As a dentist, you want to provide high-quality care to your patients while also running a profitable practice. One way to do this is to participate in a Preferred Provider Organization (PPO), which can help increase your patient volume and bring in more revenue. However, optimizing your PPO may be necessary. This means you may have to negotiate with insurance providers to ensure your costs are covered while also getting the added benefits of a PPO, which can prove to be a challenging task.
Here’s a comprehensive guide for dentists wanting to negotiate the costs of your practice being a PPO.
Understand and Prep
Before entering PPO negotiation, it’s essential to understand the negotiation process. The negotiation process involves several steps, such as preparation, initiation, negotiation, and agreement.
To prepare yourself before entering negotiations, you first need to identify your goals. Before negotiating anything, you need to know what you want. Figure out what it is that you need in return from your insurance provider.
Before negotiations start need to have a very idea of your dental practice’s financial situation. Be fully aware of things like revenue, expenses, profit margins, and how much you currently receive from PPO reimbursements. Knowing your numbers will help you make informed decisions during negotiations.
It also helps to have have a clear understanding of the PPO’s policies. Review the PPO’s policies and procedures before beginning the negotiation process so you understand things such as their fee schedules and payment policies. This has the potential to affect treatment options for your patients and procedures that your staff can perform, so be sure to understand any limitations.
Initiation and Negotiation
Once you feel you’ve properly prepared yourself to negotiate with success and you’re ready to initiate the process, call your provider’s representative or submit a request for negotiation. If you’re feeling a little shaky, don’t be afraid to bring in some reinforcements. Agencies like PPO Negotiation Solutions are here to help negotiate the lowest fees and the highest amount of revenue.
During the negotiation process, be strategic about asking for what you want. Don’t be shy about laying out what it is that your practice needs to be successful, but being flexible and willing to compromise is also important. Some strategies you might find useful include using your own data to back up requests, leveraging unique or valuable aspects of your practice, and simply just building rapport with your insurance provider.
Just as it was important to know your practice’s financial health, it’s important to know what your practice is doing. Go into negotiations with a clear goal in mind from your prep work and when you ask for what you want to achieve your goal, use the data from your practice to provide a sort of collateral to your insurance provider. Reports from practice management software may help to be persuasive.
Also, using unique aspects of your practice to your advantage can be a good negotiation strategy. For example, if you are the only dental practice in your region with a certain piece of technology or you’re located in a very rural area, insurance providers may be willing to negotiate with you to keep their customers happy.
Just generally good relationships never hurt anyone either. You want to stay on the good side of your insurance representative. A muffin basket never hurt anyone now and again.
If you have done all the work to create goals for your dental practice, you understand what your practice requires to be successful, you’ve researched PPO policies, you’ve built strategies, and you have at last won the battle of negotiation with your insurance provider, then it is time to sign the agreement. Be sure to take a good look at the contract and make sure it spells out clearly the requirements of each party and that everything documented in the contract was thoroughly discussed and agreed upon.
In this stage of the process, you may find that an attorney or an agency such as PPO Negotiation Solutions can be especially helpful. It’s important to understand that you do have the option to walk away from a PPO contract if the terms are not favorable or the contract is not what you agreed upon in negotiation.
While it may be tempting to accept terms even if they have you seeing less revenue just for the added benefits of seeing an increased number of incoming patients, accepting an offer you didn’t want may ultimately harm your practice. Terms are still negotiable before you sign the contract, so be sure that what you agree to on paper truly agrees with the goals you set for your practice.
Negotiating fees and reimbursement rates can be a lot of work. Let PPO Negotiation Solutions take the hard work out of PPO contracts. Contact us to schedule a consultation and get started increasing your revenue today!