Participating with PPO plans used to be a straightforward process of signing on directly with each carrier and abiding by a fee schedule. The industry has changed drastically with the introduction of PPO leasing. Through PPO leasing, you can sign on with one plan, and it could potentially put you in-network with a handful of other carriers, giving them permission to put you in-network and utilize their fee schedules.
PPO leasing was designed to work at the provider’s disadvantage.
Fee schedule sharing allows companies to pick and choose how to process claims and will generally process claims through the lowest fee schedule option they see. You may notice some companies defaulting your payments through lower-paying fee schedules or putting you in-network when you did not intend on participating. Insurance carriers attempt to make it difficult for offices to know where leasing is and can take place. We at e-DentalMarket have worked for thousands of providers with our PPO Negotiations & Optimization services. We have spent years researching how leasing works and successfully help offices completely optimize their PPO reimbursements for increased revenue.
Many don’t know that leasing can actually work to your advantage if you have the knowledge. There may be great paying leasing options that you are unaware of that could be used for a handful of plans for 20%-60%+ increases over your current direct contracts or leasing options.
Here are the steps that we take in our PPO Negotiation & Optimization services to assist offices with untangling the web and increasing their PPO revenue:
- Identify and analyze the current structure. We begin by identifying the current participation, leasing arrangements taking place, and analyzing current fees.
- Negotiating increases to direct contracts & potential leasers. This process used to be straightforward before leasing. Successful direct negotiations require the best leverage. Most don’t know that the main relevant leverage is what each leasing option is paying.
- Compare and analyze current and potential options. You can be in-network with a PPO plan through 10+ different options. Once each company’s fees are negotiated to their highest, we identify a strategy to optimize each carrier to use their highest leasing option.
- Optimize your structure. Implement changes to your PPO structure that get each carrier paying on their best option rather than defaulting to the lowest. This often requires clean-up of overlapping leasing options.
The best way to optimize your revenue with PPOs is through professionals. The Practice Support Team can get you started with a PPO Analysis at no charge for BRAVO Gold and Platinum accounts. Then, schedule a free consultation call with e-DentalMarket to discuss your options to increase revenue.
Written by Kelsey Gorr, Director of Insurance Optimization, e-DentalMarket
Category: Practice ConsultingBack to Articles