PPO Negotiation Solutions

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Dental negotiations

Strategies for Dental PPO Negotiations and Credentialing

Negotiations and dental credentialing can seem like a lengthy and time-consuming process. But if you want to increase your profits and provide more services to your patients, they are necessary to keep your practice thriving. Here, we will discuss some strategies for dental PPO negotiations and tips for credentialing, including assessing your opportunities, renegotiating with insurance plans, and contracting your negotiations to a third-party specialist.

Importance of PPO Negotiations and Credentialing

First, let us talk about why PPO negotiations and credentialing are important and can benefit your dental practice. Put simply, credentialing is the process of verifying a dentist’s background for an insurance company. Patients prefer going to dental providers who are in-network with their insurance provider, as it saves them money. Many patients will neglect their dental care, due to not being able to afford regular care. Being credentialed with various insurance plans is important, to service more dental clients. Different insurances have different requirements for applications and credentialing processes.

In addition to credentialing, negotiating contracts with an insurance company can also increase your profits, as well as increase patient satisfaction. By negotiating fees and the reimbursement schedule with insurance companies and increasing your profit margin, you could better serve patient needs.

Assess Your Opportunities

Once you have decided to move forward with new negotiations, the first step is to assess your opportunities for growth. Explore different employers in your local community. What plans are the larger dental practices in-network with? What medical benefits do local organizations offer to their employees? Is there potential for a large gain in clientele if negotiating with that organization’s dental insurance plan?

Enrolling in a large organization’s insurance plan could increase competition between you and other dental practices. Contact the larger organization’s HR department in your area for marketing. Be sure to understand all the details of the plan first, to avoid any unneeded stress on your practice. Evaluate the potential workload and ensure your staff is equipped to handle the increased patient demand.

Let’s look at an example scenario for seizing an opportunity for growth. Assume that there is a large healthcare chain in your local area, and it owns several local hospitals, walk-in clinics, and medical offices. You could contact the HR department of the chain and find that they offer their employees a specific plan with Blue Cross Blue Shield. Enrolling in this plan would make you an in-network provider for all the organization’s employees, thus increasing your potential client gain.

Another way to boost profit for your dental practice is ensuring that you are not underutilizing dental codes. Assess this opportunity for improvement, and ensure your staff is adequately trained to code reimbursement forms effectively. Optimizing your insurance plan’s coding tools is essential to ensure increased revenue and the best patient outcomes. In addition to evaluating your coding process, also consider your cash prices. What are other dentists charging for services in your area? It may be beneficial to adjust your charges.

Do Not Be Afraid to Renegotiate

A general rule of thumb is that if it is not mentioned in the contract, it is not an offered service. Carefully review all contracts. Specify concerns and questions if the contract is not satisfactory, before signing. The ADA recommends dental practices to negotiate. Be aware of some insurance companies that are more difficult to navigate and weigh your pros and cons prior to entering a contract with their insurance.

For example, entering a contract with Medicaid can be a lengthy credentialing process. However, if a large population in your area carries Medicaid, it may be beneficial for your dental practice to accept Medicaid as an in-network service. When re-negotiating with an insurance plan, make sure you are updated on current plans in your area and what your fees should be. Leverage your knowledge of the area, and other dental practice’s fees. Also, contact the plan carrier and request a custom fee schedule based on your selected billing codes. Negotiating will save you time and money in the long haul.

Contract Out Your Negotiations

One helpful option is to contract out your negotiations to a third-party company, like PPO Negotiation Solutions. How can companies like PPO Negotiation Solutions be helpful? They can increase insurance reimbursements, create new patient opportunities and decrease negative impacts on patients. Their goal is to increase your revenue and increase your practice’s knowledge of insurance negotiations.

Outsourcing your negotiations could be helpful if you are a solo practice looking to boost your revenue. It can be difficult to stay up-to-date on the latest information. PPO Negotiation Solutions works full time on your dental contract negotiations, so you do not have to worry about neglecting other aspects of your dental practice. Save yourself the time and money and contact them today.

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Tips for Negotiating Dental Credentialing Contracts

As a dental practice, you are likely investing ample time and energy in your patients, to ensure the best patient outcomes. But are you also investing enough time and energy to ensure you are getting the most opportunities for growth and profit? Why is credentialing important and how can it help my dental practice? Since organizational growth and development equals positive patient outcomes, let us look at some successful tips to negotiate dental insurance credentialing contracts.

The Importance of Credentialing

First, it is important to understand why credentialing is important. In short, credentialing is the process of verifying a dentist’s background for an insurance company. Patients are now more likely to choose services from dental providers that are in-network with their insurance company due to costs. It is very important to be credentialed with various insurance plans. By credentialing with a wide number of popular plans, your client base can be greatly increased. Different insurance companies require different applications and processes to become credentialed with their organization. Weighing the pros and cons with each insurance provider is essential before entering a contract.

Assess Opportunities

Assess your opportunities for growth with different payment options and insurance companies. Explore in-network vs out-of-network opportunities. If your dental practice is in a populated area, explore different employers in your local community. Are there large organizations that carry a particular plan? If you were to enroll in their plan, is there potential for a large gain in clientele? Becoming in-network with that plan may be a good financial move.

Consider other competing dental practices in the area, as well. Enrolling in a large organization’s plan could increase competition between you and other practices. Contact the large organization’s HR department for marketing and insurance. But be sure to understand all the details of the plan first to avoid any unneeded stress on your practice. Evaluate the potential workload and ensure your staff is equipped to handle the increase in workload.

Here’s an example scenario for seizing an opportunity for growth. There is a large healthcare chain in your local area, and it owns several local hospitals, walk-in clinics, and offices. You contact the HR department of the chain and find that they use a particular insurance plan for the entire healthcare organization. Enrolling in this plan would make you an in-network dental provider to all employees of this chain, increasing your potential client gain.

Reimbursement Opportunities

Using a skilled negotiator to negotiate fees and credential scheduling can be a useful tactic. Stay up to date on the latest information about popular insurance plans. Even though some insurance companies advertise that they are non-negotiable, ask to negotiate. Some plans will only offer negotiation if you are a specialist, so be mindful, and consider hiring a negotiator.

Be aware of third-party companies. They may have better scheduling, but there could be hidden costs. If needed, consider outsourcing negotiations until your staff is up to date. The American Dental Association posted an article on their website encouraging dental companies to negotiate with insurance companies for higher reimbursement rates. The article stated that companies used to negotiate with insurances were “on the rise,” and a doctor in the article mentioned that it allowed her more time to focus on her patients. Carefully consider which negotiation specialist is right for you and your company.

Read the Fine Print and Renegotiate

It is safe to say that if it is not mentioned in the contract, it is not an offered service. Do not make assumptions. If you feel like there is something missing from the contract, investigate whether or not it is an offered service and request clarification in the contract. Be aware of some insurance companies with contracts that are more difficult to navigate and weigh the pros and cons of entering a contract.

For example, Medicaid can be difficult to navigate and typically requires a lengthy credentialing process. However, if a large population in your area carries Medicaid, it may be beneficial for your dental practice to offer Medicaid as an in-network service. If you are looking to re-negotiate with an insurance plan, make sure you are updated on current plans in your area and what your fees should be. Determine the leverage you can use by knowing what services you can offer in your area and the patient demand of the services. Contact the plan carrier and request a custom fee schedule based on your selected billing codes.

Company Contracts

Consider contracts with companies to do negotiations for you. How can companies like Strategic Practice Solutions be helpful? They can increase insurance reimbursements, create new patient opportunities and decrease negative impacts on patients. Their goal is to increase your revenue and increase your dental practice’s knowledge of insurance negotiations. They work full-time on your dental contract negotiations, so you can be free to better serve your patients. Save yourself the time and money and contact them today.

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Five Medical Billing and Practice Tips

Medical billing and coding for your dental practice can seem overwhelming. Taking a proactive approach to your medical billing process can save costs and lead to increased revenue for your dental practice. Being proactive means preventing problems before they happen. This can be done by establishing a clear collections process for patients, minimizing claims and coding errors, quickly responding to denied claims, and staying informed on the latest healthcare regulations. If these steps are not giving you the results you want, outsourcing to a professional company is also an option.

Establish a Clear Process for Payment Collection

A step-by-step process for payment collection should be available for patients upon entering your dental practice. Patients should have a clear understanding of what they should be expected to pay at their visit. This can be done by providing an agreement in their new-patient paperwork. Some practices also post signage to remind patients that they may be responsible for copays or out-of-pocket costs at the time of their visit.

Another way to ensure that payment is collected is to be sure the patient demographics and contact information is correct. Patient addresses, phone numbers, and insurance information should be verified at each visit. When insurance is verified with patients, make it a habit to also very eligibility. Patients may be mailed a bill for services, but also consider options for electronic billing via patient portals or a website.

Electronic billing can be an easier, hassle-free way for patients to pay their bills and can avoid missed or late payments. This can save time from a team member making follow-up payment calls. Ensure patients are aware of the various ways that they can pay for services, including financing options or other payment plans, and the methods of payment accepted at your dental practice.

Minimize Claim and Coding Errors

It can be easy to make a medical bill error. If a medical claim is rejected, the cycle for acceptance can take weeks to receive insurance reimbursement. Common sources of error to be aware of include incorrect patient information (name, birth date), incorrect billing information, duplicate billing, poor provider documentation of dental visit or procedure and missing procedural codes.

Double-check claims prior to submitting for diagnosis code errors. ICD codes should be specific to avoid claim denials. An article in Business News Daily calls auditing for errors “scrubbing,” which “generates cleaner claims, a reduction in denials and improved payor communication.” The article also suggests using technology as a way of error prevention.

Certain software automates steps in the claims process, such as “suggesting medical codes” and “checking medical claims against common insurance payor rules.” Use of this technology can save your practice time and money. The cost of the software and the time invested in training your team to use it can usually be recovered by the added revenue you will realize from reduced coding errors.

Respond to Denied and Rejected Claims

It is important to differentiate between rejected claims and denied claims. Claims can be rejected due to an error, like an incorrect patient name or incorrect insurance identification number. In that case, the claim could be resubmitted. It is an avoidable process that costs your dental practice more time and money.

A claim that has been denied has been deemed unpayable by the insurance company, usually due to contract terms. A denied claim may be appealed by the patient. This is a lengthy process for the patient and the dental practice, and may require more documentation on the part of the practice. Regardless of the reason for rejection or denial, prompt handling of the claim will result in faster reimbursement. Be ready to cooperate with patients who appeal rejected claims in order to facilitate faster payment.

Stay Informed

Healthcare is constantly changing and so are best patient care practices. To maximize your dental practice’s revenue, you should stay updated on the latest healthcare and dental care regulations. Medicare billing regulations are important to follow. It is likely that a significant amount of your patient population is covered by Medicare, and thus, errors could affect reimbursement rates.

Also, keep updated on problem patient payment accounts. For example, patients whose accounts are routinely late or are behind in payments should be regularly reminded to make payments, or possibly outsourced to a collection agency. Using the latest billing and coding software, as mentioned above, can also help you keep track of problem patients and make routine contacts to remind them of payment.

Consider Outsourcing

A vast amount of work goes into running a dental practice. From patient management to staff management to billing and claims management, there is a lot to manage! Sometimes, errors can fall through the cracks when there are so many other concerning issues, leading to denials, rejections and decreased revenue. Outsourcing medical billing to a professional company that specializes in these services can have several benefits.

Strategic Practice Solutions can offer dedicated staffing to handle claims processing, allowing you to have more time to focus on patient care. They are completely knowledgeable about the most recent healthcare rules and dental care regulations, so you do not have to worry about missing important information and updates. Other benefits include faster claim submissions and decreased claim errors. These professionals know dental coding and claims, and especially the most problematic ones. They can prevent many coding and billing problems that cause you headaches.

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What is Credentialing in Dental Care?

Dental credentialing is a process in which a dentist enters a contract with an insurance provider in order to offer those dental insurance benefits to clients. The benefit to the dentist is access to a larger client base and increased business opportunities. However, it can be a rigorous process to get credentialed by an insurance company. So, why would a dentist choose to be credentialed? If you choose to be credentialed, what is the process for doing so? This article will discuss the ins and outs of dental credentialing to get you started in the right direction for your dental practice.

Benefits of Credentialing

In order to enter a contract, dentists must provide proof of a dental degree and license, malpractice insurance, and law compliance. It is important to read through a contract before signing it. The contract gives details about the insurance plan and will also list what a dentist can and cannot charge a patient for specific dental services.

Sometimes, an insurance company will state that some services are not billable. For example, if a patient’s temporary crown becomes loose and needs to be replaced, insurance may state in its terms that this is not a billable service. But for self-pay or out-of-network, a dentist might bill a charge to replace a temporary crown. These may seem like cons to credentialing. However, many patients rely on dental insurance to afford dental care. Often, patients will refuse dental care based on their out-of-pocket costs.

Dentists within the same dental practice can choose to either be “in-network” or “out-of-network” with the same insurance provider. Each dentist will be credentialed individually if they choose to be in-network. Take time to explore which insurance providers are common in your area, and which ones will most affect your client base before entering contracts.

How to Get Credentialed

Once you have decided to move forward and join with an insurance company, there are a few steps that you need to take. First, you will need to do a full application before reaching out to dental insurance companies. This can be made easier by using the credentialing tool on the American Dental Association’s website. It will give you a list of documents that you will need. These include your NPI number, dental license, proof of malpractice insurance, DEA certificate, specialized degrees or certificates and professional references.

Once your application is submitted, you can reach out to dental companies and make inquiries. Begin by going to the company’s website and looking for an option to join their network. After submitting an inquiry, the company will send you a contract. Make sure you receive a fee schedule, and thoroughly review it. Negotiate to your approval. Sign only when you are satisfied with the results.

Tips for a Smoother Application Process

Now that you know the importance of credentialing and the basics of how to get started, let us discuss how to get the process done quickly and efficiently so that you can get to taking care of your patients.

First, make sure that you enter a response for each application question. Even if it does not apply to you, enter “N/A” rather than leaving it blank.

Next, make sure your malpractice insurance, all submitted forms, and signatures are updated. The credentialing process can take several months, and you do not want it to take longer due to a clerical error that was preventable.

Once you submit the application, confirm it was received. Routine follow-ups via email with insurance companies are important. Keep a log of who you contacted, when and what the details of the response. Routine follow-up will ensure you get the responses in the timeliest manner. It can be a painful process, but will be worth it for both your patients and your practice.

Beware of Medicaid

Depending on the size of your practice, there are some insurances you may want to look out for when it comes to choosing with whom you want to enter a contact. Medicaid insurances require a few more steps and a bit more effort to maintain and therefore may be recommended for larger practices. For one, it is two different application processes – one process with the state, and another with a managed care company. You will need a state Medicaid provider number. And typically, the credentialing process takes longer than other insurances. It may take more time in consistent follow-up emails and phone calls.

Getting credentialed for your dental practice is time-consuming and leaves less time to focus on your patients. There is another option. Consider outsourcing and hiring a third-party company to take over this process for you. Companies like Strategic Practice Solutions can provide company training for office managers to help dentists keep up with credentialing or manage it all for you. Contact them today for your dental practice needs.

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How to Improve Patient Communication

Good provider-to-patient communication is essential in a dental practice. Studies have shown the value and essential relationships between good provider communication and positive patient outcomes. In a rapidly changing healthcare world where more technology is utilized, it’s important to improve and maintain good communication with patients.

This article will discuss more about why communication is important. And, what steps you can take to improve communication in your dental practice. Also, it includes maintaining positive nonverbal communication, being respectful of patients, simplifying patient interactions, making good first and final impressions.

What are the Benefits of Improved Communication?

The most obvious benefit of improved communication is patient satisfaction. People like to be well-informed about their health care status and plan of care. When patients are satisfied with the communication between themselves and their dental care provider, they are more likely to return to the same dental practice for their oral care needs.

There is a correlation between adverse events with patients and poor communication. An article that summarizes a Health Grades report from May 2012 demonstrates that this has been true for years. In the report, hospitals that were ranked by patients in the top percentages for nursing and physician communication had lower rates of adverse patient safety events. For example, bedsores occurred approximately 46% more frequently in hospitals that patients had ranked in the lowest 10% for provider communication.

An article by TeamHealth lists several more benefits, including patient adherence, lower readmission rates, improved mortality rates, lower malpractice risk, and reduction in care costs. Also noted are reduced adverse advents and medical errors. Simply improving how a practitioner communicates with a patient can have a drastic effect on both the patient and the entire medical or dental practice.

How can you improve patient communication in your dental practice?

Improve Nonverbal Communication

Sometimes our actions speak louder than words. Possibly, the easiest changes we can make in the way we communicate is in our nonverbal communication. Examples of negative nonverbal communication include frowning, foot-tapping, crossing arms, rolling eyes, grunting, or sighing. Our non-verbal communication can present as being pushy, impatient, or uncaring even if that is not our intention. Be mindful of how you appear to your patients. Maintaining an open stance and smiling can make all the difference in an encounter.

Be Respectful

This point can seem obvious; however, there are some things people do unintentionally that can make others feel disrespected. Typically, one could say to follow the “golden rule” that states to treat others the way you want to be treated. But in today’s world, we often come across many cultural differences, and not everyone wishes to be treated the same. There are few pointers, though, that can generally be used across the board to show respect.

One of those ways is through active listening. Active listening involves maintaining eye contact, focusing on your patient, and asking appropriate questions to ensure that you understand your patient correctly. This lets your patient know that you are engaged and care about their well-being.

Another way to show respect is to greet patients by their formal names. Examples are Mrs. Jones or Mr. Smith. If you know your patient well, or if they have asked, it is acceptable to call them by their first names, but using a name can make an encounter more personable.

Make Interactions Easier

As dental providers, we can sometimes get caught up in the medical jargon when explaining a diagnosis and processes to patients. And, patients may not always stop you to ask questions when they do not understand. This can lead to non-compliance, mistakes, and patient dissatisfaction. Try to simplify the conversation and use layman’s terms when discussing each patient’s dental diagnosis and treatment options. Use short sentences and allow ample time for patients to respond with questions. Finally, provide simple written instructions, if necessary, to ensure that patients do not forget important topics that were discussed at their visit.

End on a Good Note

We discussed the importance of greetings and first impressions, but last impressions are also important. After the completion of a dental care visit, follow up by asking the patient if there are more questions or concerns that you, as their dental provider, could address during the visit. Summarize the visit and review the next steps, including follow-up appointments, testing, and treatment plans.

It can be helpful to end the visit with positive words, such as, “I hope you feel better now” or “Hang in there, you are making progress!” A positive ending to every dental visit will make a patient feel cared for, important and valued, and much more likely to return to your dental practice.

Consult an Expert

Have you tried to improve communication in the workplace but still feel like you could use some more training? Consult a professional agency that specializes in workplace communications. Strategic Practice Solutions provides private consulting and team member review to provide a customized approach to help your business thrive.

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5 Tips to Grow Your Dental Practice

Every dental practice wants to experience healthy growth. It is important to continue working on ways to improve and grow your dental practice. Patient satisfaction and safety are the goals, but financial success and the satisfaction of your team members are also important for success! Some tips include setting short and long-term goals, investing in your team, maintaining a positive work environment, and increase or change your marketing strategies. Let’s explore these in more detail.

Set Goals

Identify what needs you have in your practice. Notice trends and analyze data. One business blog suggests using tools to assess your needs, such as SWOT analysis, benchmarking, market research, trend analysis, and attending webinars. Once you have identified your needs, set your goals. Goals should be specific, measurable, attainable, relevant, and time-bound (S.M.A.R.T. goals). Always set a time frame to achieve each goal and prioritize your goals for orderly pursuit and success.

In order to achieve a goal, you need a plan. How much time do you expect to need to achieve your short and long-term goals? Obtain resources, set your budget, and assign responsibilities to those participating in the process. It is helpful to measure results throughout the process as well as at the end. Measuring results can assist in the setting of new goals. Never stop asking, “How can we do this better?”

Invest in Your Team

Team members should be adequately trained for the position they hold and have the tools needed to perform efficiently. This could include leadership training, sales training and human resource training. Don’t forget opportunities for professional advancement. Having good and open communication with your team allows them to communicate their workplace needs. Well-trained employees can make all the difference in a successful thriving business.

Investing in your team does not just apply to their training, however. Treat your team members with respect. Invest in what will make them satisfied working at your business. Show them appreciation often and be sure to inquire about what would help the workplace morale. Happy team members are more likely to invest time and effort into their work, leading to increased revenue and patient satisfaction for your practice. What are some ways that you are currently investing in your team? How could you improve?

Maintain a Positive Culture

A positive work environment is essential to a successful business. Your team should be clear on expectations and standards. Positive culture should carry over to patient care. Patients then should also be clear on expectations and standards. Positive work environments can be obtained by keeping a positive attitude, having open communication with team members, and maintaining a culture of respect. Allow for your team members’ feedback – good and bad! Prioritize respect, diversity, and inclusivity.

Maintaining a positive culture also means ensuring that you are hiring the right team members into your culture. When hiring new staff, keep your current staff dynamics and needs in mind. It could be helpful to do peer interviews and invite your team members’ opinions on the potential hire. Hiring the wrong person could have a negative effect on your practice culture. Your practice’s culture is what you make it!

Increase Marketing

News flash! You need patients to have a dental practice! Your biggest marketer is a body of satisfied patients; with this dynamic at work, your business will grow through word-of-mouth advertising, which is really the best form of marketing. As a dental provider, you need to ensure that your current patients trust you to provide them with quality care and invest in their health.

Take it up a notch and do follow-up personal calls to patients or send personalized mail. Begin a regular monthly email newsletter to keep your patients informed. People value trust and respect, especially with their health care providers. Direct connection establishes loyalty. Loyal patients will continue investing in your business and market your business, as well. Social media is another popular way to market your business.

If you do not already have a website, get one and keep it updated with the services you offer, schedules, and even a bio profile of your employees to make it personable. Promoting ads on social media platforms is another option. According to an ad by Forbes, social media marketing is critical, with almost a third of 16-24 year-olds learning about new products and services through paid ads on popular social media platforms. It goes on to state that social media is a popular way that customers hear about new products.

Get Professional Help

A professional company to assist in marketing your practice is also an option. Some companies can not only assist in marketing but also provide training and marketing strategy management. If you are not familiar with managing a website or social media, consider hiring a professional to do so. It can make all the difference when looking to gain new clientele.

Strategic Practice Solutions is your one-stop shop for assistance with training your team, setting your goals, and being proactive in growing your dental practice. Do not settle for mediocre when you can accomplish more with the help of a team of experts. We are ready to help you be successful! Contact us today and start growing your business!

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