{"id":938,"date":"2022-08-30T15:19:33","date_gmt":"2022-08-30T15:19:33","guid":{"rendered":"https:\/\/blog.advancedpracticemanagement.com\/blog\/?p=938"},"modified":"2022-08-30T15:19:33","modified_gmt":"2022-08-30T15:19:33","slug":"negotiating-ppo-reimbursements","status":"publish","type":"post","link":"https:\/\/blog.advancedpracticemanagement.com\/blog\/negotiating-ppo-reimbursements\/","title":{"rendered":"Negotiating PPO Reimbursements"},"content":{"rendered":"

In case you weren\u2019t able to attend our recent Scottsdale, AZ seminar, here are some recommendations from practice management consultant, Bill Rossi.\u00a0 There can be a lot of money to be made if you handle this correctly:<\/p>\n

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  1. Do your homework<\/u>. To get a sense of your fee reductions, prepare a spreadsheet with vertical columns going left to right listing first your top procedures by frequency.\u00a0 The second column will be your full fee for each procedure.\u00a0 The remaining columns would be for each PPO plan and their reduced reimbursement for each procedure.\u00a0 Add the totals at the bottom of each column to see how much of a percentage discount you\u2019re taking in the aggregate from each PPO.<\/li>\n<\/ol>\n

    If you haven\u2019t done so recently, raise your fees.\u00a0 This will give you more ammunition to argue the PPO reimbursements are too low.If you are aware of other doctors\u2019 reimbursement levels, use it to your advantage against the insurance companies.\u00a0 For instance, an office employee who used to work in another office may tell you that the other doctor\u2019s reimbursements are higher than yours.\u00a0 This is not privileged information.<\/p>\n

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    1. Call and negotiate<\/u>. The doctor should be the one making the call, not an office manager and not an out-of-state management consultant.\u00a0 You will be the most effective, as you are the only one who can make a credible threat of dropping that plan.<\/li>\n<\/ol>\n

      If you call saying you want to renegotiate, you may be given the run-around.\u00a0 So, if necessary, tell whomever answers the phone that you\u2019re a new doctor thinking about signing up with their network.\u00a0 When you get through to the network manager, explain who you really are.Do not be demanding and argumentative.\u00a0 Approach this in the likeable style of detective Columbo and consider the following kinds of lines: \u201cMaybe I\u2019m missing something, but I have to ask, is it true you are paying others more for the exact same procedures?\u201d and \u201cDelta is paying $800 for a crown and Aetna is paying $750.\u00a0 That\u2019s more than what you\u2019re paying.\u00a0 Can\u2019t you do any better?\u00a0 Can\u2019t you help me with this?\u201dUse specific fees to make your case, and then ask them to review all of your reimbursements.\u00a0 Then, pin them down.\u00a0 Take their name, when you should expect to hear from them and how you can follow up with them in the future.Finally, review the results to verify that they didn\u2019t raise some reimbursements but lower others.<\/p>\n

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      1. Odds of success<\/u>. In Bill\u2019s experience, you might be successful one-third to one-half of the time \u2013 even with Delta.\u00a0 It is well worth the effort.\u00a0 If for example, Aetna represents 15% of your practice and you can get a 10% raise, then on $100,000 of monthly production, you will earn an additional $1,500 of free money each month going forward.\u00a0 Get into the habit of doing this with each of your plans each year.<\/li>\n<\/ol>\n

        In the next Newsletter, we will summarize Bill\u2019s recommendations for dropping a lousy PPO and limiting the fallout.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

        In case you weren\u2019t able to attend our recent Scottsdale, AZ seminar, here are some recommendations from practice management consultant, Bill Rossi.\u00a0 There can be a lot of money to be made if you handle this correctly: Do your homework. To get a sense of your fee reductions, prepare a spreadsheet with vertical columns going […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"wds_primary_category":0,"footnotes":""},"categories":[4],"tags":[],"class_list":["post-938","post","type-post","status-publish","format-standard","hentry","category-dental-practice-management"],"_links":{"self":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/posts\/938","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/comments?post=938"}],"version-history":[{"count":0,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/posts\/938\/revisions"}],"wp:attachment":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/media?parent=938"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/categories?post=938"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/tags?post=938"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}