollar figure wherever the records support one, a ranked list of what to fix, and a 90-day plan.

It does not negotiate fee schedules, give legal advice on contracts or make clinical judgments, and it never takes a share of production or collections. It is built for owner-led practices with $2 million or more in annual collections and two or more doctors or locations. The next step is a free 20-minute call, where a practice that does not need the Review is told so.