📈 Case Study: How One Practice Used UCR Optimization to Boost PPO Negotiation Power

The numbers don’t lie: Most dental practices are leaving thousands of dollars on the table every
month—and they don’t even realize it. Why? Because their UCR fee schedules are outdated,
undervalued, and silently sabotaging their PPO contracts.

In this case study, we share how one growth-focused dental practice overcame that exact
problem—transforming a 40–50% write-off rate into a scalable, high-production machine
through strategic UCR fee optimization and PPO renegotiation.

👤 Meet Dr. Janahgiri: Ambitious, Patient-Centered, and Drowning in Write-Offs

When Dr. Janahgiri opened his dental practice in 2011, he was laser-focused on growth. Like
many new practice owners, he signed up with every PPO network he could—hoping the influx
of insured patients would build his base quickly.

And it worked—at first.

Within a few years, his practice was consistently booked, his staff was growing, and he had built
a solid reputation in his community.

But there was a problem hiding under the surface:
🔍 He was writing off nearly 50% of his production.

His UCR fee schedule hadn’t been touched since he opened, and as a result:

• His PPO reimbursements were stagnating
• Profit margins were razor-thin
• He couldn’t reinvest in technology, marketing, or his growing team

“I knew something wasn’t adding up. We were busier than ever—but our collections just didn’t
reflect that.”
— Dr. Janahgiri

🧩 The Real Problem: Outdated UCR Fees = No Negotiation Leverage

Dr. Janahgiri’s billing specialist referred him to PPO Negotiation Solutions, recognizing that
the problem wasn’t just a PPO issue—it was structural.

Upon review, our team uncovered:

• A significant gap between his UCR fees and market averages (many fell in the 40th
percentile)
• Multiple PPO contracts paying below industry benchmarks

• No clear strategy for updating fee schedules or leveraging UCR data in negotiations

His undervalued UCR fees were actively capping his PPO reimbursements—and limiting his
ability to grow.

🔧 Our Solution: A Strategic UCR-to-PPO Optimization Plan

We implemented a phased, data-driven strategy to rebuild Dr. Janahgiri’s fee architecture from
the ground up. Here’s how:

Step 1: Comprehensive UCR Fee Analysis

We compared his current fees to ZIP code-specific UCR benchmarks using industry percentile
data.

Key findings:

• 70% of his top 40 procedures were priced below the 50th percentile
• Crown and restorative codes were underpriced by 20–30%
• Preventive and diagnostic fees were aligned to PPO rates (a big red flag)

📌 Recommendation: Adjust UCR fees to 75th percentile for general dentistry, 80th percentile
for specialty codes.

Step 2: Rebuild and Implement New UCR Fee Schedule

We helped Dr. Janahgiri:

• Create a new UCR fee schedule aligned with regional norms and profitability goals
• Phase in the updated fees gradually to minimize patient resistance
• Update his practice management system and treatment plans to reflect the new UCRs

Most importantly: Every new UCR fee was now strategically higher than the highest
contracted PPO rate—preserving future leverage.

Step 3: Timeline-Based PPO Contract Negotiations

Armed with a more competitive UCR schedule, we moved to renegotiate key PPO contracts—
starting with:

• His highest volume payers
• Contracts closest to renewal
• Plans with historically poor reimbursements

Our approach:

• Submitted updated UCRs and detailed rationale
• Demonstrated regional fee benchmarking
• Focused on high-impact CDT codes tied to production
• Spread negotiations over 12 months to avoid disruption

📌 Note: Having recently updated UCRs was crucial—without it, the PPOs wouldn’t consider a
fee adjustment.

💰 The Results: Doubling Production, Slashing Write-Offs, Reinvesting in Growth

Over the next 18 months, Dr. Janahgiri saw dramatic improvements:

Metric                                               Before                                    After

Average Write-Off %                      47%                                       29%

Monthly Production                     ~$120,000                           ~$240,000

PPO Reimbursement Increase         —                                       +17% avg across top 5 PPOs

Technology Budget                         Limited                               Added CBCT & upgraded chairs

Marketing Budget                          $0/month                             $2,000/month investment

Patient Volume                                Flat                                        +22% growth year-over-year

Beyond the numbers:

• Dr. Janahgiri was able to reinvest in technology, hiring, and community outreach
• He had greater clarity on the value of his services
• His front office team was more confident in presenting fees and explaining insurance
write-offs

“I finally felt like I was in control of the financial health of my practice. And that gave me the
freedom to think bigger.”
— Dr. Janahgiri

🧠 Lessons Learned for Any Dental Practice

If you’re struggling with low PPO reimbursements or feel like you’re working harder for less—
it’s time to look upstream.

Here’s what Dr. Janahgiri’s case teaches us:

✅ 1. UCR Fees Are the Foundation of Your Profitability

If your UCR fees aren’t up to date, nothing else works—not your membership plans, your PPO
negotiations, or your fee-for-service growth.

✅ 2. PPO Negotiation Without UCR Optimization Is a Dead End

You can’t ask for higher fees if your UCRs are lower than the PPO’s current allowances. Your
“full fee” is your proof of value.

✅ 3. It’s Never Too Late to Fix Your Fee Schedule

Even practices that have been in-network for a decade can course-correct—with the right data,
plan, and timeline.

🔍 Is It Time to Rebuild Your UCR Strategy?

If you’re not sure how your UCR fees stack up—or if your PPO contracts are holding you
hostage—start with a simple question:

“When was the last time we reviewed or updated our full fee schedule?”

If the answer is:

• “I don’t know”
• “We just copy the PPO fees”
• “It’s been years”

Then it’s time to take action.

🧭 Let’s Build a UCR-to-PPO Strategy That Works

PPO Negotiation Solutions offers:

• 📊 Custom UCR Fee Analysis Reports
• 📆 Strategic PPO Renegotiation Timelines
• 📁 Fee Schedule Rebuilds
• 🧑‍ 🏫 Training for Billing and Front Office Teams
• 🧩 Practice-Specific Profitability Consulting

We don’t just negotiate contracts—we help you build the foundation that makes those
negotiations successful.

📞 Book a Discovery Call and let’s talk about your numbers, your goals, and how we can
bridge the gap.