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.