PPO Negotiation Solutions

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Dental negotiations

Navigating PPO Negotiations in the Dental Industry

Why are PPO negotiations so important? Many dentists wish to avoid this complex and time-consuming process altogether, but errors in your PPO negotiations can cost you serious money.

Did you know?

  • Dentists write off nearly 40% of PPO reimbursements. That’s almost $4,000 of every $10,000 you make on insured patients!
  • It takes over 30 hours to complete credentialing for a dental office.
  • 7 out of 10 dental startups do not set their UCR fees correctly.

Navigating PPO negotiations in the dental industry can be daunting for dental practices of all sizes. Participating in PPO networks can be a great way to attract new patients, but it can also be a significant financial burden if not managed properly.

Essential PPO Dynamics for Better Financial Success

A Preferred Provider Organization (PPO) is a group of dentists under a joint contract to charge specific fees for approved services. Dentists and specialists in a PPO network agree to provide services at discounted rates ranging from 25% to 50% less than the provider’s usual and customary rates.

Here are some essential dynamics to consider when negotiating or renegotiating your PPO contract.

Understand Your Costs

Before entering into any negotiations, it’s essential to understand your costs. You need to know the cost of the following:

  • Property rental or ownership
  • Property upkeep
  • Utilities
  • Insurance
  • Supplies
  • Taxes (local, state, & federal)
  • Employees (salary, benefits, training, etc.)
  • Professional fees & associations
  • Marketing

An accurate evaluation of your operational costs is critical to determine your pricing and profit margins. Knowing your costs is also essential for determining where to reduce costs for a more significant profit.

Know Your Worth

It’s essential to know your worth when negotiating with PPO networks. You need to understand what your services are worth and how they compare to other dental practices in your area. This information can help you negotiate better rates with PPO networks.

A vital aspect of understanding your worth involves setting your fee schedule. Your “usual, customary, and reasonable” (UCR) fees are the guidelines by which an out-of-network dentist can charge a patient if the dentist is not a member of the patient’s PPO network.

You must adequately balance your fee schedule to at least 80% to ensure your practice remains competitive while allowing room for future negotiations. All your PPO contracts with insurance providers are based on your UCR fee schedule. Therefore, make sure you balance your fees before you negotiate for a PPO reimbursement contract.

Negotiate from a Position of Strength

The dual knowledge of your costs and worth above allows you to negotiate from a position of strength. Insurance companies desire a popular and vital dental practice. They want profitable practices in their PPO network because this makes them a healthy profit, too. With accurate knowledge of your needs and a good idea of your overall value, you can push for better fees and benefits from the PPO.

Be Flexible

This may seem contradictory to the above topic, but it is integral to negotiations. Being willing to compromise on some terms, and knowing where to compromise, can often win you a much better overall PPO contact. For example, you may need to accept a lower reimbursement rate for specific procedures, like those you don’t often do, in exchange for higher reimbursement rates for more popular procedures. Dentists willing to give and take for the greater good will find PPO negotiations go smoother and often more in their favor.

Keep Up with Industry Changes

Like everything else, today’s dental industry is constantly changing, and keeping up with those changes is essential. This includes changes in reimbursement rates, new technologies, and changes in regulations. Staying informed can help you negotiate better deals with PPO networks. Sometimes this means you should begin offering unique or specialized services to meet modern patient demands. This can often mean investing in new equipment and training for yourself and your team, so consider those costs in your PPO negotiations.

Consider Outsourcing Your PPO Negotiations

Outsourcing your PPO negotiations to PPO Negotiation Solutions can save you time and money. Our team of seasoned PPO negotiators can negotiate on your behalf and help you get better rates with PPO networks. They can also keep up with industry changes and ensure you get the best deals possible. When we negotiate better deals with your PPO networks, this attracts more patients to your dental practice and significantly increases your profitability.

We help:

  • Startups
  • Fee-for-Service Practices
  • Established PPO Practices
  • Practices Seeking to Add Associates
  • Those Seeking to Purchase a Practice
  • Those Needing Assistance with Credentialing

Take our PPO Revenue Assessment to determine which PPO contracts may be eligible for negotiations and an estimated revenue increase. Or, contact us today to schedule a consultation to discuss your unique needs.

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Harnessing the Power of Dental PPO Negotiations

Harnessing the Power of Dental PPO Negotiations

As a dentist, you likely understand the importance of negotiating with PPOs (preferred provider organizations) to maximize your practice’s revenue potential. And if you don’t yet understand, you should. PPOs are a type of dental insurance plan that contracts with dental providers to offer discounted rates to their members.

For instance, a patient may purchase a healthcare plan through an insurance company and that insurance company may contract with you to be one of their preferred providers. If you are a preferred provider, patients who see you will pay a lower cost because you are in-network, meaning you have a contract agreement with the insurance company. While PPOs can increase patient volume, they can also come with challenges like low reimbursement rates and limited treatment options.

Fortunately, there are several strategies you can use to effectively negotiate PPO contracts and increase your practice’s profitability. Here are some things you should know about the basics of PPO negotiations. Also, here are some tips that will give you the ability to successfully navigate the process.

Understanding Dental PPO Negotiations

Dental PPO negotiations can be complex and time-consuming, but they’re also a crucial part of growing your dental practice. There are a few key concepts to keep in mind if you want to negotiate a PPO contract:

You need to know your numbers. Before you enter negotiations with a PPO, it’s essential to understand your practice’s financials inside and out. If you’re already involved in a contract, you need to have a crystal-clear idea of the following:

  • your dental practice’s revenue
  • dental practice’s expenses
  • profit margins
  • how much you receive from PPO reimbursements

Knowing your numbers will give you a clear picture of your practice’s finances and help you make informed decisions during negotiations.

You also need to have a clear understanding of the PPO’s policies. It’s important to thoroughly review the PPO’s policies and procedures before beginning the negotiation process. This includes understanding their fee schedules and payment policies. Remember – this is not only something that can affect you and your staff. A PPO can affect your patients as well. This can affect the treatment options your patients have at your practice, so be sure you understand any limitations on treatment options. Having a clear understanding of these policies will help you negotiate more effectively and avoid any surprises down the line.

Also, it’s worth noting that negotiating with PPOs requires preparation and strategy. Before entering into negotiations, it’s essential to have a clear understanding of your practice’s value proposition. This includes the quality of care you provide and the services you offer. You should also have a plan for how to approach negotiations and a clear understanding of your bottom line.

Tips for Successful Dental PPO Negotiations

Now that you understand the basics of PPO negotiations, you can dive into some specific strategies to maximize your reimbursement and harness that negotiation power.

When walking into a negotiation, know what you have to offer and be confident in your value – know what you can use as leverage. As previously mentioned, understanding the value of your practice’s proposition is key to successful PPO negotiations which involve:

  • being able to effectively communicate the quality of care you provide
  • communicate your treatment philosophy
  • convey the services you offer

By highlighting your practice’s strengths, you can demonstrate your value to the PPO. You can also negotiate for higher reimbursement rates and fewer restrictions.

Another powerful tool you have available to you is knowing the data from your practice and making that data available as proof of your value during negotiations. Track your practice’s performance metrics so you can demonstrate its value and negotiate for better reimbursement. Patient retention rates and treatment case acceptance are just some of these performance metrics that you can track. You can also use data to identify areas where you can improve your practice such as:

  • increasing patient volume
  • optimizing your treatment options

While knowing your worth is potentially the most important thing you can do, it can help to build relationships with PPO representatives. If you’re able to cultivate positive relationships, you may find that you can negotiate more effectively. Moreover, building a more profitable practice which includes the following:

  • communicating with representatives regularly
  • providing feedback on their policies
  • being willing to negotiate in an honorable, trustworthy manner

By building trust and rapport with PPO representatives, you can increase your chances of successfully negotiating for higher reimbursement rates.

Finally, it’s important to remember that you always have the option to walk away from a PPO contract if the terms are not favorable. While it can be tempting to accept lower reimbursement rates or unfavorable policies to bolster the number of incoming patients, accepting that lower offer may ultimately harm your practice’s bottom line. By being willing to walk away from unfavorable contracts, you can protect your practice’s financial health and remain open to negotiating for better terms in the future.

If you’re ready to learn how to harness the power of negotiation and sign the dotted line under the most favorable terms for you and your patients, PPO Negotiation Solutions can help. We can get you started with assessments for your practice available at no cost to you and a consultation to discuss the terms you’re looking for in a PPO. Contact PPO Negotiation Solutions today!

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A Comprehensive Guide to Dental PPO Negotiation Solutions

As a dentist, you want to provide high-quality care to your patients while also running a profitable practice. One way to do this is to participate in a Preferred Provider Organization (PPO), which can help increase your patient volume and bring in more revenue. However, optimizing your PPO may be necessary. This means you may have to negotiate with insurance providers to ensure your costs are covered while also getting the added benefits of a PPO, which can prove to be a challenging task.

Here’s a comprehensive guide for dentists wanting to negotiate the costs of your practice being a PPO.

Understand and Prep

Before entering PPO negotiation, it’s essential to understand the negotiation process. The negotiation process involves several steps, such as preparation, initiation, negotiation, and agreement.

To prepare yourself before entering negotiations, you first need to identify your goals. Before negotiating anything, you need to know what you want. Figure out what it is that you need in return from your insurance provider.

Before negotiations start need to have a very idea of your dental practice’s financial situation. Be fully aware of things like revenue, expenses, profit margins, and how much you currently receive from PPO reimbursements. Knowing your numbers will help you make informed decisions during negotiations.

It also helps to have have a clear understanding of the PPO’s policies. Review the PPO’s policies and procedures before beginning the negotiation process so you understand things such as their fee schedules and payment policies. This has the potential to affect treatment options for your patients and procedures that your staff can perform, so be sure to understand any limitations.

Initiation and Negotiation

Once you feel you’ve properly prepared yourself to negotiate with success and you’re ready to initiate the process, call your provider’s representative or submit a request for negotiation. If you’re feeling a little shaky, don’t be afraid to bring in some reinforcements. Agencies like PPO Negotiation Solutions are here to help negotiate the lowest fees and the highest amount of revenue.

During the negotiation process, be strategic about asking for what you want. Don’t be shy about laying out what it is that your practice needs to be successful, but being flexible and willing to compromise is also important. Some strategies you might find useful include using your own data to back up requests, leveraging unique or valuable aspects of your practice, and simply just building rapport with your insurance provider.

Just as it was important to know your practice’s financial health, it’s important to know what your practice is doing. Go into negotiations with a clear goal in mind from your prep work and when you ask for what you want to achieve your goal, use the data from your practice to provide a sort of collateral to your insurance provider. Reports from practice management software may help to be persuasive.

Also, using unique aspects of your practice to your advantage can be a good negotiation strategy. For example, if you are the only dental practice in your region with a certain piece of technology or you’re located in a very rural area, insurance providers may be willing to negotiate with you to keep their customers happy.

Just generally good relationships never hurt anyone either. You want to stay on the good side of your insurance representative. A muffin basket never hurt anyone now and again.

Agreement

If you have done all the work to create goals for your dental practice, you understand what your practice requires to be successful, you’ve researched PPO policies, you’ve built strategies, and you have at last won the battle of negotiation with your insurance provider, then it is time to sign the agreement. Be sure to take a good look at the contract and make sure it spells out clearly the requirements of each party and that everything documented in the contract was thoroughly discussed and agreed upon.

In this stage of the process, you may find that an attorney or an agency such as PPO Negotiation Solutions can be especially helpful. It’s important to understand that you do have the option to walk away from a PPO contract if the terms are not favorable or the contract is not what you agreed upon in negotiation.

While it may be tempting to accept terms even if they have you seeing less revenue just for the added benefits of seeing an increased number of incoming patients, accepting an offer you didn’t want may ultimately harm your practice. Terms are still negotiable before you sign the contract, so be sure that what you agree to on paper truly agrees with the goals you set for your practice.

Negotiating fees and reimbursement rates can be a lot of work. Let PPO Negotiation Solutions take the hard work out of PPO contracts. Contact us to schedule a consultation and get started increasing your revenue today!

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How to Choose the Best PPO Negotiator

If you desire to be an in-network (PPO) provider, it is of utmost importance to negotiate fees for your participation right from the beginning. Once you have made the decision to become an in-network provider, you want to negotiate your initial contract and fees as quickly as possible, as becoming credentialed and actually gaining in-network status can take 90-120 days. Most contracts are for a term of 18 to 24 months. Be sure to make a note on your calendar when fees may be re-negotiated and allow plenty of time for this process. Or you may want to hire the best PPO negotiator.

Take the following steps before deciding to join a PPO:

Review the Plan Carefully

Make sure the PPO you are considering covers procedures offered by your practice. It may be a good idea to contact the PPO and request their most current contract, a copy of their processing policy, and the in-network fee schedule. Consider these things carefully to make sure your dental practice and the PPO are compatible. Ask the best PPO negotiator to help review the plan.

Know Your PPO Patient Coverage

The decision you make now will have a great impact on your bottom line in the future. As a result, you may want to determine the number of patients you have who are covered by each PPO plan before you decide on a particular PPO. The success of your practice depends upon this decision.

Setting Your UCR Fees

Get an idea of the fees for services of other dental offices in your immediate geographical area. A good place to begin is in the 80th percentile of others in the area. You do not want to set your fees too low, as you will be re-negotiating the fees in the future. It is important to have some bargaining power and room to negotiate an increase in fees in the future.

Know the PPO Plans Offered In the Target Patient Area

Make a list of the largest employers in your target area for patients such as schools, hospitals, federal, and state offices. Contact their human resources departments and inquire who holds the contract for their dental benefits. Joining these PPOs would be a great way to gain new patients for your practice.

Organize Plan Information Being Considered

As you continue to gather plan information from a variety of PPOs, keep all information organized in some type of folder. As you accept assignments from networks, move your contracts and fee schedules to a large binder with dividers for each insurance carrier. Be sure to label the dates of re-negotiation where they can be seen easily.

List Your Practice’s Top 30 Production Codes

Most dental practices can account for the top 90% of their billable production with 30 codes. If your practice is set up with a program to determine such percentages, you may be able to access a report to determine this figure. If you have prepared a list, you can compare PPOs that offer coverage for your most frequently billed services.

List Negotiating Leverages In Your Favor

Some things to consider as you negotiate your contract and fees with a PPO are the number of dental professionals in your area, specialties offered, hours of availability, teledentistry availability, electronic claim processing, EFT enabled, and online portals for pre-authorization. Ask if they share networks with other insurance carriers. You can always opt-out of any such agreements if you wish by writing a letter stating your opt-out preference.

Initiate Negotiations By Email

Verify any discussions you have with an email to the network recruiter. Ask for a fee schedule containing the top 30 codes from the list you created. Set a time for them to respond to your proposal. Be prepared for the fact that some insurance carriers do not negotiate. Review the fees you are offered and send in a counter-proposal if you are not satisfied. Once you do accept a fee schedule, keep a list of them. Audit your claims regularly to be sure the fees you agreed upon are being honored.

The dentist in question should negotiate their own contracts and fees with PPOs. For the most part, dentists have a much greater opportunity to attain more favorable fees. You must be persistent during the negotiation process. Organization of materials is extremely important. Remember to always be polite during this lengthy process. There is always also the possibility of staying out-of-network. If you make this decision, be prepared to treat more patients in less time. This decision gives you the freedom to treat more patients, but your fees will be lower.

If you are considering becoming a member of a PPO or dropping membership, let PPO Negotiation Solutions, the best dental PPO negotiator, assist you! Contact one of our consultants before making this critical decision for your dental practice. We can help you to work smarter and get paid better. Contact us today to schedule a consultation!

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How Does Negotiating Dental Fees Impact Your Business?

Due to the effects of the COVID-19 pandemic, dental offices are increasing infection control standards. The American Dental Association (ADA) has issued recommendations to control the transmission of infection, which closely align with the guidelines from the Centers for Disease Control. As a result of the new infection guidelines and the need for additional personal protective equipment, dental offices are negotiating dental fees in order to cover the cost of care increase.

Negotiating with each benefit provider for increases in fees should be done by each dentist individually. Be prepared to do your homework to have the most accurate information from everything, from a list of the strengths of your practice to which procedure codes used by your practice generate the most revenue. Be sure to be prepared to quote the exact date of the last time you negotiated dental fees with your insurance carriers and your special circumstances for re-negotiation.

Increased Profitability

Most dentists do not think of raising fees very often. However, if you never negotiate for a raise in dental fees, you cannot make the necessary improvements to allow your practice to grow and thrive. You must keep making investments to keep your current patient base and attract more patients in order to remain profitable. If fees are never increased, this limits the success of your practice. This will also begin to hurt your overall patient experience.

The result of raising fees at a reasonable rate enables you to:

  • continue to invest in training
  • invest in technology
  • invest in upgrades to your dental practice

Developing a fee schedule and negotiating dental fees periodically is key to the success of your practice. When fees are raised, ensure the amount is across the board for all fees. The American Dental Association offers a survey of dental fees to assist you.

Practice Growth

No matter how successful your dental practice becomes, there is always room for improvement. Your patients expect you to provide excellent service and care. A good way to continue experiencing practice growth is to keep your website current and credible. The internet is used by practically every consumer, and they need to be able to find your practice.

Another idea is to implement a patient reminder system to confirm and/or reschedule appointments. Most patients are familiar with a text-based reminder system to engage them in a familiar manner. You may want to ask each patient how they would like to receive a reminder of their next appointment. Consider new opportunities to connect with your patients and promote your office advances to them. This will make them confident in your care and build your credibility with them.

The “Bottom-Line”

Dental offices, like any other type of service-oriented business, have to make a profit to remain open. Not only do you want to remain in business, but you also want to employ talented dental professionals. Also, to stay up-to-date on the latest treatments and technology. There has to be an acceptable balance between profitability and patient well-being. In order for your practice to employ successful hygienists and provide the kind of quality care the patient expects, negotiating dental fees must be done in a knowledgeable way to create a profitable practice.

Things to consider are basic overhead such as rent, team member salaries, equipment costs, and insurance. Other things to consider are not so tangible, such as office production, dentist production, patient education, hygiene percentages, preventive percentages, and restorative percentages. These considerations should always be at the forefront when negotiating dental fees to maintain the appropriate balance between numbers and patient care. To achieve this balance, you must offer the patients care through education and prevention, which will in turn, guide them to their needed treatment plan.

As you build relationships with patients and educate them on the appropriate treatments, you build mutual trust. This adds value to the dental practice and will positively impact your patients. There are many ways to increase dental practice revenue. You as the dentist must be in the driver’s seat and have a current understanding of where your dental practice stands in regard to location, patient data, team member data, and overhead expenses in order to negotiate dental fees with providers that will continue to sustain a thriving dental practice.

One way to remain on top of the game when it comes to negotiating dental fees and “level the playing field,” so to speak, is to hire a professional to take your information and negotiate the fees on your behalf. The team at PPO Negotiation Solutions are experts in their field and have been negotiating dental fees for 30 years. They have an impeccable reputation and have the negotiation process down to a science. It will save you precious time you can devote to your patients and their care. Check out their complimentary assessment and schedule your consultation today!

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What You Should Know About Insurance Negotiations

Did you know you can negotiate fee reimbursement rates with an insurance company as a dental service provider? You can and you should! Negotiated fees are fees a dentist who is “in-network” agrees to accept as payment for services provided to the patient, less co-payments, deductibles, cost sharing and benefit maximums.

Insurance companies do not pay all dentists the same for the same exact services they each provide. Every extra dollar your dental practice negotiates with an insurance company for services rendered is another dollar in your pocket. Negotiated fees are subject to change, as they can be re-negotiated once the contract with the insurance company for reimbursement has ended. This generally occurs every 18-24 months. It is very important to remember the terms and period of your contract with insurance providers to be in a position to re-negotiate, and hopefully, receive fee increases. A good practice to get in the habit of is reviewing your fee schedules on an annual basis, as it is usually the dentist that initiates the re-negotiating process.

Negotiating fees has dramatically changed recently and is a lot of work. It is truly a difficult process. For instance, many costs have increased recently due to the COVID-19 pandemic. There are added costs for PPE, plexiglas shielding and air purifying systems. Let’s look into what is involved with negotiating fees with insurance companies.

Know Where You Stand

You must have accurate information to begin choosing what and how to negotiate with insurance companies. First, review your current office fee schedule. Examine them to find out how you compare with other dental practices in your local area. Maintain your bargaining power by making sure your fee schedule is not too low. Make sure your UCR fees are in the 80th percentile with other practices in your zip code.

You must be organized when negotiating fee schedule offers and remain politely persistent. Keep negotiating until all offers have been exhausted. Once you have agreed upon fees with an insurance provider, make sure to audit your insurance claims over the next three months to confirm the insurance provider is honoring the agreed-upon fee schedule. As a matter of fact, healthy protocol says to audit a dozen claims every six months to maintain the honor of the fee schedule.

Know Your Insurance Providers

Next is to determine the number of insurance companies with which you actually have a contract. You should have contracts with at least 10-plus insurance companies. Also, if you are contracted by one insurance company, it may turn out you are contracted with several companies. A lot of insurance companies contract with each other to share patients and fees. Always read the fine print when signing contracts with insurance providers, and remember to only sign with insurance companies you feel are necessary for your dental practice.

A good way to begin researching local insurance providers is to call the Human Resources Departments of businesses in your area to ask which company holds the contract for their dental benefits. Find out what plans are offered by the local major employers in your patient area. Don’t forget to consider schools, hospitals, federal and state offices and large nationally-owned companies. You may discover new opportunities to update your current plans with other plan agreements that will benefit your practice.

Know Your Leverage

When negotiating with insurance providers, be sure to make the provider aware of the ways it could benefit from entering a contract with your dental practice. To represent your leverage as a service provider, be knowledgeable about the following:

  1. Added per patient cost due to COVID-19 related changes
  2. Saturation of dentists in your area
  3. Specialty services offered
  4. Appointment availability for new patients and current subscribers
  5. Your philosophy of care regarding preventive services
  6. Availability of teledentistry
  7. Your patient satisfaction rate
  8. Electronic claim processing capacity
  9. EFT-enabled for receipt of claims payments
  10. Use of online portals for eligibility and pre-authorizations
  11. Date of last contract increase compared to cost of living increase for same time

Know Your Dental Office Production

Based on your dental office production, determine which CDT codes are at the top of the list for your dental practice. Ninety percent of your practice’s billable production is usually covered by approximately 30 codes. Dental offices use these Current Dental Terminology codes to identify dental procedures which cover oral health. A procedural code has an alphanumeric code beginning with the letter “D” followed by four numbers. These codes are maintained by the American Dental Association (ADA).

Contact the Carriers

The final step is to contact the insurance carrier to speak to an agent, retention specialist or provider relations

manager/specialist to initiate the negotiations. Plan to discuss your decrease in revenue under your current contract along with all the advantages to the carrier your dental practice can provide. Ask for a review and increase in fee reimbursement for your top 30 codes. Inquire about receiving an additional per-visit fee to cover the addition of PPE expenses.

Ask the carrier if they have a co-lease agreement or network share agreement with any other carriers. Review the fees offered to you by the carrier and do not be afraid to make counter-proposals. Finally, when you accept fees, keep a detailed list of the contracts accepted, terms and all final fee schedules.

After consideration of all the steps involved in the negotiation of fees with insurance providers for your dental practice, you may decide negotiating with insurance companies appears to be too time consuming and too difficult. There are companies specifically designed to help you. These companies represent hundreds of dental offices and are familiar with negotiating with insurance companies. PPO Negotiation Solutions is there to help you! Contact them for your complimentary assessment and schedule a consultation today!

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