{"id":10874,"date":"2022-06-03T08:40:59","date_gmt":"2022-06-03T13:40:59","guid":{"rendered":"https:\/\/www.cainwatters.com\/digitalblogs\/?p=10874"},"modified":"2022-06-08T13:50:47","modified_gmt":"2022-06-08T18:50:47","slug":"negotiate-ppo-fees-inflation-rises","status":"publish","type":"post","link":"https:\/\/www.cainwatters.com\/digitalblogs\/negotiate-ppo-fees-inflation-rises\/","title":{"rendered":"Steps to Negotiating PPO Fees as Inflation Rises"},"content":{"rendered":"\t\t
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With inflation going through the roof, employee salaries soaring and other expenses rising fast, dental practices everywhere are feeling the profitability pinch. While raising fees is the most obvious solution (if you haven\u2019t, now is the time<\/span><\/a>) to offset the higher costs, there is another card that dentists can play to help mitigate the effects of inflation, and it pays off more than some might think: renegotiating PPO fees with insurance providers.<\/p>

PPO fee negotiations are not a new tactic, but it\u2019s one that many dentists either aren\u2019t aware of or are too wary of the time, effort and frustration involved to try.<\/p>

\u201cYes, you can and absolutely should renegotiate PPO insurance fees,\u201d says Ben Tuinei, Managing Partner and President of dental insurance reimbursement specialists Veritas Dental Resources<\/span><\/a>. \u201cIt\u2019s not a quick and easy process, but it can pay off big time, especially in an inflationary period like the one we\u2019re in now.\u201d<\/p>

The Case for Renegotiating Fees<\/strong><\/h5>

According to Ben, the average dental practice forgives about 40-45% of production due to low PPO insurance reimbursement fees. However, practices that negotiate often see an increase of about 7% on the low end, with some reaching as high as 30%.<\/p>

\u201cAs inflation pushes past 8% or higher in some parts of the country, renegotiating PPO fees is important for practices to sustain their business,\u201d says Ben. \u201cThe mission among dentists right now is they don\u2019t want to water down their services by relinquishing the labs or cutting staffing to retain profitability, and ultimately getting more from their insurance providers is a way to avoid that.\u201d<\/p>

Meanwhile, PPO fees continue to defy logic as insurance companies trend their fees lower, making the situation all the more challenging for dentists.<\/p>

\u201cPPO fees are actually trending down if you can believe that,\u201d says Ben. \u201cNegotiating fees creates a third-party payor strategy that allows dentists to protect the financial component\u2014so practices can keep the integrity and quality of dentistry.\u201d<\/p>

While more and more practices are starting to make PPO fee negotiations a priority, the industry as a whole is still slow to adopt it as a common practice.<\/p>

\u201cThere are about 170,000 dentists in the U.S., but only about 10% fight back,\u201d says Ben. \u201cInsurance companies will take that all day long.\u201d<\/p>

So why are practices hesitant to renegotiate fees? Ben says the problem many practice owners face is simple. They don\u2019t know where or how to start.<\/p>

Two Ways to Navigate the Negotiation Process<\/strong><\/h5>

You can do it yourself. <\/strong><\/h4>

Practice owners can task themselves or a trusted office staff member to take on the insurance companies. Full transparency, this isn\u2019t a quick or easy task, but setting time aside and committing the hours needed to educate themselves on the process and then take action needed to negotiate with insurance providers is possible.<\/p>

Prepare yourself with the information you will need when proposing fee increases with your providers. Know which procedure codes generate the highest total revenue for your practice, including frequency, current discounted fee and the extent of these procedure codes\u2019 contribution to your overall practice revenue. Also come with your desired fee for each procedure code and the date when your fees were last revisited.<\/p>

\u201cInsurance companies design their processes to confuse both the practice and the patient,\u201d says Ben. \u201cIt\u2019s in their best interest to make the process difficult because the less they pay to dentists, the better they look to Wall Street.\u201d<\/p>

Basically, it\u2019s a war of attrition, and Ben says this is usually the part of the process where individuals give up or settle for a percentage or two increase. If you spend hours of your time on this and get a 4% increase, it\u2019s likely the insurance company is still walking away a winner because it very easily could\u2019ve and should\u2019ve been 7%, 10% or even more.<\/p>

\u201cPractices feel like they are playing hardball, but the truth is, the game was never fair to begin with,\u201d says Ben. \u201cBe patient and don\u2019t give up. Don\u2019t accept the first offer every time.\u201d<\/p>

Hire a specialist.<\/strong><\/h4>

The second way to negotiate insurance rates is to hire a company that specializes in dealing with PPO insurance. These companies know the insurance game, the tactics and how to navigate them in the most efficient way possible.<\/p>

\u201cUsing a specialist to handle your PPO negotiations is not unlike hiring an attorney,\u201d says Ben. \u201cYou could represent yourself and possibly get a settlement, but with an attorney, you could get 10 times that amount\u2014without the massive time investment.\u201d<\/p>

Another way a fee negotiation expert could help is to get a point of reference for how your fee schedule compares to similar practices in your area.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\u201cPractices who go at it alone, usually have a blind spot when it comes to knowing how they compare to peer practices,\u201d says Ben. \u201cIt\u2019s our job to know that a similar practice in your area is getting $1,100 per crown when yours is only getting $1,000.\u201d<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Full-service negotiation specialists like Veritas can also help practices\u2019 structure PPO contracts not only to make sure they are getting paid the highest rates but also to navigate them through the delicate process of eliminating unnecessary participation with plans that will not help them grow.<\/p>

Finally, and possibly the most important in these uncertain times is that going with a PPO negotiation specialist can lift the burden off the shoulders of the entire practice.<\/p>

\u201cI\u2019ve had clients tell me how relieved they are to have the day-to-day stress of the entire process off their radar,\u201d says Ben. \u201cWe try to take as much of the worry off their plate, so in the end, they can keep their profitability, keep their staff, and keep doing what they do best for their patients.\u201d<\/p>

To get more information on the complexities of PPO negotiations and the fees involved with bringing in a specialist, Ben and his Veritas team offer a complimentary PPO Negotiating and PPO Optimization Analysis<\/span><\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\tFor questions about the current state of inflation, raising fees or any other issue with your dental practice, CWA is always just a call or click away. Feel free to contact our team<\/span><\/a><\/strong> to talk to a CWA advisor.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

With inflation going through the roof, employee salaries soaring and other expenses rising fast, dental practices everywhere are feeling the profitability pinch. While raising fees is the most obvious solution (if you haven\u2019t, now is the time) to offset the higher costs, there is another card that dentists can play to help mitigate the effects […]<\/p>\n","protected":false},"author":7,"featured_media":10881,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":"","_ppma_block_editor_authors":""},"categories":[18,17,20,21],"tags":[],"ppma_author":[48],"class_list":["post-10874","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-financial-planning","category-investing","category-practice-management","category-tax-news"],"acf":[],"yoast_head":"\nSteps to Negotiating PPO Fees as Inflation Rises<\/title>\n<meta name=\"description\" content=\"PPO fee negotiations are not a new tactic in the dental industry but it's a process than can pay off in the long-term. 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