Billed and Paid Amounts for Preventive Dental Procedures in Wisconsin Medicaid

Objectives: To examine the trends and variations in billed and paid amounts for preventive dental procedures by race, age and gender in Wisconsin Dental Medicaid
Methods: We analyzed data from the Wisconsin Medicaid claims database from 2001-2013 for preventive dental procedures for children and adults. Billed and paid amounts were aggregated over a visit and adjusted for inflation based on the medical care consumer price index produced by the Bureau of Labor Statistics. Quantile regression was used to examine the trends over time and the effect of patient demographics.
Results: The overall 50^th and 75^th percentile of the billed amount were $84.97 and $105.53, and the paid amount were $35.80 and $41.66. The billed amounts showed slight increases at the 50th and 75th percentiles with a more pronounced increase at the 90^th, 95^th and 97.5^th percentiles for preventive dental services over time. There was a $2.24 (95% CI $2.22-$2.26) increase per year in the 75^th percentile of the billed amount which reflects a $26.88 (95% CI $26.61-$27.15) increase from 2001 to 2013. At the same time there was a $1.34 (95% CI $1.34-$1.34) decrease per year in the 75^th percentiles of the paid amount per year for an overall $16.07 (95% CI $16.04-$16.11) decrease from 2001 to 2013. As a result, the percentage of the billed amount that was paid decreased 1.98% (95% CI: 1.97%-1.99%) per year or 23.7% (95% CI: 23.6%-23.8%) overall. Racial/ethnic variability in the 75th percentile of billed and paid amounts per visit was low, with $1-$3 lower values for whites as compared to racial/ethnic minorities. In terms of the billed/paid ratio, American Indians had the lowest value at 47.7% compared to 50.0%-51.6% for whites, African Americans and Hispanic patients. In addition, higher billed and paid amount were found in children age 10-19 years old. The 75th percentiles of the billed and paid amount for children 10-19 years old were significantly higher ($26.73 for billed and $9.92 for paid) than for adult from 20-69 years old.

Conclusions: We found that the billed amount increased over time, while the paid amount decreased after adjustment for inflation. Policy makers and payers should look into closing the increasing gap identified between billed and paid amounts to help improve access to dental care and reduce disparities in Medicaid enrollees