PPO Negotiation Solutions

We Level The Playing Field Between Dental Practices and Insurance Companies

credentialing

Why Should You Outsource Credentialing?

The process of credentialing verifies dentists and those who assist them are properly trained and certified and have the experience to provide dental services to patients. It also ensures high standards of safety are met. If a dental office does not have the proper medical credentialing, it typically cannot obtain reimbursements from insurance services including Medicaid/Medicare. All types of medical software are designed to be utilized by offices that are medically credentialed. There is no way to thrive in the dental industry without proper credentialing.

It is of the utmost importance that all dental professionals have an understanding of medical credentialing. It is paramount to make sure all medical professionals are proven qualified to treat patients. The process of keeping up with credentialing is difficult and time-consuming; however, it is necessary so everyone in your dental practice remains in-network to decrease the chance for loss of income.

Credentialing does require a mountain of paperwork, which includes proof of the following:

  • education
  • residency
  • training
  • work history
  • licenses if required
  • specialty certificates
  • malpractice history.

The process must be repeated every 2-3 years to remain in the insurance network. 

Let’s take a look at some reasons your dental practice should outsource the credentialing process. Save your dental staff the headaches, as well as make the process go smoothly and end positively for everyone. 

Avoid Missed Deadlines

Did you know you can fail to re-credential just by missing the deadline date? This can cause the serious problem of falling out of network and will cost your practice in the long run. If you outsource, this issue can be avoided. The party you choose to complete these actions for you will track the schedules, send reminders, and make sure all required paperwork is submitted correctly and on time. Problem solved!

Reduce Staff Stress

It requires so much time to credential, and it puts a ton of stress on your administrative team. Not only are they required to keep up their regular routine, but they also have the added burden of all the other paperwork. If you choose to outsource the work, you can rest in knowing you have an experienced and knowledgeable team that knows the process well. As a result, the credentialing and re-credentialing will be done correctly and will leave your dental team free to focus on your patients.

Improve Accuracy and Efficiency

Whomever you choose to outsource your credentialing services will have the most up-to-date software to assist them with the process. This will reduce the chance of manual errors in spreadsheets, paper documents, and checklists spread everywhere. Cloud-based systems make it much easier to verify, update, and check for errors.

Get a Better Fee Schedule

If you decide to re-credential, you may just quickly begin the process without thinking about reviewing the terms of your current contract with the insurance provider and missing out on the opportunity to negotiate something better. If you outsource, you will have the benefit of an experienced representative to look over your previous contract and advise you whether to renew, renegotiate, or look for other options.

Get the Support You Need

If you outsource, you also have the opportunity to choose how much support you want or need by utilizing your chosen credentialing source to access tools to assist you with tracking information you require, such as licenses, fee schedules, and deadline reminders. You will also have personal support from someone who is experienced and can answer any questions you may encounter.

Having fully credentialed dentists and staff makes your patients more confident about their dental care. It also makes your dental practice more attractive to other employees such as dentists, hygienists, dental assistants, and support staff. Your professionalism will be irrefutable with access to all your documentation, as well as an assurance to all your current and new patients. Credentialing is proof to private health insurance companies, so your staff can work with patients. It helps to decrease medical errors.

Any new team member candidates should begin the process of credentialing as soon as possible, as it could take up to four months to complete the process. Human resource staff may want to create and prepare credentialing packets to help them. It is important to try to identify any delays that could be encountered during credentialing new hires, so your dental practice does not skip a beat in patient care and revenue continues to flow.

PPO Negotiation Solutions is a trusted partner to many dental practices just like yours. We have built an impeccable reputation after 30 years of experience. Our unique process helps to save your dental practice time and increases your new patient prospects. PPO Negotiation Solutions helps you operate your dental office with PPOs from a position of power! Contact us today!

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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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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 Make UCR Work for Your Practice

How your dental practice gets paid is of supreme importance. There are numerous elements that surround the entire area of accounts receivables, and it literally “pays” be know how these aspects factor into your overall income strategy. A working knowledge of UCR can actually benefit your dental practice and help you avoid financial losses.

First, let us define what UCR is as it pertains to dentistry. The acronym stands for usual, customary and reasonable. However, to many dentistry practices, it seems rather unreasonable and not at all fair. Basically, the term UCR applies to the fees and reimbursements that insurance companies pay to dentistry offices for services. It has been adopted by dentistry and can be found on EOB (Explanation of Benefits) forms that offices use to request reimbursement from insurance plans. Since the reimbursement amounts can often seem unfair, here are some ways to make UCR work for your practice and avoid taking a financial loss.

Understanding UCR

UCR is not actually a number; instead, it is a range of numbers based on percentages. Insurance companies will pay out a certain percentage based on the cost of a dental procedure. Even though it is based on percentages, there is also a cap on how much the company will pay for each procedure and insurance will pay out whichever cost is less. Zip code and percentage plays a large factor in determining UCR at insurance companies. Geographical area has some weigh-in on the amount that insurance will pay. Let us look at an example.

In your geographical area, let us assume that the majority of dentists chart $200 for a crown; so, the insurance company would set the fee at $200. Let us say that your office charges $150 for crowns. A patient’s insurance plan pays 50% toward the charge, which is $75, leaving a $75 remaining balance. In another scenario, let us say your office charges more than the average $200; say you charge $300. Insurance would still pay 50%, or $150 and there would be a $150 balance remaining.

How UCR Affects Your Practice

Dentist offices may be forced to lower charges for services in their area to retain clients. However, lowering charges for services too much can result in a financial loss to the business. Knowing UCR levels could mean increased revenue for your business.

An article details a hypothetical scenario about an average dentist office’s profit: “…dental practice grossing $400,000 per year. The average overhead in a $400,000 practice is 70 percent. If our hypothetical office is open 40 hours per week, 50 weeks per year, then the dentist works 2,000 hours per year. The office overhead is $280,000. Total overhead ($280,000) divided by 2,000 hours gives us an hourly overhead of $140. That is the fixed overhead before the doctor is paid a single penny.

Now say a patient were to come in needing a prophylactic cleaning and claimed it to be covered at 100%.” …the office submits the claim form. The fee for the cleaning was $85, the overhead cost was $140, and the doctor`s/hygienist`s salary must be added to that. The office just lost $55, plus the salary of the doctor/hygienist.”

In another explanation of the effects on patients and business, it is stated, “In situations where a single company serves one geographical area, their usual, customary and reasonable fee schedule affects the prices of dental services in the area. Where a dentist charges more than the set usual, customary and reasonable fees, they have no option but to lower their fees in line with the average charges in the area. Consequently, when a dentist realizes that they charge less than what is set in their area of practice, the chances are that they will raise their fees.”

How to Make UCR Work for You

One item on your agenda should be analyzing your fees. By assuming that you will only be reimbursed 70%, for example, you could be losing money. Different plans could be paying 80% or even 90% but could be reimbursing you less money because you are charging less for your services. Routinely monitor your EOBs (explanation of benefits) and find out which plans cover at what percentages.

Pre-certification and pre-authorization are easy steps to take to ensure maximum benefits. Pre-certification verifies that a patient is active with an insurance plan. Pre-authorization involves submitting a request for treatment to insurance for payment. Some insurance companies require this for payment! Verifying benefits can be combined with the pre-authorization process. You want to be sure that the procedure you are requesting to be performed is covered under the patient’s insurance plan.

So how can companies like PPO Negotiation Solutions help your business? PPO Negotiation Solutions has an eight-step process to save you money and increase your revenue. Part of that process is to evaluate your current UCR and PPO fee schedules in comparison with other dental practices in your area. Also work on PPO fee negotiations, provider credentialing, and staff education. Let the experts educate you and set you on the path to success. Call or click today!

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Tips for Dental Insurance Credentialing

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? Since organizational growth and development equals positive patient outcomes, let us look at some successful tips for dental insurance credentialing.

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 to go to providers that are in-network with their insurance due to costs. It is very important to be credentialed with various insurance plans. By credentialing with a various number of popular plans, client base can be greatly increased.

Assess Opportunities

Assess your opportunities for growth. 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? 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. 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.

An example scenario for seizing an opportunity for growth would be a large healthcare chain in your local area that 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 chain. Enrolling in this plan would make you an in-network provider to all employees of this chain, increasing your potential client gain.

Consider Current Clients

Consider your current clients. Are the majority in-network or out-of-network with your current plans? If you were to make a major change, how would that affect your revenue? There may be the possibility of losing current clients if you were to no longer accept their insurance plans at your business. On the other side, could changing to this plan be beneficial to the majority of your current patients? It may allow patients to receive more dental care or procedures they otherwise could not afford. Your current patients’ satisfaction is equally as important as gaining more clients.

To place this point in perspective, say your clinic has approximately 50% of clients with one plan and 50% with another major plan. If your clinic were to go out-of-network with one of the major plans, you could potentially lose 50% of your patients if they were to decide to switch to a different office that was in-network. If a large amount of your patients are out-of-network with a plan and could be in-network, you could make a larger profit and the patient may have more benefits, as well.

Reimbursement Opportunities-Negotiation

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. 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.

Dig Deeper

More profit for your business could be obtained by ensuring that you are not underutilizing dental codes. Are you aware of all the dental plans in which you are enrolled? Ensure your staff is adequately trained to code reimbursement forms effectively. Optimizing your insurance plan’s coding tools effectively is essential to ensure increased revenue and to ensure the best patient outcomes. Another tactic is to explore the cash prices being charged by other dentists in your area. You want to be sure you are charging enough for your services.

Company Contracts

Consider contracts with companies to do negotiations for you. How can companies like PPO Negotiation Solutions be helpful? They can increase insurance reimbursements, create new patient opportunities and decrease negative impacts on patients. The Mission of PPO Negotiation Solutions is to “enrich dental practices, not only through increasing their revenue, but also their understanding, while streamlining processes for optimal day to day well-being.”

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