If you choose to be an in-network (PPO) provider, it is integral to negotiate reasonable fees!
Negotiate initial PPO contract fees; most contracts have 18 to 24-month terms. At the end of the contract period, you may have an opportunity to renegotiate. Here are some key strategies to keep in mind:
1. Review Your Current Fees.
The first step is to review your current fees. If you set your UCR fee schedule too low for your area, you will have a difficult time renegotiating. Order the NDAS fee disc from Burkhart and set a goal to maintain your fees in the 80th percentile for your zip code.
2. Map Your Participation.
Understand your current exposure by “mapping” plans you participate with, network share arrangements, and the total number of patients and annual production generated by each plan. Speak with a retention specialist and ask if they have a “co-lease agreement” or “network share arrangement” with any carriers if you are not sure. For example, when a plan, such as Aetna, shares fee schedules with another carrier, such as Principal. This data will help you with future participation decisions.
3. Determine Your Top 30 Codes.
These 30 codes generally account for 90% of production. Determine the top 30 codes through a “Report by Procedure” code report. Focus on these codes during your re-negotiation. A simple spreadsheet will allow you to find average adjustments by plan. The Practice Support Team can do this for you – reach out for a complimentary PPO Analysis.
4. Determine Your Negotiating Advantage.
Negotiations boil down to supply and demand based on how motivated the carrier is to add dentists to their network. You may also have leverage based on location, specialty, hours, and patient retention.
5. Initiate PPO Negotiations.
Do this with a retention specialist. Ask for a custom schedule based on the 30 codes you identified in strategy 3.
6. Be Prepared.
A few carriers simply do not renegotiate. Some place everyone in the same geographical area under the same fee schedule. Some offer limited or no negotiation opportunities. Others will offer “tiered” schedules. If you do not accept the first one, they send a second one that is slightly higher. You will benefit the most from a custom schedule based on your 30 codes.
7. Review Fees Offered.
Do not hesitate to send in a counter-proposal. Keep track of your total write-off percentage with each proposal. In some cases, it may make more sense to drop a plan or limit entrance for new patients. Let us help if you decide to drop one, you’ll need a strategy to retain patients.
8. Plan for the Future.
Keep a list of the accepted contract terms and copies of fee schedules. Ensure the insurance company honors your agreed-on fee schedule through auditing a dozen claims semi-annually.
The Practice Support Team can help if you have questions about your PPO participation level. We are here with complimentary consulting support for our valued Burkhart clients!
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