PPO Negotiation Solutions

We Level The Playing Field Between Dental Practices and Insurance Companies

Blog

What CDT Code Changes Has the ADA Implemented for 2021?

Given the nature of our current global circumstance concerning  COVID-19,  in addition to dental technologies advances and ever-evolving dental procedures, there is now an updated version of the American Dental Association’s code on dental procedures and nomenclature.  Following two ADA Code Maintenance Committee meetings held in March and April of last year,  Current Dental Terminology (CDT) changes were implemented to place best interests on behalf of those in the dental profession, their patients, and third-party payers.  CDT codes are the only HIPAA-recognized dentistry code set and are required when electronic health care transactions occur. As well, when the ADA alters the codes, carriers must adopt said updates. It’s important for dental practices to stay up-to-date, informed, and well-versed in CDT code changes.

What Has Changed With CDT 2021

  • 28 new codes
  • 7 revised codes
  • 4 deleted codes
  • 22 editorial changes (actions that clarify without changing the CDT Code entry procedure’s extent or purpose).

New dental codes for 2021 provide greater specificity for accurate patient record-keeping and to make claim processing simpler. Note that a new or revised code does not dictate reimbursement from insurance providers. In addition, while codes may be recognized, they may not at all be reimbursed. In essence, codes are provided in numerical terms and help articulate the services between providers and insurance companies.

In short, CDT 2021 contains new codes for dental procedures related to:

  • Testing to identify patients who may potentially be infected with the coronavirus
  • Counseling for the control and prevention of negative impacts on oral, behavioral, and systemic health deriving from high-risk substance use, including vaping
  • Caries prevention medicament application
  • Teledentistry-derived image captures performed by a licensed practitioner to forward to another dentist for interpretation

Update Your Billing System Each Year to Reflect Code Updates

Updating your practice’s billing system each year to reflect CDT code changes will help clarify treatment for team members, patients, and third-party payers.  Doing so provides accurate estimates for your patient load and allows for proper reimbursement. Prior to the year’s end, most insurance carriers notify in-network providers of their requirements and reimbursement protocols.

Establish and Execute an Annual Four-Step Protocol

The objective of CDT Code is to attain uniformity, consistency and specificity in accurately documenting treatment in the dental industry. Therefore, establishing and executing a yearly four-step protocol helps to ensure that your practice, billing system, and insurance coordinator all reflect the new CDT updates.

Here is a sample protocol for consideration:

  1. Remove deleted codes from your billing software.
  2. Set fees for the newly enlisted codes.
  3. Contact insurance companies to review processing guidelines for the changes.
  4. With your staff, cover how CDT updates/impacts may alter chart note records, posting, and communication with patients for procedures offered.

CDT 2021 Code Changes Overview 

28 New Codes

  1. D0604: Antigen testing for a public health-related pathogen, including coronavirus
  2. D0605: Antibody testing for a public health-related pathogen, including coronavirus
  3. D0701: Panoramic radiographic image – capture only
  4. D0702: 2-D cephalometric radiographic image – capture only
  5. D0703: 2-D oral-facial photographic image – capture only
  6. D0704: 3-D photographic image – capture only
  7. D0705: Extra-oral posterior dental radiographic image – capture only
  8. D0706: Intraoral occlusal radiographic image – capture only
  9. D0707: Intraoral periapical radiographic image – capture only
  10. D0708: Intraoral bitewing radiographic image – capture only
  11. D0709: Intraoral complete series of radiographic images – capture only
  12. D1321: Counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance abuse
  13. D1355: Caries preventative medicament application – per tooth
  14. D2928: Prefabricated porcelain/ceramic crown – permanent tooth
  15. D3471: Surgical repair of root resorption – anterior tooth
  16. D3472: Surgical repair of root resorption – premolar tooth
  17. D3473: Surgical repair of root resorption – molar tooth
  18. D3501: Surgical exposure of root surface without apicoectomy or repair of root resorption – anterior
  19. D3502: Surgical exposure of root surface without apicoectomy or repair of root resorption – premolar
  20. D3503: Surgical exposure of root surface without apicoectomy or repair of root resorption – molar
  21. D5995: Periodontal medicament carrier with peripheral seal – lab-made – maxillary arch
  22. D5996: Periodontal medicament carrier with peripheral seal – lab-made – mandibular arch
  23. D6191: Semi-precious abutment – placement
  24. D6192: Semi-precious attachment – placement
  25. D7961: Buccal/labial frenectomy
  26. D7962: Lingual frenectomy
  27. D7993: Surgical placement of craniofacial implant – extraoral
  28. D7994: Surgical placement of zygomatic implant

7 Revised Codes

  1. D1110: Prophylaxis adult – removal of plaque, calculus, and stains from tooth structure and implants
  2. D1120: Prophylaxis child – removal of plaque, calculus, and stains from tooth structure and implants
  3. D1557: Removed language that specified the procedure was done by a dentist or practice that did not originally place the appliance
  4. D1558:Removed language that specified the procedure was done by a dentist or practice that did not originally place the appliance
  5. D6011: Removed language specific to access to place a healing cap or to enable placement of an abutment
  6. D6091: Removed language that the procedure applies to the replaceable male or female component of the abutment
  7. D9971: Defined per tooth specifications

4 Deleted Codes

  1. D3427: Several new codes replace this code for greater accuracy
  2. D5994: Replaced with D5995 and D5996
  3. D6052: Replaced with D6192
  4. D7960: Replaced with D7961 and D7962

 

Read More

3 Major KPIs to Focus on When Planning Goals & Growth for Your Practice

A successful practice requires a knowledgeable manager and a strategic business plan. In order to create strategic business plans that help dental practice thrive, managers need the proper information, and much of this information is derived from KPIs.

KPI stands for Key Performance Indicator. KPIs can indicate the performance of a number of areas of practice and are a vital tool in determining the health of your business. This is not only important as an indicator of its current status, but also when planning goals and determining the growth potential of your practice. Three major KPIs to focus on when planning new goals are as follows:

  • Budgeted hours
  • Production
  • Generated income compared with overhead costs

In this article, we will discuss exactly how each of these KPIs can help you make the best decisions for the future of your practice.

Keep an Eye on Budgeted Hours to Ensure Monthly Goals are Met

Budgeted monthly hours and monthly revenue go hand in hand and should be one of the first KPIs to consider. In order to succeed in hitting its goal, each practice should base its monthly budget or goals on the number of days/ hours a provider is scheduled to work.

While this may seem straight forward, it is a factor that is often overlooked as things come up and schedules shift. Often times, a practice may not realize that they will not hit their monthly goal because a provider decided to work less than originally anticipated in a particular month.

Numbers may also change due to the way the calendar days and holidays fall. For example, some years may have four weekends in any given month while the next year may have five. A small change in numbers here and there may not seem like a big deal, but this can lead to a difference of thousands of dollars in overall revenue and can be the blind spot that many practices overlook when trying to figure out why their they did not reach their set goals.

Production / Visit vs. Production / Hour

Daily revenue can be analyzed by looking at the production rate per visit as well as the production rate per hour. The per visit rate is indicative of the revenue of each individual patient visit, while the per hour rate is a more commonly used way to gauge the overall income of the practice. Examining the KPI of both rates can help determine in what areas the practice could be doing better and is useful in making adjustments to meet growth goals.

While each practice may have different reasons for not meeting their revenue goals, some of the most common factors include the following:

  • A reduction in the amount of hours a provider works
  • Not meeting the necessary daily production
  • Not meeting the needed number of daily visitors
  • The types of procedures the practice performs
  • Case acceptance

Although often overlooked, many of these factors are easily remedied once they are identified. For example, a provider having to take off work can be remedied by finding another to temporarily cover the shift or by rescheduling already set appointments. Chart audits and proper training are also ways to ensure that providers are keeping up with the necessary procedures and that everyone is on the same understanding concerning the operations of the practice.

Accurate Overhead Cost Tracking and Ongoing Comparison with Income Generated

A third major KPI to focus on when planning goals and growth for your practice concerns overhead costs compared to generated income. These are the numbers that stem from many of the aforementioned factors and are affected by any number of these each month. For this reason, it is important to pay close attention to these numbers and to keep accurate and current information of where your practice stands.

The following are some of the main overhead costs of a dental practice along with the average percentage of the practice’s income necessary to cover these expenses:

  • Rent/Mortgage, 5-7%
  • Laboratory, 8-12%
  • Dental supplies, 5-7%
  • Payroll/Staff salaries, 25-30%

A successful manager will understand the expected percentage of generated income that will have to go to pay these overhead costs. With this information in hand, it is possible to not only form a monthly budget, but also to set accurate and achievable revenue goals as well as successfully planning and achieving business growth.

SMART Practices

A manager of any practice can only set goals and grow a business by understanding the current status of the business as well as why it is so. After all, a situation can only be handled once it is identified and understood. KPIs are useful tools for staying on top of your practice’s financial goals, but simply seeing numbers without any idea of how to assess them will not be much help for setting goals.

Data and statistics are only useful to us if they are properly understood. One method to doing so is through something known as the SMART criteria. This acronym stands for Specific, Measurable, Attainable, Relevant, and Time-bound, and is used to evaluate individual KPIs.

KPIs are merely indicators and are only successful if they meet all aspects of the SMART criteria. When this is not the case, the KPI is likely not beneficial to the goals of your practice and should be reworked.

At the end of the day, the objective of a KPI is to help businesses understand the status of their operation and to figure out how to improve it. Useful KPIs are key to helping your practice achieve its financial goals and find sustainable growth. No matter how your practice determines its unique KPIs, these three areas of focus are key to a successful business.

Read More

Find Your Practice’s Blind Spots to Increase Your Revenues

One of the best things you could do for your dental practice is taking the time to adequately assess your strengths and weaknesses. It can be tempting to focus only on what you are doing well and on what is working, but the reality is that seeking out blind spots and then working to resolve them can do even more to save you money and to provide increased workflow efficiencies that net you more income per month.

What is a blind spot? Is it simply something that is neglected or that someone has not paid attention to in quite some time?  The short answer is yes, blind spots are often areas that have been forgotten or ignored and are thus not operating at their maximum efficiency. In order to remedy blind spots, however, you must first figure out how to examine something you currently have no idea you are overlooking. While some blind spots are obvious, others will require intentional, disciplined seeking to uncover fully.

Engaging in comprehensive practice analysis can reveal many areas that could either be managed more carefully to eliminate wasted time, or that could be leveraged in a new or better way to net more income from each visit. In this article, we examine the following three common areas that practices can improve to increase revenues:

  • New patient call conversions
  • Individual patient visits
  • Hourly income rates

With an honest and comprehensive examination of business operations, any practice is sure to find some area of focus wherein they can improve and grow.

Increase Revenue Through New Patient Call Conversions

New patients are a vital part of a successful business, and it is up each practice to ensure that they take the necessary steps to continually grow their clientele. However, this is where we find the first blind spot in many businesses.

New patient calls are an important opportunity for practices to ensure that potential new patients become long-time patients. However, many practices find that their new patient call conversion rates are much lower than what is desired in a successful business.

Trips to the dentist can be a nerve-wracking experience for many, so a good relationship between staff and patients is important to keep them coming back to your office. Successful new patient call will not only lay the foundation for such a happy and trusting relationship, but it will continue to move the process forward by scheduling an appointment for an in-person visit.

The ideal new patient call conversion rate of a successful practice is at least 90%, meaning that at least 90% of all new patient callers become returning patients. However, this is an area of the business that is often not monitored and may be a major blind spot that is holding back the potential revenue of a practice.

Conversion rates are often low because staff is not properly trained in how to speak with potential new patients or on what steps to take to get an appointment scheduled. Recorded new patient calls are a great tool to help train staff on what and what not to say and do for a successful call and, in turn, an increased conversion rate.

Increase Revenue By Increasing Production Per Visit

Each individual patient visit has the potential for an increase in the practice’s production. Whether it comes at that particular visit or from one yet to be scheduled, certain steps can be taken during each individual patient’s visit to ensure that the office is not missing out on any potential revenue. Ensuring that all proper steps are taken at each visit is, however, is a common blind spot of many practices.

Each patient visit includes a series of steps for staff to conduct. From validating patient information to performing all necessary operations and scheduling follow-up appointments, each part of a visit has the potential for revenue for the business. Practices could be missing out on their full per-visit potential if staff misses any part of a visit, some common examples including the following:

  • Failure to update incorrect patient information
  • Not scheduling the patient’s next appointment
  • A miscalculation of or failure to charge the proper fees

An increased rate of revenue per visit is often improved through training and organization. Clearly defined procedures and a well-versed staff are a practice’s best chance of making the maximum revenue potential per patient visit.

Increase Revenue By Increasing Production Per Hour

The rate of production per hour is how most practices determine how well they are doing financially. However, when the numbers aren’t where they should be, it is often also a blind spot and is frequently forgotten when companies try to figure out how to improve.

One of the most common blind spots when it comes to the hourly rate of production in an office lies in the individual production rates of doctors and hygienists. While a hygienist can see an average of 7 to 8 patients per 8 hour shift, doctors average 0.5-1.5 patients per hygiene visit, depending on the practice. If the average of an office is lower than this or if there are regularly gaps in the schedules of either doctors or hygienists, then the office is likely not living up to it’s hourly potential. A common strategy to avoiding such gaps throughout the day is to over-schedule appointments. Statistics show that patients will inevitably either cancel or skip appointments, so over-scheduling ensures that there are no gaps in the daily schedule of an office.

The hourly rate of production can also by affected by a number of other factors, including the following:

  • A variance in calendar days per month
  • Over or under-scheduling staff
  • A variance in the number of patient cancellations

The net hourly revenue of a practice is what remains after all hourly costs are deducted. With this blind spot uncovered, increasing your hourly production rate is as simple as finding where costs are high and where profit is lacking.

In Summary

The blind spots of a practice often lie in the fine details of the operation, but they can also have a significant impact on the overall revenue of the business. Examining the above three common blind spots can help your practice find what isn’t working so that you can increase your revenue and operate at full potential.

Read More

How To Create Same Store Growth For Your Dental Practice

Almost every dentist would love to increase the revenue their practice generates while not hiring more staff. In business, this is called “same-store sales growth.” There are countless ways to use effective dental practice management and marketing to increase revenue. It takes some vision, creativity, research, planning and investment, but it is not too difficult for a dentist and their staff to increase the revenue a practice brings in. The following are a number of very simple, straightforward and cost-efficient steps dentists can use to enjoy same-store sales growth.

  1. Provide High-Quality Service At Affordable Prices

A Satisfied customer is one of the best forms of advertising. That’s because it’s free and shared with passion and conviction from a trusted person. When a patient believes a dentist delivered the high-quality dental services they needed at a very affordable price, they are very likely to tell their family, friends, and anyone else who will listen, what a great deal they received on their dental services. Satisfied dental patients often write glowing reviews on Yelp and other consumer review sites and talk about it on social media without having to be paid. This attracts more patients and revenue.

  1. Increase Production per Visit/ hours

An example of how this applies to the hygiene department: Training to obtain a “perio” focused hygiene department can conservatively get the hourly hygiene production of  $155 to go to $200/ hour

What impact will the additional $45 prod/ hour have on your practice?

Variables impacting Dentist’s production/hour are: adding “same day dentistry” procedures. Procedures identified in the hygiene room and used to fill in cancelations/openings on the dentist’s schedule.

Increase case acceptance to treatment that is over @ $2,500 in value are the variables that impact production/ hour.

  1. Create A Warm, Welcoming, Relaxing, Comfortable Environment

Many people dread going to the dentist. They associate it with sharp implements and painful procedures. One way to attract more patients is to have the word spread about how warm, welcoming and comfortable the environment and atmosphere in the dental office is. If the environment in your dental office is soothing and relaxing, it puts patients in a better frame of mind and that can improve the experience they have. Soft music and lighting in common areas and a warm, friendly staff talking in soothing tones makes people more comfortable with the experience and their family, friends and acquaintances will also want to experience it.

  1. Have A Staff of Well-Trained, Caring, Professionals

The dental office staff is the patient’s first point of contact with your practice. If

you have a team of well-trained, highly skilled, caring professionals on your staff, the patient will know they are going to be well taken care of from the moment they walk in the door. Having a smiling, friendly receptionist welcome you to the dental office, ask about your dental problems, give you clear, simple, straightforward answers to your questions and calmly and skillfully take care of you makes patients feel like they’re being helped by caring, knowledgeable, experts qualified, able and happy to provide the help they need. Those patients will bring you more clients and additional revenue.

Action :  We highly suggest management review the practices onboarding procedures to ensure all new hires are aware of the practice’s core beliefs, practice etiquette, and learn the duties & skills of their position so patients receive the “ red carpet” experience

Example: Train the front desk staff to appoint every patient for their next visit prior to leaving the office. Keep in mind that getting patients to make their next appointment is not as easy as simply asking the patient when he or she would like to come back

  1. Expand The Services You Offer

One effective way to increase same store revenue in your dental practice is to expand the services you offer. This creates new revenue streams by providing more services for the patients you already have and attracting new patients for the additional services you now offer. When patients are comfortable with and have confidence in the dental care services you provide, they are more likely to turn to you themselves and recommend you to others for your new services. You can increase your income without adding new patients when your current patients begin coming to you for multiple dental procedures. Rather than refer your patients to other dentists, taking care of their needs yourself can increase your same store revenue.

Action: We suggest you look at the number of endodontic, perio, extraction, implant and orthodontic cases your practice refers out on a monthly bases to see how much revenue could be added back to the practice if a provider was hired to perform those procedures.

Hiring a specialist to work 1 day/ week to perform specific procedures is a good place to start.  In addition, provide opportunities for  associates to take courses and/or join study clubs to increase their skills with  endo, sleep apnea, Invisalign etc.

  1. Build Trust Through Patient Engagement

One key to profitable dentistry practice management is engaging with your patients. It costs less to retain your existing patients than to recruit new ones. Plus, when you engage with patients it builds a level of trust that not only keeps them coming back, but also motivates them to refer their family, friends and associates to your practice. Engaging with your core group of patients who regularly come to you for the dental care gives the practice stability. Sending them helpful dental care tips through newsletters or direct mailings keeps them engaged by giving them more value for their dental care dollar.

Action: You’ve heard the saying “out of sight, out of mind”? It is so true!  Your practice needs to find ways to remain in clear view of your patient’s eyes. Social media is a great way for the practice to share how they are giving back to the community, to inform patients of dental related items and to announce fun events, contests and/or specials they are running throughout the year – especially during the Holidays. This will keep your practice in clear view of your current patients and will get them to be an “active” participant. 

  1. Offer More Convenient Regular And Emergency Hours

Many patients choose a dentist because they have convenient regular and emergency hours. No matter how good a dentist is, they will lose patients if they are closed when patients need them most. Ask your patients if opening earlier on certain days and staying open later on other days will make it more convenient for them, their family, and their friends, to come in for the dental services they need. Commit to providing emergency dental services when patients need it. This can give you access to a whole new revenue stream that can make your practice more popular and more profitable.

  1. Offer Incentives And Rewards For Patient Referrals

The average patient who thinks you do great work will refer people to your practice but sometimes an extra nudge is needed. If you offer incentives and rewards for patients who refer friends to your practice, it can significantly increase same store growth in revenue for a very small investment. Offering patients simple incentives and rewards like a free cleaning or discounts on their dental care for X number of referrals can motivate them to actively recruit clients for you. Personal recommendations are more persuasive to people making dental care decisions and can cost you less than paying for an ad.

Action: It’s puzzling why some practices are afraid to ask their patients for referrals or do not run an effective referral program. New patients referred over from a current patient are more inclined to keep their scheduled appointments and will often move forward with treatment much easier than new patients from another source. Do you have an patient referral program?  If you do have a referral program, are you aware of how successful it is?  How many new patient leads schedule and keep their appointments from a “patient referral” each month?

  1. Laser Focus Your Social Media Marketing

Using social media marketing targeting tools like Local Awareness Facebook Ads to make people within a 50-mile radius of your practice aware of its location, hours and services is an excellent way to make your social media marketing efforts more focused, targeted and effective. You can even add a ‘Get directions’ link and a call to action  button that is a highly visible and easy prompt to encourage and remind the person how easy it is to make an appointment, get answers to their questions, and get any other relevant details.

Action: We often find practices that either delegate their social media marketing to an internal team member or outsource. However, it amazes us that they seldomly evaluate the effectiveness of their energies.  We suggest you review your social media activity and outcomes routinely at the end of each month to identify what is working well; as well as, areas that are not working well and/or require tweaking.

  1. Use Facebook Demographic Targeting

About 90% of dental buying decisions are made by women. Many women within a 50-mile radius of your dental office are on Facebook regularly. You can target Facebook ads to women with children in your area and tap into a very lucrative market. Targeted ads can create income streams that continually grow as the children get older and need more complex dental services.

  1. Don’t Forget The Appointment Reminders

People have so many things that compete for their attention, it’s easy for them to forget their semi-annual dental checkup for themselves or one of their children or the teeth cleaning appointment they made months ago. A simple way to help your practice increase its revenue year to year is to give your patients a phone call or send them post cards or emails to remind them of their appointments. You can also use those same those communication methods to make them aware of special discounts you are offering on teeth cleaning and whitening or other dental care services.

Same-Store Growth

With some thought, planning, focused action, and an investment of a little time and a small amount of money, same-store sales growth is possible for any dental care practice.

Read More

Are you AWARE of the BCBSM change!

PPO Negotiations hope this finds you well.  2020 will definitely be ONE for the record books! First there was Covid-19 and now a change of the Network Administrator for BCBSM that struck the dental industry as of October 1, 2020

Our goal is to make sure you and your practice(s) are aware of the BCBSM changes. There was no formal public announcement to allow practices the opportunity to make necessary changes in their participation level. I can honestly say, based on our investigative calls, everyone has been blindsided.  Representatives at BCBS, Dentaquest, and UCCI were not prepared for this major change.  It has taken us at least 4 days to figure out what has been going on and the impact it will have on dental practices. I have shared what we have learnt thus far:

As of October 1st, United Concordia ( UCCI) became the primary network partner for the BCBS of Michigan [ BCBSM] Commercial Plans. This means, UCCI will manage all IN-NETWORK provider contracts and are now responsible for maintaining provider records. As you and your offices may remember, it was a nightmare when BCBSM changed their claim administrator from DNOA to Dentquest back in November 2019.  At that time, offices were being seen in networks with Dentamax that either never credentialed with Dentemax or termed with Dentemax.

We are noticing BCBS providers in the state of Michigan are experiencing one or more of the following…..

◾Providers “OON” with BCBSM are now being seen in-network with Dentemax  under UCCI system which means their BCBSM claims will be paid on the Dentemax fees

◾Providers ” UNDER ASSIGNMENT” with BCBSM are now being seen ” IN  NETWORK” with a UCCI network group, which means their BCBSM claims will be paid  on the fees associated with that network.

◾Providers who had BCBSM claims  paid under one of the listed groups may notice their claims are being paid under one of the other groups listed – depending on the process UCCI determines to pay the claims under. ..

Careington Care      Connection        Principle

Maverest                DNOA              UCCI

Dentemax

We advise your admin team to keep a watchful eye on the BCBSM EOB’s for services rendered post 10-01-2020 to ensure they are being paid properly.  In the event they are not, Dentaquest is suggesting all providers reach out to UCCI at 800-307-8514 to begin the troubleshooting process.

We at PPO Negotiations are working on how to strategically help our clients achieve the highest level of reimbursement from this Network change that stormed the dental field.    Please contact us if you are having difficulty in correcting your provider status with UCCI.

Local: 586.803.7501
Toll Free: 888.421.1808

Read More

10 Things You Need to Know About You and PPO’s

As a dentist, do you feel like you are at the mercy of the PPOs? Is writing off tens of thousands of dollars because of how you participate in dental PPOs hurting your practice? Do you feel trapped into giving deep discounts to PPOs in order to keep existing patients? If you are at a point where you are considering cutting back on PPO participation, here are ten things that you need to know when it comes to you and PPO’s.

1. You Have Much More Power Than You Realize

The insurance companies won’t make any money at all if you don’t provide the quality dental care patients need. This gives your practice the upper hand in its relationship with the PPOs. They are simply promoting the dental services you provide and taking too big a share of the money you generate. You are the one making the patients happy with the quality dental care you provide. Let the insurance company know that you will no longer provide services to patients at the repayment rate you receive. They will be forced to give you better rates or lose all the money you generate for them.

2. Dental Practices Can Thrive with Little PPO Participation Or None At All

You may be concerned that if you stop accepting PPO patients, the reduction in your patient base may reduce your production and revenue stream too drastically. But this isn’t true. Many dentists don’t accept PPO patients and still maintain a robust business with a steady stream of income and new patients. High-quality dental care retains existing and brings in new patients. If you provide excellent dental care at competitive prices, your satisfied patients will tell their family, friends and acquaintances about the quality of your dental services. Referrals will continually generate new patients.

3. Dentists Can Determine the Right PPO Participation Balance

When dentists set their own fees they charge, they strike a balance between charging fees that are too high for most patients and too low to be profitable. You can do the same thing when participating in PPO programs. You can moderate your participation in PPO programs by deciding how many PPO patients you will accept, in what plan and at what reimbursement rate. You may be willing to have only 20% of your dental patients come from PPOs and only if the PPO pays what you consider fair compensation for your dental services.

4. You May Already Have Out-Of-Network Patients

Every PPO has some patients who use out-of-network dental care providers because of their exceptional service. These services are still covered by the insurance companies. You may already have some out-of-network patients for
whom you provide care. The patient decides which dentist, in or out the PPO network, they will go to for the quality dental services they need. Dentists providing the best and most advanced dental care possible can be confident in the fees charged. The patients will make PPOs pay you to provide the dental care they need.

5. Companies Select PPOs to Retain Top Talent

Employers provide dental coverage for their employees to attract and retain top talent. PPOs are selected to save money, while providing the dental care that their employees need. Dentists providing employees with critical dental care, not covered by the PPO, are typically paid out-of-network, or the employer will drop the PPO and replace it with one willing to pay the dentist selected by their employee. That is why many insurance companies provide good out-of-network benefits.

6. You Can Drop the PPO and Keep the PPO Patients

If your staff is well-trained, highly skilled, caring, and professional, it’s possible for your dental practice to drop the PPO and yet still retain most of the PPO’s patients. This is true, as long as, the PPO offers some type of out-of-network benefits. Most patients remain loyal to their dentist they trust and feel comfortable with. These patients are willing to pay a little more out-of-pocket for excellent quality care. In most cases, if a dentist drops underpaying PPOs, they will be able to retain the majority of the PPO patients, and at a better reimbursement rate.

7. Accentuate the Positive

Whether your patient’s PPO plan considers your dental practice to be in-network or out-of-network, it’s important when talking to patients, to accentuate the positive. Let them know other patients with the same PPO use your practice. Point out PPOs generally allow patients to use any dentist they choose. Explain to your patient how you are different or better with the dental care provided to the patient. This will benefit them should it be necessary for them to get clearance from their company’s PPO plan administrator.

8. It Is Possible to Negotiate Higher PPO Reimbursement Fees

Dentists or PPO Negotiation Solutions, acting on their behalf, have successfully negotiated higher reimbursement rates from PPOs. The main reason most dentists haven’t gotten better reimbursement fees from insurance companies is because they haven’t tried. Perhaps because they don’t have the time to devote due to their busy post COVID patient schedule, or they fear patient loss, or are intimidated by the red tape that may be met with the PPOs. However, it is in the best interest of the insurance companies to keep as many dentists as possible providing services under their PPO plans. Dealing with PPOs from a position of strength, with full knowledge of relative competitive provider rates in your area, and a particular PPO’s reimbursement rate, relative to others for the same services, will ensure that the PPO compensates you fairly.

9. Consider PPO Negotiation and/or Reducing Participation

In an attempt to increase the number of patients they serve; many dentists opt to participate in PPO plans. However, over time and with careful analysis, you may soon realize you are losing tens of thousands of dollars, because of sub-standard reimbursement from insurance companies. If the PPO reimbursement rate for dental services you provide to patients is less than 80% of its actual value, you should consider first, negotiating your fee schedule with that insurance company, or possibly reducing your PPO participation.

10. Create a Strategy for Leaving The PPO

If you feel your dental practice is losing too much money serving one, or all, of your PPO patients and you have decided to leave the PPO, create a strategy that will fortify your practice and make a plan for how to replace any patients you may lose as a result . You can build up your practice in advance of terminating certain PPOs with an effective marketing strategy that will attract new patients. In this manner your production levels will not be interrupted. Make your staff aware of the changes you have planned. Share your vision for the dental practice. Provide your staff with ways to engage prospective patients responding to your marketing campaigns in order to maintain the level of success that it currently enjoys and surpass it. Your staff will play a valuable role in the transition.

Contact PPO Negotiation Solutions

PPO Negotiation Solutions has been negotiating and optimizing PPO participation since 2012. With 30 years of experience within the dental industry, our success is unparalleled in producing not only the greatest reimbursement revenue increases, but also, the most comprehensive, un-invasive approach. We provide no hassle results quickly, starting with a thorough assessment of your patient participation mix, often through remote access to your practice management software. Your fee schedules are then analyzed relative to other dental practices in your general area.
A negotiation/participation plan is formulated and agreed upon. We negotiate higher fee schedules on your behalf directly with our highly cultivated contacts within the PPOs and meticulously follow credentialing paperwork through the system until you are safely in network. Call us today to realize a minimum 24% increase in PPO reimbursement revenue. Successful completion usually means adding around $10,000 per month or $100,000 annually to your bottom-line and our service pays for itself in the first month.

Read More