Participating with PPO plans used to be a straightforward process of signing on directly with each carrier and abiding by a fee schedule. Now it is more complicated.
The industry has changed drastically with the introduction of PPO leasing. Through PPO leasing, you can sign on with one plan, which could put you in-network with a handful of other carriers, giving them permission to put you in-network and utilize their fee schedules. An even more significant PPO exposure occurs when you contract with a third-party payor (TPA) such as DenteMax and Connection Dental.
PPO leasing works 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 they see. Companies can do this on a line-item basis per claim. You may notice some companies defaulting your payments through lower-paying fee schedules or putting you in-network when you did not intend to participate.
Insurance carriers attempt to make it difficult for offices to know where leasing is and can take place. Many don’t know that leasing can work to your advantage. There may be great paying leasing opportunities 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 to renegotiate and optimize your PPO participation.
Identify and analyze the existing structure
Identify current participation in leasing arrangements and examine current fees. You will need to access your contracted fee schedules and may need to contact those carriers to understand the leasing arrangements in place. This is a crucial part of understanding your exposure to fee schedules.
Negotiate increases to direct contracts and potential leasers
This process used to be straightforward before leasing. Successful direct negotiations require the best leverage. Understanding your leasing choices is the most relevant leverage available.
Compare and analyze current and potential options
You can be in-network with a PPO plan through 10+ different networks. Once each company’s fees are negotiated to their highest, identify a strategy to optimize each carrier to use the leasing option that provides the best reimbursement.
Optimize your structure
Implement changes to your PPO structure to have each carrier paying on their best fee schedule rather than defaulting to the lowest. This often requires a clean-up of overlapping leasing networks.
The best way to optimize your revenue with PPOs is through professionals! Practice Support Team can get you started with a PPO Analysis at no charge for clients qualifying through our Supply Savings Guarantee program or through a minimum targeted buying volume for merchandise. We can help you with the next steps in your renegotiation process and provide referrals to PPO negotiation services if you prefer to have professional assistance.
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