Cracking the PPO Code

On today’s episode of the Dentalpreneur Podcast, Dr. Mark Costes interviews “Shelley DeGroff”, Founder and CEO of PPOAdvisors. Shelley’s extensive experience and expertise in negotiating PPO contracts have helped numerous dental practices increase their revenues by securing better terms. As a former office manager, Shelley understands the challenges practices face when dealing with insurance providers, and she founded PPOAdvisors to level the playing field and help practices earn more by working smarter.

During the interview, Shelley and Mark delve into the importance of insurance verification and share valuable tips and insights on how to navigate the process effectively. They discuss the art of negotiating with insurance providers to secure more favorable contracts and increase practice profitability. Shelley’s passion for helping practices turn their PPOs into profit shines through as she shares her strategies and expertise.

If you’re looking to optimize your practice’s insurance contracts, negotiate better terms, and increase profitability, this episode is a must-listen. Tune in to gain valuable insights from Shelley Degroff, the industry expert in PPO contract negotiations. And don’t forget to visit to learn more about their services.

Join us on this informative episode to discover the power of effective insurance verification and negotiation strategies. Don’t miss out on this opportunity to take your practice to the next level. Listen now and learn from the best in the field.

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Main Takeaways

1. What are the legal implications of using someone else’s credentialing number in a dental practice, especially in the context of PPO insurance companies?

As the CEO of PPO Advisors, I encounter questions about credentialing daily. It’s crucial to understand that using another provider’s credentialing number, even with their permission, constitutes identity and NPI fraud—a federal crime. This risk is heightened in PPO-driven practices due to the sophisticated data mining techniques PPO insurance companies employ. They can easily detect discrepancies in billing patterns, leading to severe consequences, including hefty fines, imprisonment, and loss of licensure. Our firm specializes in PPO solutions and dental PPO negotiation, ensuring practices navigate these challenges legally and effectively.

2. How can dental practices transition ownership or bring in new associates without falling into legal pitfalls with PPOs?

Transitioning a practice or integrating new associates involves complex considerations, especially with PPO insurance companies. Legally, it’s imperative to avoid using another’s credentialing number. Instead, practices should consider temporary out-of-network options. This approach requires clear communication with patients about possible discounts and billing practices, areas where PPO Advisors excel. We offer PPO consulting to guide practices through these transitions, ensuring they remain profitable and compliant.

3. Can you share insights on the credentialing process and its impact on PPO profits and negotiation with PPO insurance companies?

Credentialing with PPO insurance companies is a nuanced process, essential for securing profitable PPO agreements. Each PPO has its network and fee schedules, and understanding these relationships is key to maximizing PPO profits. At PPO Advisors, we specialize in dental PPO negotiation, helping practices identify and negotiate the best terms with PPOs. This includes leveraging shared networks and avoiding pitfalls like the most favored nations clause, which can adversely affect reimbursement rates.

4. How does PPO Advisors assist dental practices in navigating insurance verification and maximizing profits from PPOs?

Insurance verification is a critical step in ensuring the financial health of a dental practice. Inaccuracies can lead to unexpected costs and affect patient satisfaction. Our team at PPO Advisors offers expert PPO consulting services, helping practices efficiently manage insurance verification processes. By outsourcing this task or utilizing advanced practice management tools, practices can focus on delivering quality care while optimizing their revenue from PPO insurance companies.

5. What strategies do you recommend for negotiating with PPO insurance companies to improve a practice’s profitability?

Negotiating with PPO insurance companies requires a deep understanding of their networks and fee schedules. Our approach at PPO Advisors involves comprehensive analysis and strategic negotiation to secure favorable terms. We advise practices never to accept the first offer and to understand the interconnectedness of different PPO networks. This knowledge enables us to negotiate effectively, ensuring practices achieve profitable PPO agreements.

6. How can practices navigate the challenges of being overly dependent on PPOs and move towards more sustainable models?

Overreliance on PPOs can limit a practice’s financial and operational flexibility. At PPO Advisors, we advocate for a balanced approach, encouraging practices to evaluate their PPO contracts and consider reducing their dependency on less profitable or restrictive PPOs. This strategic shift can enhance profitability and allow practices to explore alternative revenue streams while still providing quality care to their patients.

7. What final advice do you have for dental practices looking to optimize their relationships with PPO insurance companies?

Dental practices must be proactive and informed when dealing with PPO insurance companies. Engaging a specialized firm like PPO Advisors for dental PPO negotiation and consulting can provide the expertise needed to navigate the complex landscape of PPO agreements. By focusing on strategic negotiations, accurate insurance verification, and legal compliance, practices can maximize PPO profits and secure a more sustainable and profitable future.

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