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PROFITABLE PRACTICES PPO STRATEGIES YOU TO PPOs... “DEAL OR NO DEAL!” 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: 1. Assess 2. Negotiate 3. ACT! 44 TPD | 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).