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YOU TO PPOs...
by Bill Rossi
I n previous article “Doctors, It’s Time to Push Back on
PPOs” (The Profitable Dentist – May 2018), I wrote about
how dentists have been getting deeper and deeper into PPO
participation over the last 15 years and how it’s starting to
have severe consequences on collections, the bottom line
and even practice sovereignty. I also explained how doctors
have more power then they think they do in dealing with this
challenge. In this article I am going to suggest the steps you
can take to start closing the gap between production and
collections. They are:
| SUMMER 2018
Start by gathering information.
1. How much do you write off per year for the PPO plans
with the biggest presence in your practice?
Many offices just have one “Insurance adjustment”
code. For the most active PPOs in your office (e.g.
Delta, MetLife, etc.), you will want to set up a code for
each company. This way you can get a closer idea of
what participation with any particular PPO costs.
2. An estimate of the number or percentage of your
patients on those plans.
3. A comparative analysis of the plan’s fees versus yours.
Make your own “Insurance Reimbursement Grid” (see
example on p.43). List your fees and a sampling of the fees
for the various PPOs in your practice. You will find this very
useful. Naturally you will want to look at the procedures
that have the biggest revenue impact (which is a function of
frequency and fees and includes procedures for the typical
general dental practice like adult prophies, crowns, periodic
exams and so on – you can get this from your Analysis
of Charges (every Practice Management software
has a version of this).