As a dental practice, you are likely investing ample time and energy in your patients, to ensure the best patient outcomes. But are you also investing enough time and energy to ensure you are getting the most opportunities for growth and profit? Since organizational growth and development equals positive patient outcomes, let us look at some successful tips for dental insurance credentialing.
Importance of Credentialing
First, it is important to understand why credentialing is important. In short, credentialing is the process of verifying a dentist’s background for an insurance company. Patients are now more likely to choose to go to providers that are in-network with their insurance due to costs. It is very important to be credentialed with various insurance plans. By credentialing with a various number of popular plans, client base can be greatly increased.
Assess your opportunities for growth. If your dental practice is in a populated area, explore different employers in your local community. Are there large organizations that carry a particular plan? If you were to enroll in their plan, is there potential for a large gain in clientele? Consider other competing dental practices in the area, as well.
Enrolling in a large organization’s plan could increase competition between you and other practices. Contact the large organization’s HR department for marketing. But 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 increase in workload.
An example scenario for seizing an opportunity for growth would be a large healthcare chain in your local area that owns several local hospitals, walk-in clinics and offices. You contact the HR department of the chain and find that they use a particular insurance plan for the entire healthcare chain. Enrolling in this plan would make you an in-network provider to all employees of this chain, increasing your potential client gain.
Consider Current Clients
Consider your current clients. Are the majority in-network or out-of-network with your current plans? If you were to make a major change, how would that affect your revenue? There may be the possibility of losing current clients if you were to no longer accept their insurance plans at your business. On the other side, could changing to this plan be beneficial to the majority of your current patients? It may allow patients to receive more dental care or procedures they otherwise could not afford. Your current patients’ satisfaction is equally as important as gaining more clients.
To place this point in perspective, say your clinic has approximately 50% of clients with one plan and 50% with another major plan. If your clinic were to go out-of-network with one of the major plans, you could potentially lose 50% of your patients if they were to decide to switch to a different office that was in-network. If a large amount of your patients are out-of-network with a plan and could be in-network, you could make a larger profit and the patient may have more benefits, as well.
Using a skilled negotiator to negotiate fees and credential scheduling can be a useful tactic. Stay up to date on the latest information about popular insurance plans. Even though some insurance companies advertise that they are non-negotiable, ask to negotiate! Some plans will only offer negotiation if you are a specialist, so be mindful and consider hiring a negotiator. Be aware of third-party companies. They may have better scheduling, but there could be hidden costs.
If needed, consider outsourcing negotiations until your staff is up to date. The American Dental Association posted an article on their website, encouraging dental companies to negotiate with insurance companies. The article stated that companies used to negotiate with insurances were “on the rise” and a doctor in the article mentioned that it allowed her more time to focus on her patients. Carefully consider which negotiation specialist is right for you and your company.
More profit for your business could be obtained by ensuring that you are not underutilizing dental codes. Are you aware of all the dental plans in which you are enrolled? Ensure your staff is adequately trained to code reimbursement forms effectively. Optimizing your insurance plan’s coding tools effectively is essential to ensure increased revenue and to ensure the best patient outcomes. Another tactic is to explore the cash prices being charged by other dentists in your area. You want to be sure you are charging enough for your services.
Consider contracts with companies to do negotiations for you. How can companies like PPO Negotiation Solutions be helpful? They can increase insurance reimbursements, create new patient opportunities and decrease negative impacts on patients. The Mission of PPO Negotiation Solutions is to “enrich dental practices, not only through increasing their revenue, but also their understanding, while streamlining processes for optimal day to day well-being.”