2024 Trends in PPOs

Have you ever wondered about PPOs or struggled to understand them?

ACT Dental asked and Shelley DeGroff shed some light on this complex relationship between dental practices and insurance. Shelley is the founder and CEO of PPO Advisors, a firm that helps dental practices turn their PPOs into profit. She talks about the trends of 2024, emphasizing the importance of understanding the percentage of write-offs and the need to evaluate fee schedules. The conversation concludes by encouraging dentists to confidently play the insurance game and seek expert help when navigating the complexities of PPOs.

Main Takeaways:

✅ Evaluate fee schedules and understand write-off percentages to ensure proper reimbursement.
✅ Regularly audit EOBs to identify discrepancies in fee schedules and reimbursement.
✅ Proper credentialing and negotiating contracts are crucial for setting favorable rates.
✅ Be aware of network shares and changes and regularly assess your PPO mix.

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1. Could you introduce us to the mission and services offered by PPO Advisors in the dental industry?

PPO Advisors is a beacon for dental practices navigating the often complex waters of PPO insurance companies. Our core mission is to secure the best possible reimbursements for dental providers through meticulous PPO negotiations and contracting. Beyond negotiation, we dive deep into educating dental practices about the nuances of their insurance contracts. This includes demystifying the fine print, revealing the strategic plays behind insurance policies, and unveiling the intricate webs woven by PPO insurance companies. Our role is multifaceted: we are advocates, educators, and strategists, all in one, aiming to empower dental practices with the knowledge to thrive in a PPO-centric landscape. Our commitment to enhancing PPO profits through informed decision-making and strategic negotiations positions us as a pivotal resource for any practice looking to improve its profitability within the PPO framework.

2. With 2024 on the horizon, what should dental practices know about the evolving landscape of PPOs and fee-for-service models?

The dental insurance landscape is evolving, with significant shifts toward practices preferring to move away from PPO contracts in favor of fee-for-service models. This trend underscores a growing desire for autonomy and control over practice operations and financials. However, transitioning away from PPOs requires a nuanced approach. It’s not about severing ties with all PPO insurance companies but rather about finding the right balance that suits your practice’s needs and goals. According to ADA statistics, we’ve witnessed an encouraging trend: a rise in fee-for-service practices, jumping from 6% to 16% in recent years. This shift reflects a growing confidence among dental providers in their ability to sustain successful practices outside the stringent confines of PPO networks. It also signals a potential recalibration in the relationship between dental practices and PPO insurance companies, pushing the latter to reconsider their value proposition to retain network providers. Strategic PPO consulting can guide practices through this transition, ensuring they make informed decisions that bolster their financial health and service delivery models.

3. In light of current trends, how significant are write-off percentages, and what observations have you made regarding their impact on practices?

The topic of write-offs is critical for any practice engaged with PPO insurance companies. Our observations reveal that the average write-off percentages range from 40% to 43%, a substantial figure that significantly affects a practice’s bottom line. Alarmingly, some practices experience write-offs as high as 55-60%, often only known to them once a thorough analysis is conducted. These figures aren’t just numbers; they represent a substantial portion of potential revenue lost to the complexities of PPO contracting and reimbursement rates. It’s imperative for practices to be aware of these percentages and seek solutions to mitigate their impact actively. This is where the expertise of PPO Advisors becomes invaluable. Through comprehensive PPO consulting and negotiation services, we work diligently to educate providers on navigating these challenges effectively. We aim to reduce write-off percentages, thereby increasing PPO profits and ensuring practices can operate more profitably within the PPO system. Understanding and managing your write-off percentages is crucial to achieving financial sustainability and success in today’s competitive dental market.

4. What are the key trends in dealings with PPO insurance companies that dental practices should be aware of for 2024?

As we look toward 2024, it’s essential to recognize the evolving dynamics of PPO insurance contracts and their implications for dental practices. One key trend we’re observing is PPO insurance companies’ strategic timing of fee increases. It’s common for these increases to be rolled out at the start of the calendar year, offering practices an opportunity to renegotiate their reimbursement rates. However, it’s crucial to distinguish between inflation-driven increases and those achieved through proactive negotiation. Our role in this process is to guide practices through these negotiations, ensuring they secure the most favorable terms possible. Additionally, the intricate network of contracts and the interplay between different PPO insurance companies require a strategic approach to contracting and credentialing. Understanding PPO insurance companies’ fiscal calendars and contractual stipulations can reveal opportunities for practices to optimize their participation in these networks, ultimately leading to better reimbursement rates and more favorable contract terms.

5. How crucial is proper credentialing in PPO negotiations and managing contracts?

Credentialing is the linchpin in the relationship between dental practices and PPO insurance companies. It’s not merely a bureaucratic step; it’s a strategic maneuver that sets the stage for every subsequent interaction with PPO networks. Proper credentialing allows a practice to establish its rates and terms from a position of knowledge and strength. Conversely, missteps in credentialing can lead to suboptimal contract terms, limiting a practice’s ability to negotiate effectively in the future. It’s about understanding the vast web of PPO networks and how different contracts interact with each other, which can either open doors to favorable negotiations or close them altogether. Our expertise in dental PPO negotiation shines here, as we navigate these complex networks to secure the best possible outcomes for practices. By ensuring proper credentialing and leveraging strategic insights into PPO operations, we help practices achieve more profitable PPO engagements and pave the way for sustainable growth and success.

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