You negotiated the fee increase. Your own fee schedule may be quietly cancelling it. The Rule Most Practices Forget Dental claims are paid at the lesser of your UCR fee or your contracted fee. Always. If you negotiate a $1,150 contracted fee on a crown but your office fee for that crown is $1,100, the […]
Read MoreMedicare Advantage Dental Networks: Should Your Practice Participate?
Your patients are turning 65. Some of them are about to bring an insurance plan you don’t accept. The Shift Is Already Here In 2007, about 19% of eligible Medicare beneficiaries were enrolled in Medicare Advantage. By 2025, that number reached 54%, roughly 34 million people, according to KFF. The Congressional Budget Office projects it […]
Read MoreThe Practice Asked What Its Plans Paid. The Better Question Was What Its Chairs Were Doing
Client Profile Multi-provider general practice, Midwest metro suburb Engagement PPO Participation & Optimization Assessment Execution Window 6–8 months | Complexity: Level 4 Identified Opportunity $63,000 in projected annual gains The Situation PPO Negotiation Solutions had worked with this practice once before — during an ownership transition, handling the credentialing that established network participation and positioned […]
Read MoreDSO PPO Strategy: What Mid-Size Groups Get Wrong
DSOs and mid-size dental groups have leverage single-location practices don’t. Most don’t use it — and it costs them millions. A dental group with 5, 10, or 20 locations has structural advantages a single-location practice cannot access: Combined patient volume across geographies Multiple provider footprints in carrier networks Ability to selectively participate by location Negotiation […]
Read MoreThe ROI of PPO Negotiation: What to Actually Expect
Practices ask us what ROI to expect from PPO negotiation. The honest answer requires some math — and some honesty about what the ceiling actually is. Before hiring a PPO negotiation firm, most practice owners ask a version of the same question: “What’s the ROI?” It’s a fair question. It’s also a question with a […]
Read MoreHow to Audit EOBs Against Your Negotiated Fee Schedule
Your fee schedule is only worth what the carrier actually pays on it. A regular EOB audit is how you know. Signing a PPO contract with a negotiated fee schedule protects you against underpayment — in theory. In practice, carriers make mistakes, apply the wrong fee schedule to specific procedures, or misroute claims through leased […]
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