2022 New Year’s Resolution for Dentists

Pay Attention to Your PPO Contract to Avoid Losing Revenue

By Shelley DeGroff, Founder of PPO Advisors

For dental practice owners, one of the best New Year resolutions you can make is to pay close attention to your PPO contract. Now more than ever, insurers are looking for ways to reduce reimbursements to providers. Find out what you should do now to avoid lower revenue in 2022.

Whether it’s going to the gym, eating healthier, or spending more time with family, most of us like to start off the New Year with a few resolutions that will improve the quality of our lives. For dentists who are practice owners, here’s a resolution I think you should adopt in 2022: pay attention to what’s happening with your PPO contract. If you find my suggestion a little uninspiring, I would point out that your PPO contract has a huge impact on the profitability of your business. Now, more than ever, your lack of attention can lead to reduced revenue, which is not what anyone wants in 2022.

It’s especially important to pay attention to your PPO contract at the beginning the year because that’s when a lot of insurers like to make changes. Consider the recent announcements by Cigna, DenteMax and Aetna about their plans to lower reimbursements in 2022. While these carriers let practices know ahead of time, it’s not uncommon for insurers to make changes without giving any notice, so it’s best to check for yourself. Otherwise, you run the risk of finding out the hard way in 3-6 months when you realize revenue is down, at which point it’s hard to do anything about it.

Decide How Do You Want to Handle Changes

If your insurer does reduce your fee schedule, you should ask yourself a few questions: Are you okay with the dollar amounts your insurer requires you to write off? If not, do you want to try to fight the reduced fee schedule, or is it time to evaluate whether some of the PPOs you’re affiliated with continue to make sense for your business?

Consider Negotiating a Higher Fee Schedule

To contest lower fees, you have the option to negotiate a higher fee schedule at any time. If the idea of “negotiating” a fee schedule is new to you, you’re not alone. Insurer’s like to give the impression that the PPO contract is a take-it-or-leave-it proposition, so most practices just accept whatever terms they’re offered and don’t try to get a better deal. Insurers also discourage negotiations by layering on complexity, making it difficult for dental providers to understand what’s included in the PPO contract. That opens the door to common insurance practices such as “stacking” and “mapping,” tactics that allow carriers to forego the agreed upon fee schedule and pay less for services. Working with a firm like PPO Advisors levels the playing field for dental practices. We know how to negotiate higher fees and eliminate the loopholes carriers use to lower reimbursements.

Assess the Value of Participating in the PPO

You also may need to consider the real possibility that some PPOs are simply not worth it. This is not a decision you should make out of frustration, nor should it be based on instinct or guesswork. To decide whether a PPO is still working for your practice, there needs to be a thorough analysis based on real data, so you can see the big picture impact your PPO agreement has on your business.

The original idea behind PPOs was simple. In exchange for reducing their fees for services, dentists expected PPOs would bring more patients into their practice who wanted to stay in-network. What dentist lost in fees would be made up for in volume. The problem is that over the last decade, insurers have chipped away at that foundation, finding ever more creative ways to lower reimbursements. At this point, for some dentists, certain PPO’s no longer make sense for their business. PPO Advisors can help you make that determination.

Increase PPO Reimbursements by 20%

The bottom line is that you can’t afford to be on autopilot when it comes to your PPO. The good news is that you don’t have to do it all on your own. I founded PPO Advisors after years of managing dental offices and learning how PPOs operate. Since then, our firm has helped over 1200 practices increase their reimbursements from insurance by an average of 20%*. We can help your practice, too.

Start the new year off right by contacting PPO Advisors. Learn how our free analysis works and resolve to make 2022 the best year it can be for your practice.

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