If you desire to be an in-network (PPO) provider, it is of utmost importance to negotiate fees for your participation right from the beginning. Once you have made the decision to become an in-network provider, you want to negotiate your initial contract and fees as quickly as possible, as becoming credentialed and actually gaining in-network status can take 90-120 days. Most contracts are for a term of 18 to 24 months. Be sure to make a note on your calendar when fees may be re-negotiated and allow plenty of time for this process. Or you may want to hire the best PPO negotiator.
Take the following steps before deciding to join a PPO:
Review the Plan Carefully
Make sure the PPO you are considering covers procedures offered by your practice. It may be a good idea to contact the PPO and request their most current contract, a copy of their processing policy, and the in-network fee schedule. Consider these things carefully to make sure your dental practice and the PPO are compatible. Ask the best PPO negotiator to help review the plan.
Know Your PPO Patient Coverage
The decision you make now will have a great impact on your bottom line in the future. As a result, you may want to determine the number of patients you have who are covered by each PPO plan before you decide on a particular PPO. The success of your practice depends upon this decision.
Setting Your UCR Fees
Get an idea of the fees for services of other dental offices in your immediate geographical area. A good place to begin is in the 80th percentile of others in the area. You do not want to set your fees too low, as you will be re-negotiating the fees in the future. It is important to have some bargaining power and room to negotiate an increase in fees in the future.
Know the PPO Plans Offered In the Target Patient Area
Make a list of the largest employers in your target area for patients such as schools, hospitals, federal, and state offices. Contact their human resources departments and inquire who holds the contract for their dental benefits. Joining these PPOs would be a great way to gain new patients for your practice.
Organize Plan Information Being Considered
As you continue to gather plan information from a variety of PPOs, keep all information organized in some type of folder. As you accept assignments from networks, move your contracts and fee schedules to a large binder with dividers for each insurance carrier. Be sure to label the dates of re-negotiation where they can be seen easily.
List Your Practice’s Top 30 Production Codes
Most dental practices can account for the top 90% of their billable production with 30 codes. If your practice is set up with a program to determine such percentages, you may be able to access a report to determine this figure. If you have prepared a list, you can compare PPOs that offer coverage for your most frequently billed services.
List Negotiating Leverages In Your Favor
Some things to consider as you negotiate your contract and fees with a PPO are the number of dental professionals in your area, specialties offered, hours of availability, teledentistry availability, electronic claim processing, EFT enabled, and online portals for pre-authorization. Ask if they share networks with other insurance carriers. You can always opt-out of any such agreements if you wish by writing a letter stating your opt-out preference.
Initiate Negotiations By Email
Verify any discussions you have with an email to the network recruiter. Ask for a fee schedule containing the top 30 codes from the list you created. Set a time for them to respond to your proposal. Be prepared for the fact that some insurance carriers do not negotiate. Review the fees you are offered and send in a counter-proposal if you are not satisfied. Once you do accept a fee schedule, keep a list of them. Audit your claims regularly to be sure the fees you agreed upon are being honored.
The dentist in question should negotiate their own contracts and fees with PPOs. For the most part, dentists have a much greater opportunity to attain more favorable fees. You must be persistent during the negotiation process. Organization of materials is extremely important. Remember to always be polite during this lengthy process. There is always also the possibility of staying out-of-network. If you make this decision, be prepared to treat more patients in less time. This decision gives you the freedom to treat more patients, but your fees will be lower.
If you are considering becoming a member of a PPO or dropping membership, let PPO Negotiation Solutions, the best dental PPO negotiator, assist you! Contact one of our consultants before making this critical decision for your dental practice. We can help you to work smarter and get paid better. Contact us today to schedule a consultation!