Management of a dental practice can be complex. Dentists often become overwhelmed with tasks like scheduling, patient calls and credentialing their insurance plans.
Many dentists may be unaware that they can negotiate their PPO insurance fees for higher reimbursement rates, yet how should one go about doing so? Arm yourself with data and be ready when approaching insurers with negotiation requests.
1. Do Your Homework
Dental insurance companies are an integral component of most practices and negotiating fees with them can create opportunities for profitability. But doing so requires diligence from dentists who need to do their research beforehand.
One of the most crucial steps a dentist can take to ensure they are receiving adequate compensation from insurance companies is conducting a survey of fees paid for specific procedures by insurance companies in your area. While collecting this data from these sources may prove challenging, there are companies dedicated solely to this endeavor – as well as companies dedicated solely to this topic – offering this data directly.
Once you understand how much insurance companies are paying for specific procedures in your practice, you can determine how much to increase fees. It’s important to keep in mind that any increase should not put patients at risk by making care too expensive; 10% might be an appropriate starting point; feel free to go higher!
Negotiating insurance fees is a powerful way for dental offices to increase profits and better serve patients. While many dentists may feel powerless against insurance providers, savvy negotiations may reveal hidden treasure in terms of increased revenue and improved patient retention.
2. Review Your Contracts
While negotiating insurance fees might seem like an arduous task, doing it can bring great benefits for your dental practice’s profitability and stability. Negotiation should not be seen as something difficult. Instead, this is one of the most efficient strategies for increasing profitability and stability of any dental practice.
Prior to beginning negotiations, it’s essential that you gain an in-depth knowledge of your contracts. It is also wise to identify which insurers you have contracts with as well as their fee schedules as this information can help determine the optimal time to approach an insurance provider with requests for fee increases.
Before entering into negotiations, make sure that you have an organized list of your top procedures that are most frequently billed in your dental practice. This will enable you to ascertain what are “usual, customary and reasonable” charges in your area for these procedures – so that when entering negotiations, you can do so confident that you aren’t asking for more than other providers in your region charge.
At this stage, it is necessary to prepare a letter explaining why your requested fee increase is necessary and provide evidence proving its justification with an insurance company or patient benefits provider. This letter should include specific figures to support its justification ensuring patient benefits remain fair.
As well as these strategies, consider joining forces with other dental practices in your area to negotiate collectively and increase bargaining power with payers while more effectively conveying the importance of maintaining fair reimbursement rates for dentists. You could even hire a professional company that specializes in optimizing insurance credentialing and fee negotiations to take the burden off you and free up time to focus on growing and expanding your practice.
3. Review Your Top Procedures
As you work to revise your dental insurance fee schedules, it’s essential that you remember the importance of taking a step back and reviewing your practice in order to better understand your patient base and the services that clients utilize; with this data in hand it becomes much simpler to argue for raising fees.
Insurance companies frequently adjust their fees every two years. If a dentist doesn’t realize this is happening and doesn’t request a new fee schedule from their provider relations department, their office may continue billing at lower fees – this can significantly erode profitability over time.
If you’re uncertain of the appropriate fees to ask for, researching averages in your area and other dental practices’ fees can give a better sense of how much to ask for. Once this data is in hand, negotiation can begin by compiling a list of your top procedures – using it to craft an impressive letter convincing insurance companies of its fairness.
Negotiation can be an intricate process, made even more complex by the rise of PPO plans. Furthermore, more employers are opting for in-network dental benefits for their employees which means insurance companies may be less inclined to negotiate small increases with providers. If you need help navigating this process or don’t know where to begin negotiating, services like Unlock the PPO may offer invaluable support in making negotiations less time consuming and frustrating.
4. Make a Counter Proposal
Letters outlining the need for fee schedule increases are critical in their success. Be sure to cite specific examples, such as new services your office provides or increased operating expenses not covered by insurance. Also include data like average fees in your geographical area and competitor pricing structures.
Dentists no longer have the luxury of calling an insurance company each year and asking for an increase of five percent; insurance companies are far less willing to negotiate fees these days due to more employers choosing Preferred Provider Organization (PPO) plans, which require them to use in-network dentists in order to reduce medical and dental costs; this directly impacts an insurer’s bottom line, making them unlikely to accept an increase in reimbursements.
Furthermore, it’s crucial that each doctor engages in negotiations individually as there could be antitrust implications if several practitioners attempted to join forces and raise fees collectively. This can be a major roadblock, so many dentists opt to partner with companies specialized in insurance fee negotiations instead.
Effective insurance reimbursement rate negotiation should be at the heart of every dentist’s practice – whether for patient retention or increased profitability. Though it may appear daunting at first glance, when done right it can reap unrivalled rewards over other marketing and practice management techniques. If you would like more information about how to successfully negotiate fees with insurance providers Ben Tuinei of Veritas Dental Resources is here to provide his 7 Steps of Negotiation which will give you leverage needed to get what is owed to you as per insurance reimbursement rates.
5. Follow Up
As part of your PPO fee schedule negotiations, it’s essential that you remain vigilant. Make sure the conversation remains active by reaching out at least once every month and reinforcing the value proposition that has been presented by you and continue presenting this to them – after all, only those who advocate their case loudest receive fair reimbursement rates!
As part of this process, be sure to review your office’s fee schedule and identify any direct contracts with insurance companies. In addition, take note of your top billed procedures and understand the ways they relate to coding; for instance if your dental practice often submits composite fillings on posterior teeth then insurance may downgrade this procedure into silver or amalgam fillings instead.
One of the major obstacles a dental office faces is lacking information about what other dentists in its region are being paid for certain services, making it hard for it to convince insurance providers that an increase is warranted. A professional research firm that conducts large, accurate fee surveys may prove invaluable for this endeavor.
Successful fee schedule negotiations require research, open communication and being mindful of how price increases will impact patients. Note that annual price increases usually come as less of a shock than when raised gradually over several years. For more information about negotiating dental insurance fees or increasing reimbursement rates contact our team for a complimentary assessment – they would love to assist!
