If you decide to become an in-network (PPO) provider, from the very beginning it is of utmost importance to negotiate contract fees. Keep a record of your contract dates to be proactive in having the ability to re-negotiate your contracts. Most contracts for fees have a term of 18-24 months. In order to maintain your bargaining power as a new general practitioner, review your current office fee schedule. And use fees in at least the 80th percentile in your area of operation. These few beginning steps will assure your dental practice fees remain re-negotiable.
Examine Your Current Fee Schedule
You must not set your UCR fee schedule too low or you will not remain competitive and lose your bargaining power. Who are the major employers in the closest vicinity to your dental practice? Make a list and call their offices or human resources departments. And find out who the contract holder is for their dental benefits. The list should include schools, hospitals, manufacturing facilities with a worldwide impact and state, local and federal offices in the area. Take a look at their plans and compare their fees to the PPO fees you are about to re-negotiate. Which of the plans would offer you the best marketability for new patients?
Determine Your Top Procedure Codes
Your top 30 codes allow you to see where 90% of the production in your practice is attributed. These codes are important in determining your re-negotiation results. You may prepare a report called “Report by Procedure” to determine your top 30 codes for your practice. The CDT codes are reviewed and revised each year. If the incorrect codes are used, even by mistake, it can postpone or disable your reimbursement of claims. It may also result in charges of fraud or violations of state or federal laws. It is very important for your practice to purchase a new CDT each year. This is a manual printed annually by ADA that includes the Code on Dental Procedures and Nomenclature (CDT Code). This code contains the procedural codes for oral health and services provided in dentistry.
Determine Your Negotiating Leverage
Your practice may have a negotiating leverage because of its location, specialties, hours of operation, and ability to maintain patients. PPO negotiation normally comes down to how motivated the insurance carrier is to add dentists to its network. Consider how many dental practices are in your immediate area performing similar procedures. Question each PPO plan you are considering if they have a co-lease or network share arrangement with other carriers. Determine if the carrier has electronic claim ability and EFTs for receipt of claim payments. Do they use online portals to pre-authorize insurance claims? You need to negotiate with each network share individually, as you can always opt-out by submitting a copy of your signed contract stating your intentions to withdraw.
Initiate Negotiations with the Network Retention Specialist
Negotiate through a retention specialist by email so you will have a written record of your communications. Ask for a custom fee schedule based on the top 30 codes in your practice from each insurance provider so you can compare which one is closest to your UCR fees. You need to have a time frame in mind to allow them to respond and include it with your proposal. Some insurance companies do not negotiate because everyone is in the same general area. If you are offered a list of fees, you can always send them a counter offer — you never know until you ask.
Once you agree on a list of fees with the insurance carrier, keep an organized location with the contract terms agreed upon and the final list of fees so you can compare fees offered by each insurance provider. In order to ensure your agreement is being utilized, audit about a dozen claims every six months. This is just a good business practice to maintain. As the dentist, you should be prepared to begin negotiations for the best chance of obtaining the best fees. Consider it a good practice to write off certain codes which are not used very frequently in your practice in the past year.
PPO Negotiation Solutions can negotiate your highest fee schedules and claims reimbursement to increase your dental practice revenue. Use the complimentary assessment feature to determine which of your PPO contracts is eligible for negotiations and get an estimated revenue increase. You may then access the consultation schedule feature to pick a date and time convenient for you to speak with one of our trusted partners.
In order to level the playing field between dentists and insurance companies, it is the number one goal of PPO Negotiation Solutions to enrich dental practices through increasing their revenue and their understanding, while streamlining processes for optimal day-to-day well-being.