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Steps to Implementing Standard Operating Procedures (SOPs)

Whether in writing or digital format, Standard Operating Procedures (SOPs) should be utilized as a part of your personnel management process now more than ever dealing with a post-pandemic labor force. They are not just policies to be followed in the dental practice; they are the actual steps to be followed consistently to accomplish certain tasks in the dental office. SOPs are a repetitive set of actions to be followed by all dental personnel in order to:

  • increase performance
  • improve efficiency
  • reduce or eliminate confusion
  • to ensure the quality of services performed.

Implementing SOPs provides consistency of service to dental patients and protects the dental office in an ever-changing environment. They are a visible support on display for your team members. The creation of SOPs clearly communicates the dentist’s expectations. So the dentist does not have to continually state over and over what is expected from each team member. SOPs also provide a virtual means of training new hires in the dental office. This includes the training of those new employees with little or no dental work experience. They also can be used as a review in team meetings to coach employees. Through teamwork, your missions will be accomplished.

Benefits of Standard Operating Procedures

The first objective of the SOP is to identify or summarize a certain task that must be performed. It must describe the purpose of the task and when, where, how and by whom it must be performed, while at the same time, define any uncommon or specialized terms so the steps can be clearly understood by the dental associate performing the task. The SOP must also address concerns with necessary equipment, supplies or any health and safety precautions. They describe in detail through the implementation of charts,tables, pictures or diagrams each step to confirm the correct procedures are being performed accurately.

The many benefits of established SOPs in the dental practice include but are not limited to:

  • Reduced training time for new hires
  • Better communication with employees about how to accomplish their job duties
  • Consistency of task completion
  • Holding employees accountable
  • Ensuring safety standards are met, avoiding knowledge loss when shifting duties from one employee to another or in the event of turnover
  • Simpler integration of new employees
  • Quality control: SOPs ensure that your services are delivered in the same way from start to finish

Establishing Your Own SOP

To create your dental office’s own SOPs, make a list of every team member’s job duties. Review the list with your employees to learn more about what each team member does on a daily basis.

The next step is to decide what you will use to show each step of the SOP. Will you use a flow chart or a series of pictures with step-by-step instructions?

Ask for the input of your dental office team members to make sure the SOP can be clearly understood and all are on the same page about what it covers and what duties are required.

Next, who will be utilizing the Standard Operating Procedures? Will it be new or existing employees? Can each team member read and follow the directions on the SOP clearly?

Finally, put the SOP in writing or on electronic media. The step-by-step instructions should be very simple to understand and easy to view. Write the SOP in the active voice and present verb tense. Do not use the word “you” as a part of your directions. It should be understood. Make it short and sweet. The words used to write the SOP should make crystal clear the task to be completed. Use your style of instruction to illustrate the process, and be sure to follow the same style used in the office manuals or employee handbooks so everything is consistent.

Dental office SOPs should be so detailed that even someone with very limited knowledge of the directions can perform the procedure satisfactorily without supervision.

They should be so detail-oriented, there is no question in the team member’s mind at any given time the steps required to complete any procedure. The experience level required to perform each task should be set out in the section of the employee handbook titled “Personnel Qualifications.”

The last task to be done with writing the SOP is to review, test, edit and repeat this system every six or twelve months with the intention of improving the procedure or reflecting any changes made to the procedure. The SOP will not be of any benefit to the dental practice unless it is kept current and relevant to the team. SOPs are the procedures for all critical tasks performed in the dental office to result in the desired outcomes that fulfill the mission and objectives of the dental practice.

By contacting the experts at PPO Negotiation Solutions, you can learn more about how they can help your dental practice through a complimentary assessment or by scheduling a consultation!

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Have You Considered Being In-Network?

The term “in-network” is defined as health care facilities – hospitals, doctors, dentists, specialists, pharmacies –

that have an agreement with insurance companies to provide medical care to their insured members at a discounted rate. The rate is agreed upon by the health care provider. Patients will typically pay less with an in-network provider. At the time patients receive care, they pay what is referred to as a co-pay for covered health care services when their provider is in-network. If they choose to use an out-of-network provider, there are no co-pays, but they will pay more for the service.

Patients need to do the following to verify if your dental practice is in or out of their network:

  • review their insurance company’s website
  • call their dental office
  • call their insurance provider or agent

If your dental office is out-of-network for them, there is not a contract between you as their service provider and their insurance company, and as a result, the patient will pay more out of their own pocket or have to pay the total amount of the service provided.

When prospective patients compare dental practices in their community for dental services, if your practice is in-network, it is most likely patients will make the decision to have you complete their treatment in order to save money. Also, the insurance companies may refer patients to your practice for service as well. Once your practice is declared in-network or a participating provider with one or several insurance companies, you can add their plans to your website as well as on social media sites. This is sure to spread the word and attract new patients to your dental practice.

How to Become In-Network

In order to become a member of a network, you must have a contract with the health insurance company or companies. Today’s health insurance plans consist of managed-care such as HMOs, PPOs, and POS plans. This means the insurance company has a list of dentists and facilities from which your patients can choose for their treatment. The list is referred to as the provider network. These plans usually are more affordable than fee-for-service plans; however, they do limit the patients’ freedom to choose their medical providers.

Health insurance companies determine who they contract with based on your discount as a provider and how available your services are to customers. Your dental educational background and board certification are also considered to become in-network, and once your dental practice is in a network, you agree to follow the plan’s rules.

Health Maintenance Organization (HMO)

An HMO is a health insurance plan that has a low co-pay and no deductibles or coinsurance. While there is less freedom for your patients to choose providers, the fees are often lower because they offer a large pool of patients who can’t go outside the network. HMO providers can offer a larger discount. The main rule for your practice and patients is to stay within the network.

Preferred Provider Organization (PPO)

A PPO health insurance plan offers patients the option of visiting providers outside the network. The only reason to go outside the plan is if your patient or yourself feels the best care can be found outside the network. The downside to this is your patients will probably pay a higher price (copays, deductibles, and coinsurance) than if they had stayed inside the network.

Provider Sponsored Organization (PSO)

A PSO is an organization for managed care that accepts full risk for beneficiary lives. They receive a fixed monthly payment to provide the care for Medicare beneficiaries. A PSO is required to supply all medical services required by Medicare Law primarily through its network.

Getting There With Credentialing

In order to become in-network, you enroll with the company or companies you want to be in-network with. The next process with each company you have to complete is called the credentialing process. This simply means you fill out an application, but the process is anything but simple. A single wrong answer or missed question means you must start over because the document cannot be amended. This application form takes 40 hours to complete, and if you start the process, you must complete it. Most dental practices that try to take on this process alone are very overwhelmed. Especially filling out multiple forms for multiple companies.

Attempting to handle the process of becoming credentialed can strain the time and energy of the team members of your dental practice. Their time and energy are usually better spent on patients and operating the dental practice. Most dental care practices prefer to hire someone and work with them to become credentialed.

Now is a great time to begin the process as the year 2022 is just beginning.

After 30 years of experience, Strategic Practice Solutions and PPO Negotiation Solutions are experts at handling PPO negotiation and participation optimization. They outperform any other PPO negotiator. Their process saves you time and increases new patient prospects. Schedule your complimentary assessment and/or consultation today!

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What Should You Expect from the Credentialing Process?

The credentialing process is necessary to become in-network with one or more PPO insurance providers. This is good for your dental practice to obtain new patients and help the practice grow. Your main job is to provide quality health care service to your patients. But since you are running the business, you should also benefit from it as well.

The first step to become credentialed is to enroll with a company or companies you want to become in-network with. The information you will need to provide consists of such things as practice history, education, certifications, licenses, etc. You will need to complete a very thorough application for each company with which you have enrolled. Each application requires approximately 40 hours to complete. If you make an error when filling out the application, you must start over. Once you begin the application document, you have to finish it. This can be quite a daunting task and require your dental team to spend hours on completion.

Select An Insurance Company

In order to determine the insurance company or companies you choose to become in-network with, you will need to do some research. You may want to look to see what large companies are in your surrounding area and which insurance providers they use. When you do this, you will have a larger patient base from those companies. Because other dentists in the area may not accept their insurance. The name of your dental practice may also be given to the employers/employees of these companies on their list of participating providers.

Contact the Insurance Company

You might consider reaching out to the provider relations department for each of the insurance companies you have enrolled with. This is in order to assist you with their credentialing process. Otherwise, you will spend way too much time determining the following:

  • who you need to speak with
  • what is the best time to call
  • where to send an email, etc.

Negotiate Expenses

The first item that has to be settled before submitting your credentialing application to an insurance company is to agree on a fee schedule. Always check to find out if fee negotiations can be done. At this point, if fee negotiations are allowed, you will want to speak with a rep to get the highest fee schedule they will offer. Once this process is complete and your credentialing application has been submitted, you will be locked into a fee schedule for 12-36 months before you are allowed to negotiate another fee increase.

Complete Insurance Application

All questions must be answered and all supporting documentation must be submitted when completing the credentialing application. If you fail to answer all questions or to submit one required document, you will have to begin again. The insurance company will verify if your information is correct. This is referred to as the vetting process. If you answer incorrectly or skip a question or do not submit all required documentation, this will only prolong the lengthy processing time with the insurance company.

Once you become credentialed with the insurance company, you are bound to your contract and must follow their fee schedules, which will determine what you can or cannot charge your patients. It is of most importance you read and fully understand your contract. It will allow for the insurance company to audit your dental practice. If you have multiple dentists in the office, they will all need to credential separately. If each of the dentists in the practice are not properly credentialed, the claims being submitted to the insurance company in question may be sitting somewhere for a long period of time and not get paid. It is a very good idea to contact the provider relations department. This is to make sure they have the needed information to process claims. Your payments will arrive much quicker.

Out-Of-Network Providers

The dentist has to make the decision which plans are the best to participate in based on the nearby competition. Dentists who decide to remain out-of-network will receive larger payments because they are not bound by contract. However, they could find themselves losing patients to in-network providers due to the patient having to pay less out-of-pocket for services.

Benefits of In-Network Status

Gaining in-network status can be very beneficial for your dental practice. If you are an in-network provider, you can post it on your webpage to inform prospective patients which coverage you accept. PPO providers might refer new patients to you as well. Being an in-network provider may give you leverage over other practices in the area if patients save money by visiting your practice for treatment.

As you can see, the entire credentialing process and gaining the in-network status is a very complex and time-consuming job to undertake. It can be very taxing for you and your team members. If your dental practice becomes in-network, it is very important to look at how you participate with insurance companies to maximize your profits. PPO Negotiation Solutions can help your bottom line. After all, they have 30 years of experience in handling PPO negotiation and participation optimization. Let them put their impeccable reputation to work for you!

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How Credentialing Helps Your Dental Practice

Credentialing is what is necessary to become in-network in order to participate with a myriad of insurance companies and their different plans. There are various types of insurance providers including PPO, DMO, HMO, DHMO, Medicaid and within each type, there are several insurance providers. Dental patients are much more likely to seek treatment with a dentist who participates with their insurance plans.

Up to 50% of new patients come from insurance and other referrals. This benefits your practice by increasing your overall potential and revenue. By credentialing your dental practitioners, you will encourage patients to trust in your providers, enabling your practice to enroll with insurance companies so you will receive third-party reimbursement.

Roughly 77% of the population holds dental benefits. These benefits come from a variety of providers that include private payers and public programs like Medicaid. Licensed health care service plans are required to monitor the qualifications of their participating providers and follow National Committee on Quality Assurance (NCQA) standards. This is also one of many reasons for credentialing, as it places your dental practitioners in the best light to prospective patients.

These documents are necessary to complete your credentialing application:

  • A copy of your state license
  • A copy of your professional insurance face sheet
  • Complete practice information
  • Your practice NPI Number

You may also need the following:

  • Hospital affiliation information
  • A copy of your anesthesia license
  • Your Medicare number
  • A copy of your DEA (Drug Enforcement Administration) license
  • Your Medicaid number
  • A copy of your CDS (Controlled Dangerous Substances) license
  • BLS (Basic Life Support) certification information
  • ACLS (Advanced Cardiovascular Life Support) certification information

This information may be needed depending upon the state in which you practice, and sometimes, additional documents may be required.

In-Network Benefits

When you obtain in-network status with PPO insurance companies, patients who are enrolled in these particular plans save money on their dental treatments. When the people in your community need to have dental care performed, this will give your practice an edge over other dental practices. Also, the insurance providers themselves will refer clients to your practice who are in need of an in-network dentist or dental specialist.

Once you obtain this status, you can advertise the plans you accept on your website and other social media. This marketing will attract new patients to your practice and result in more sustainable future growth. Every insurance company is different, and their applications and credentialing processes may not be entirely the same.

The American Dental Association (ADA) collaborated with the Council for Affordable Quality Healthcare (CAQH) Proview and created a one-stop-shop for all licensed dentists in the U.S. to be able to enter and share their professional and practice data with dental plans and other healthcare organizations. This service reduces the burden of the credentialing process.

Vital for Future Growth

Seeking credentialing helps to ensure your practice is in a good position to serve patients at reasonable prices and still profit from sizable reimbursements. Credentialing is vital for the future growth of your practice and should not be put off for very long. Reimbursements from insurance and Medicaid are a significant part of overall revenue.

Becoming credentialed to serve Medicaid patients can also result in significant benefits. This process is similar to an insurance company, but may require more information. Government health plans such as Medicare and Medicaid will not pay for any out-of-network services. Dental practices not in network with their patient’s dental plan are at risk of losing their patients. This affects the revenue, patient base, and the bottom line of any dental practice.

It is a standard process for dentists to receive requests for information regarding credentialing or recredentialing from a licensed dental plan. This is to ensure that enrollees who select a participating dentist can be assured their dentist has met minimum uniform requirements.

Credentialing Assistance

Many dental practices do not have the time nor the staff to handle the process of taking the appropriate steps to credential each practitioner in their office. There are many forms to complete and quite a bit of information to be gathered to complete the credentialing process. At this point, most practices will find it is very helpful and reduces stress to employ a credentialing service to assist them.

PPO Negotiation Solutions are trusted partners to hundreds of dental practices. They can negotiate your highest fee schedules and claims reimbursements upon credentialing. Strategic Practice Solutions and PPO Negotiations Solutions are experts at handling PPO negotiation and participation optimization. After 30 years of experience, they have an impeccable reputation and have it down to a science.

With PPO Negotiation Solutions as your credentialing partner, you can interact with PPOs from a position of power. This is because they handle the details of your negotiations. This includes:

  • AUDIT your current PPO Payor Mix Percentage & UCR fees relative to competitors
  • DEVELOP a Negotiation Plan outlining your participation directly or through rented networks
  • NEGOTIATE directly through our highly cultivated PPO contacts to produce the greatest number of patients at the highest rate of reimbursement
  • FILE AND TRACK credentialing forms until you are safely “in network”
  • COACH your team remotely, online, and/or onsite for maximum understanding & ongoing results

Contact us at PPO Negotiation Solutions today and learn more!

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What Dentists Should Know About PPO Re-Negotiation

If you decide to become an in-network (PPO) provider, from the very beginning it is of utmost importance to negotiate contract fees. Keep a record of your contract dates to be proactive in having the ability to re-negotiate your contracts. Most contracts for fees have a term of 18-24 months. In order to maintain your bargaining power as a new general practitioner, review your current office fee schedule. And use fees in at least the 80th percentile in your area of operation. These few beginning steps will assure your dental practice fees remain re-negotiable.

Examine Your Current Fee Schedule

You must not set your UCR fee schedule too low or you will not remain competitive and lose your bargaining power. Who are the major employers in the closest vicinity to your dental practice? Make a list and call their offices or human resources departments. And find out who the contract holder is for their dental benefits. The list should include schools, hospitals, manufacturing facilities with a worldwide impact and state, local and federal offices in the area. Take a look at their plans and compare their fees to the PPO fees you are about to re-negotiate. Which of the plans would offer you the best marketability for new patients? 

Determine Your Top Procedure Codes

Your top 30 codes allow you to see where 90% of the production in your practice is attributed. These codes are important in determining your re-negotiation results. You may prepare a report called “Report by Procedure” to determine your top 30 codes for your practice. The CDT codes are reviewed and revised each year. If the incorrect codes are used, even by mistake, it can postpone or disable your reimbursement of claims. It may also result in charges of fraud or violations of state or federal laws. It is very important for your practice to purchase a new CDT each year. This is a manual printed annually by ADA that includes the Code on Dental Procedures and Nomenclature (CDT Code). This code contains the procedural codes for oral health and services provided in dentistry.

Determine Your Negotiating Leverage

Your practice may have a negotiating leverage because of its location, specialties, hours of operation, and ability to maintain patients. PPO negotiation normally comes down to how motivated the insurance carrier is to add dentists to its network. Consider how many dental practices are in your immediate area performing similar procedures. Question each PPO plan you are considering if they have a co-lease or network share arrangement with other carriers. Determine if the carrier has electronic claim ability and EFTs for receipt of claim payments. Do they use online portals to pre-authorize insurance claims? You need to negotiate with each network share individually, as you can always opt-out by submitting a copy of your signed contract stating your intentions to withdraw.

Initiate Negotiations with the Network Retention Specialist

Negotiate through a retention specialist by email so you will have a written record of your communications. Ask for a custom fee schedule based on the top 30 codes in your practice from each insurance provider so you can compare which one is closest to your UCR fees. You need to have a time frame in mind to allow them to respond and include it with your proposal. Some insurance companies do not negotiate because everyone is in the same general area. If you are offered a list of fees, you can always send them a counter offer — you never know until you ask. 

Once you agree on a list of fees with the insurance carrier, keep an organized location with the contract terms agreed upon and the final list of fees so you can compare fees offered by each insurance provider. In order to ensure your agreement is being utilized, audit about a dozen claims every six months. This is just a good business practice to maintain. As the dentist, you should be prepared to begin negotiations for the best chance of obtaining the best fees. Consider it a good practice to write off certain codes which are not used very frequently in your practice in the past year.

PPO Negotiation Solutions can negotiate your highest fee schedules and claims reimbursement to increase your dental practice revenue. Use the complimentary assessment feature to determine which of your PPO contracts is eligible for negotiations and get an estimated revenue increase. You may then access the consultation schedule feature to pick a date and time convenient for you to speak with one of our trusted partners. 

In order to level the playing field between dentists and insurance companies, it is the number one goal of PPO Negotiation Solutions to enrich dental practices through increasing their revenue and their understanding, while streamlining processes for optimal day-to-day well-being.

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Should You Hire a Negotiator?

A part of the job the dentist may not have considered when opening a dental practice is dealing with insurance companies. As a matter of fact, it is one of the particularly stressful things the office deals with; but it is so very necessary. Dentists are in the business to make money and insurance companies want to make money, as well. As a result, they try to keep fees as low as possible. The less they have to pay the dental practice, the more money they make. Dentists need to learn to counter-offer to ensure they make the most money possible to cover the expenses of the business and make a good living. 

There are classes available to learn to be a knowledgeable PPO fee negotiator, or you may decide to hire a negotiator. To prepare for future earning capacity, it may be wise to hire a professional negotiator. Negotiators know how to compare different offers for the same patients and these offers can be considered accordingly. Someone who has ongoing experience with insurance companies is important to give your dental practice guidance. A negotiator will have the background knowledge to be able to identify areas of improvement for your practice and to work with insurance providers to get better rates.

How to Choose the Right Negotiator for Your Practice

The negotiating professional you hire should know and understand insurance companies well. A clear understanding of the boundaries the insurance companies work with will benefit the dentist. They must demonstrate a professional, knowledgeable manner of negotiating without being rude or overpowering. Claims and issues which tend to go along with them should not even be mentioned, as insurance company negotiators have nothing to do with the claims process. Your negotiator should always present your practice in a positive light for future successful negotiations. 

Negotiators, unlike dentists, communicate with the same insurance representatives each time. They often contact them directly and become well acquainted. As a result, the insurance representatives get to know your negotiator and how well they understand the industry. Don’t let your dental office get included on a “red flag list” during negotiations based on how your company is represented. Your dental clients will benefit from strong and positive negotiating relationships. 

The negotiator you choose should be persistent with following up with companies and making sure your paperwork is being processed in a timely manner. They should be in contact with your insurance company on a regular basis to get the best reimbursement rates. Choose a negotiator with a top reputation with other dental practices in your area. If they are having great success for other practices, chances are good they will work just as diligently for you. You want to be represented professionally when working with insurance providers. Hire a negotiator who realizes they not only represent themselves, but your practice as well. Quality PPO fee negotiators specialize in strategy and data computation to get the best results.

Educating You and Your Team

Dental assistants are often the eyes and ears of the dental office. They are very important for the success of clinical record keeping and for success before, during and after any procedure. The dental assistant:

  • Helps complete patient information forms
  • Takes and records vital signs
  • Charts and documents patient findings from the dental exam 
  • Processes dental radiographs
  • Processes dental photographs
  • Organizes patient records
  • Prepares for each patient treatment 

In order to qualify for the presentation of a case, the dental assistant choses the corresponding CDT codes so the treatment plan includes all procedures completed and to be completed in future appointments. Dental assistants must be involved in this process to learn to properly get a claim paid. Proper narratives are required in the dental notes from each procedure, along with proper radiographs, periodontal charting and other diagnostic tools. Dedicated time to train dental staff must be set aside at regular intervals, as it will have a positive effect on team growth, care of patients and team relationships. 

To summarize, whether you make the decision to handle re-negotiations on your own or decide to hire a professional to negotiate for you, foster realistic expectations. Some insurance companies will not negotiate and some will. Just make sure to maximize your results by researching how each insurance company works. Whoever negotiates on your behalf is a representative of your dental practice. Your results depend upon them. Creating and maintaining a good reputation is key to receiving top dollar because you understand the industry and package negotiations to benefit you and the providers. 

One of the trickiest parts of the negotiating process is comparing the final offers. Someone who stays up-to-date on the industry is very important when guiding your dental practice. At PPO Negotiation Solutions, not only have we made a company commitment to ourselves to do it right, but we have also made this commitment to our doctors and carriers. For more information on our services and finding out if they are a good fit for your dental practice, get your complimentary assessment or schedule your consultation today.

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