PPO Problems? When to Add, Drop, or Change PPO Participation Info

PPO Problems? When to Add, Drop, or Change PPO Participation

PPOs (preferred provider organizations) are groups of medical providers that have agreed to provide services to members at reduced costs.

Dr. Nacho, the CEO and founder of Dental Nachos, is discussing the challenges that dentists face in their profession and how they can reduce stress and increase success. He mentions that one of the biggest challenges is dealing with insurance and understanding what a patient’s coverage is. He also mentions that dental insurance works more like a coupon with benefits and blackout dates, and that it’s important for dentists to have a good understanding of insurance to be able to communicate effectively with patients. He also states that Shea, will share more about insurance and its negotiation.

The discussion is focused on providing guidance for dental providers on how to effectively participate in PPOs (preferred provider organizations) and increase their revenue.

Shea Forcades, the guest speaker emphasizes the various strategies for negotiating with PPOs (preferred provider organizations) in a dental practice.
The main points discussed include understanding your participation with PPOs, ensuring that you don’t waste time on the wrong procedure codes, approaching the PPO negotiation process, and comparing offers received from PPOs.

She also suggests using spreadsheet and analysis tools to compare UCR (usual, customary, and reasonable) fees with reimbursement rates and to ensure that your fees are competitive for your area. The passage also recommends reaching out to provider relations to request fee schedules and to check for any errors or discrepancies in the schedules.

The highlights of the discussion are:
-The importance of understanding one’s participation in PPOs and current reimbursements from those PPOs
-Advising to only participate with PPOs that have reimbursement rates that are higher than average and to consider negotiating for higher reimbursement rates in order to remain profitable.
-Suggestion of visiting www.ppoguy.com to download a step-by-step breakdown of the framework they discussed.
-Suggesting understanding how you’re participating, know which fee schedules those plans are following and document your actual fee schedule reimbursements.

We make dental staff training fun by bringing Pizza and Beer (or other drinks) during the training so your team can actually enjoy themselves.

For more assistance contact, your local Hayes representative to help ensure that your staff and practice are compliant with your local Hayes Handpiece representative