Added overhead expenses, including increased employee compensation, supply costs, and low insurance reimbursement rates, are forcing practices to evaluate their managed care plans.

A recent survey in Dental Economics reported that 64.9% of dentists listed rising overhead as a top concern, and 55.3% listed declining insurance reimbursements as an ongoing challenge. In response, dental practices are critically evaluating their participation levels, and Burkhart’s Practice Support Team can help.

When managing your participation in PPO networks, consider the following steps:

Know Your Patient Volume and Write-off Requirements:

Determine how many patients use each of your agreed-upon fee schedules and the average write-off per plan.
Use this knowledge to make informed decisions about PPO participation.

2. Direct Contracts and Network Share Arrangements:

You may have direct contracts, network share arrangements, and third-party administrator plans (TPAs).
Network share arrangements occur when carriers share their fee schedules with each other, making you in-network with the shared arrangement.
For example, Aetna shares its fee schedule with Ameritas, Assurant, DHA, SunLife, Principal, and Guardian.

3. Third-Party Administrators (TPAs):

If you are contracted with a TPA or “umbrella plan,” your exposure increases significantly.
TPAs can hold around fifty contracts (e.g., Connection Dental) or over two hundred contracts (e.g., Dentemax).

4. Monitor In-Network Status:

Regularly check your Explanation of Benefits (EOBs) to identify write-off requirements to determine which fee schedule insurance plans are accessing.
If you are unsure of your status, visit insurance websites and use their “find an in-network provider” feature to verify your status.

5. Calculate write-off by carrier.

Practice management software can show this, or you can calculate your weighted average write-off by the frequency of CDT codes billed over the last 12 months.
A side-by-side visual comparison showing the percentage of write-offs and number of patients per plan will empower you to take the next step, whether to renegotiate, restructure, or drop a plan.

6. Create a plan. Before abandoning a PPO plan, consider these factors for your practice:

Establish a solid foundation with long-term treatment planning.
Implement effective coding protocols.
Focus on targeted marketing.
Develop verbal scripting for your team.
Calculate the number of patients you can afford to lose without affecting revenue. Retained out-of-network patients allow you to collect your full office fee, requiring fewer patients to meet revenue goals.

At Burkhart, we obsess over our clients and your success. Connect with our consulting team to dive deeper into your coding protocols and managed care reimbursement levels to identify lost opportunities or help you move through a successful change in network status while still retaining the maximum number of patients. The best part? We provide strategies to recoup the lost production and provide the service at no cost to our Platinum and Supply Savings Guarantee clients!

Request your PPO Impact Analysis through your Burkhart Account Manager or the Practice Support Team.

Your success is our success. Please reach out to us anytime.
Learn more, visit the Practice Support Team page, email us at PracticeSupportTeam@BurkhartDental.com, or call 1.800.665.5323.

Category: Practice Consulting