5 Ways to Increase PPO Reimbursement

Choosing whether or not to participate with an insurance plan can have a big impact on the success of your dental practice. There are many factors to consider, pros and cons to weigh, and demographic data to gather to make the most informed decision for your practice and your patients. When choosing to participate with an insurance plan as a preferred provider, one of the agreements is a negotiated fee schedule. If you have ever felt stuck in a revenue rut, you’re not alone. Keep reading for 5 ways to increase your PPO reimbursement.

PPO reimbursement & inflation

According to the American Dental Association (ADA), 59% of adults aged 19-64 have private dental insurance — meaning dental insurance offered through employment or an individual plan. The same study states that 51.3% of children aged 2-18 have private dental insurance. These stats mean that for the majority of dental practices, a significant portion of the patient base has private insurance.

What does this mean for dental practices as they face inflation and rising costs of supplies, wages, and more? According to a weekly report of polled dentists polled by the ADA, rising costs and low insurance reimbursement are #2 and #3 on the list of biggest concerns. If your practice participates with one or more PPO plans, you may share this concern. But you don’t need to continue feeling stuck in a revenue rut. 

Know your PPO participation types

There are three different PPO plan participation types:

1. Direct contract
2. PPO to PPO leasing
3. Umbrella networking

A direct contract is a direct contract between the dentist and the insurance plan. 

PPO to PPO leasing is when an insurance plan shares its PPO network of dentists with other PPOs. This means that dentists participating as a preferred provider with one insurance will then have to participate as a preferred provider with other insurance in this shared network. Have you noticed PPO leasing in your practice? 

An umbrella network is when multiple PPO insurance plans fall under the umbrella of one insurance plan’s network. This is another way insurance plans can expand in-network access. Do you know if you are currently under any umbrella networks?

Increase PPO reimbursement with direct PPO negotiations

What specific insurance plans do you currently participate in? Many of the major insurance companies negotiate fees every 2 years and have optimization options. The best practice is to negotiate your PPO fee schedules when the option is available, but this can be a tedious and time-consuming process. If the person initiating the negotiations doesn’t have the experience and dedication necessary, as well as the appropriate contacts at the carriers, they can quickly feel stuck or shut down in the process. 

CLICK HERE TO GET EXPERT HELP WITH PPO NEGOTIATIONS >>> 

Increase PPO reimbursement with PPO optimization

As seen above, there are many different PPO plan types and many dentists can abruptly find themselves being reimbursed with different fee schedules or making PPO adjustments on plans they aren’t familiar with. 

PPO optimization is something that many dental practices are not familiar with, but it is an available avenue to increase PPO reimbursement. PPO optimization clearly maps out and optimizes plan participation in order to get the highest rate of PPO reimbursement with the optimal amount of patients. 

CLICK HERE TO GET EXPERT HELP WITH PPO OPTIMIZATION >>> 

Matching the appropriate CDT code

You’ve negotiated your PPO fees, you’ve optimized your PPO plans, and you’ve completed the treatment. Now what? 

Matching the appropriate CDT code to the treatment provided not only keeps you compliant, it maximizes your legitimate PPO reimbursement while decreasing risk. 

Over the past 3 years, there have been over 160 CDT code changes. Is your dental practice up-to-date? 

If you don’t have a coding resource, grab yours today >>>

Increase PPO reimbursement by reviewing claims

One of the first steps in effective revenue cycle management is to review your claims before sending them to verify the accuracy of the patient and insurance information. This reduces the avoidable denials due to inaccurate information but requires crucial pre-appointment processes.

Here are a few tips:

• Have a copy of the insurance card and photo ID on file
• Check all claims for the correct patient information
  • Legal name, date of birth, ID number, etc.
• Check all claims for the correct insurance information
  • Address, group number, payor ID, etc.

Sending clean primary and secondary claims 

Click here to learn what constitutes a clean dental claim, why they are crucial to your dental practice revenue, and how you can optimize your processes to increase your PPO reimbursement without packing your schedule.

eAssist Dental Solutions and Unitas PPO Solutions

eAssist Dental Solutions and Unitas PPO Solutions are here to help. Increasing PPO reimbursement may seem like an unattainable goal. But with professional experience and knowledge, you can negotiate your PPO fees and outsource your dental billing to collect 100% on every dental claim. This is the peace of mind you deserve.

Sources:

ADA.org — FAQs about dental coverage, access and outcomes

Colgate.com — Types of Dental Coverage

NADP.org — Understanding Dental Benefits

American Dental Association, Economic Outlook and Emerging Issues in Dentistry