PPO Negotiation Solutions

We Level The Playing Field Between Dental Practices and Insurance Companies

Dental negotiations

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 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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10 Tips for Private Equity Stockholders and DSOs to Optimize PPO

Insurance negotiations and credentialing are essential parts of maintaining a dental practice. To have the most profit, negotiations for fee schedules will need to be done regularly and by someone who is trained and familiar with the processes. Providers credentialed with a variety of insurance will benefit from the most patient flow and retention. Let’s look at 10 easy tips to optimize these negotiations and, ultimately, guarantee patient retention.

Know Your Current Situation

It is important to understand the importance of PPOs, and how they affect patient retention in your practice. Be well-informed of your current PPO contracts. Review your current fee structure and parameters of all contracts. Are your contracts affecting multiple DSO locations, if applicable? Next, make note of the annual revenue for each PPO in each of your locations. For example, if your dental practice is close to a major company, like a hospital, it would be beneficial to explore their dental provider benefits.

Maintain a Stable Environment

Credentialing and negotiations, while necessary, can be a lengthy process. High employment turnover can affect the process and can drastically impact patient turnover and revenue. It can lengthen the process due to new employees needing to be credentialed or trained on new policies. Try to maintain your workplace and staff, to ensure adequate patient flow during the credentialing and negotiation processes.

Review Standard Practice Fees

The reason to review fees is to maintain the price of services and safeguard against inflation and neglect. Standard fees should be reviewed regularly by someone who values input from different departments. Also, consider factoring in multiple outside data sources to ensure your team has made an accurate assessment. If adequate, then use the data for your pricing model and to renegotiate adequately for new fees when the time comes.

Define Your Desired Outcomes

To be successful, define your objectives and goals early in the negotiation process. Your goals may change throughout the process. As goals change, ensure you are also developing success plans for each goal. It is recommended to have both short-term and long-term goals that are measurable and attainable. Each goal should have objectives or steps to achieve the result. Once goals are set, circle back and monitor your progress frequently to ensure you are staying on track.

Develop a Process to Collect and Analyze Data

Analyze your current process for collecting, processing, and comparing data. How can your current process be improved to be most efficient? Having a goal for analyzing processes is needed to ensure that no time or money is being wasted on insufficient processes. Once you have fine-tuned your process, monitor and periodically reassess for improvements, asking yourself if goals are being achieved in a timely manner.

Be Patient, but Persistent

Like mentioned earlier, negotiation and credentialing processes can be lengthy and time-consuming. Having an expert team working on negotiations can make for a smoother process. Maintain open communication and communicate frequently to ensure the process is running efficiently and to avoid delays. It may be helpful to set benchmarks for responses and follow up with representatives if responses are not received timely. If you do have a specialized team performing these duties for you, make a point to be in frequent communication with them to ensure they are following up on contracts efficiently.

Respect Confidentiality

It is important to honor confidentiality agreements without exception. Using an unrelated organization’s compensations in a negotiation is irrelevant and a confidentiality breach. Promote and emphasize confidentiality to all team members. Breaching confidentiality can negatively impact your DSO contracts and patient retention.

Communicate Proactively

Be prepared for questions from those not involved in the decision-making process, especially when big changes are being implemented. Understandably, the changes may incite anxiety in some team members. Examples of change include adding new plans or becoming out of network with payors. Communicate updates with staff throughout the process and, if necessary, provide training and support to help them adjust and be efficient in their roles.

Keep Track of Agreements

Keep track of all new agreements. The effective dates will vary throughout the year. Every agreement should be honored for at least two years before negotiating again. For example, review monthly which contracts are ending and plan to follow up with negotiations. Staying on top of negotiation contracts will ensure your practice is getting the best fees.

Obtain Adequate Resources

As your dental organization grows, there will be more profits at stake when negotiating with insurances. Use your most educated experts to assist in negotiations. If needed, contact a professional third party for managing the tasks of credentialing and negotiations. PPO Negotiation Solutions can increase your practice revenue and assist in streamlining your processes for improved outcomes. Contact the professionals today and let them help your practice thrive!

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Resilient Dental Practices During and After the Pandemic

The methods for patient care in dental practices changed drastically in 2020. In March 2020, the CDC released a statement recommending that dental practices postpone elective procedures, surgeries, and non-urgent visits. Although the recommendations have been updated and more elective procedures were allowed, the COVID-19 virus is still present, and it is unknown what the future holds for businesses and healthcare.

Due to the pandemic, dental practices had to get creative with how they cared for patients, with many adopting virtual services to provide care. Let’s talk about some ways that dental practices have maintained their business during the pandemic that are still being utilized today.

Loans and Grants

Due to the need to cancel and postpone many patient appointments, dental practices had to investigate ways to sustain themselves financially for the short term. The CARES Act, introduced in 2020, included financial assistance for businesses, including paycheck protection programs, emergency Economic Injury Disaster Loans (EIDL), delayed payroll tax payments, enhanced unemployment benefits, and more. Small Business Administration loans were available to assist with payroll-related costs, mortgage payments, and even utilities. These financial options were very beneficial to dental practices in 2020, and some benefits are still being used today as some practices still struggle to return to normalcy.

Review of Insurance Plans

Another way that dental practices could help their revenue during the pandemic is to audit their fee schedules with insurance plans. Typically, contracts are due for negotiation after two years. The purpose of reviewing fees is to maintain the price of services and prevent inflation and neglect. Investigate to see which insurance fees are due for negotiation. Before negotiating, review some negotiating tips to ensure you are getting the best fees. Communicate regularly with insurance providers and team members about changes in plans.

Chart Auditing

Understandably, patients over the last year and a half have likely suffered from financial hardships. You may not have been auditing charts as frequently due to giving patients a grace period to bring their accounts up to date. However, now that things are getting back to normal, it would be a good time to audit patient charts for late payments and missed payments. When reaching out to patients to collect a payment, ensure they are aware of your payment plan options, and assist them in working out a plan that will work for them and the dental practice.

Updating Your Dental Practice’s Website

Recently, people have been using the internet more than ever. When businesses were shut down for the pandemic, many began to utilize electronic means of communication. Your business website is especially important to maintain patient contact, educate patients, manage appointments, and receive payment for services. An easy-to-use and visually appealing website is also a marketing strategy to attract new clients. If your website has not been recently updated or is not user-friendly, make some updates to attract new patients and promote better communication with them. Once updated, track your website metrics and monitor for needed improvements and changes.

Promoting a Better Office Culture

Staffing changes, layoffs, and financial hardships have likely impacted your office culture. Take note of your staff’s needs during this difficult time. Promote a positive work environment by being helpful and maintaining a positive attitude. Ask your team what you can do to make their time at work more enjoyable. Review some tips for improving your office culture. Happy staff is more likely to stay with their jobs. And patients will also benefit from the positive and healing environment.

Improve Communication

Communication has changed from in-person to mostly virtual over the last year. Your staff has likely perfected the various forms of virtual communication with the use of telehealth. But some people may be a little rusty with in-person communications now that dental practices have reopened. Review patient communication basics with your team. Encourage clear, detailed, and frequent communication with patients before, during, and after their visit. Notate some important communication tips to share with your team.

Update Procedures and Equipment

Now would be a perfect time to update your systems, equipment, and even protocols for your dental office. Advanced patient care is needed during this time to really recover from possible losses. Patients will be impressed by advanced technologies and improved treatment options. Once necessary improvements and updates are made, promote the changes on your website, social media, and by word of mouth to attract new patients.

Outsourcing

Outsourcing your negotiations and credentialing could be very beneficial as your dental practice recovers from 2020. A team of professionals would assist in the following:

  • negotiation of PPO fees
  • credentialing providers,
  • reviewing your current processes for possible improvement

 

  • PPO Negotiation Solutions can also provide education on how to better improve your processes, recover losses and ensure better financial outcomes. Call or click today to let them improve your dental practice and assist with recovery opportunities.
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