6 Steps to Higher Profits for PPO Practices

Navigating insurance complications in a PPO practice can be frustrating. Many dentists are reluctant to invest in a PPO practice because of the additional headaches, even if it comes with the security of guaranteed patient flow.

The discounted fees and extra hoops to jump through do not need to rob you of high profits, however. Here are six steps to increasing profits in a PPO practice.

1. Negotiate higher PPO fees.

Sometimes, PPO fees vary significantly from practice to practice. If you have not negotiated your fees, you could immediately see a boost by negotiating a fee increase.

To do so, check to see rates from other practices in your area. You can usually get enough information for this purpose using a location-specific report from Henry Schein. Once you know how your rates compare, you can start negotiating yourself or outsource it to negotiating partners.

Negotiating better fees is one of the best ways to increase profits because of the compounding effect even a small percentage increase has when applied to hundreds or thousands of procedures.

2. Implement scheduling efficiencies.

Salaries and wages add up. Schedule your dentists, specialists, and hygienists wisely so they are not sitting around. Also, check whether you can schedule patients differently to cut down your labor costs. If you schedule efficiently, you can reduce waste and better align labor costs with performance.

3. Maximize insurance on the front end.

Vivek Kinra of PPO Profits shared with the Nifty Thrifty Dentists Facebook community his strategy for maximizing insurance benefits on the front end. If you have not seen it, check it out. It can help you increase case acceptance, reduce unused insurance benefits, and get paid faster.

You can also maximize insurance benefits by directing marketing efforts to patients in need of high-profit treatment. Similarly, you can avoid wasting time and money pursuing patients seeking unprofitable procedures.

4. Improve appointment efficiencies by implementing best practices.

One way to increase profits when your fees are fixed is to spend less time performing the procedure. That allows you to complete more procedures at the same time.

Evaluate how each team member is performing procedures. Some might have picked up inefficient practices from prior jobs. Others might have highly efficient practices. You might have a preferred way to perform tasks. 

If your way is more efficient, document it and train everyone else to do it that way. If you do not have a preferred way, take a look at your team. Who is the most efficient? They can set an example of how to do things, too.

5. Improve case acceptance.

There is no doubt that maximizing insurance on the front end helps improve case acceptance. PPO patients make many health decisions based on insurance. They are much more likely to accept treatment if their insurance covers it. Utilize insurance to their benefit. Make insurance work for your patients so they accept treatment.

Additionally, talk with them about the benefits of their treatment plan would have for their life. Instead of explaining the technical side of your treatment plan, ask them about how their issue is impacting their life. Frame your suggested treatment in the context of the pain, discomfort, or inconvenience they describe. 

When you frame treatments within the context of using a patient’s insurance coverage to solve a problem they describe to you, they will be much more likely to move forward.

6. Maximize insurance on the back end.

 

If you only file claims and wait you are leaving a lot of money on the table. Before filing a claim, make sure all paperwork is in order. If not, your claim could be delayed or denied, and time is not on your side. After filing, follow up on every claim within a few days to make sure they were received. If not, resubmit them. 

Finally, appeal claim denials as necessary. Send a written request to reconsider the claim. Add any documentation you think will give the carrier more information about why you recommended the procedure. You did the work. You did it for good reason. Make sure they have everything they need to approve your claim and get you paid.

There is no reason you cannot increase practice profits.

To run a successful PPO practice, efficiency is key. These six steps can help you dramatically increase profits, even when your fees are fixed. All you need to do is negotiate your fees, implement efficiencies, and improve claim filing and follow-up.For more help and additional strategies, join me and thousands of other dental professionals in the Nifty Thrifty Dentists Facebook group.