As an office manager or dentist, you understand that running a successful practice requires not only excellent clinical skills but also savvy business acumen. One critical aspect of managing a profitable dental practice is negotiating with insurance companies.
Understanding the PPO Challenge
Before we dive into negotiation tactics, it's crucial to comprehend why transitioning away from underperforming PPOs is a vital step for your dental practices. We break this down in part one of our series: Identifying the Most Important Benchmarks that Indicate Whether a PPO is Good, Bad, or Manageable.
The Art of Negotiation
Negotiation is both an art and a skill, and mastering it can be transformative for your dental practice. Here are some essential negotiation principles and strategies to consider:
Preparation is Key
Thoroughly research the PPOs you're contracted with. Understand their fee schedules, policies, and negotiation history.
Be clear about the value your practice offers. Highlight your reputation, quality of care, and the patient experience you provide.
Before entering negotiations, identify alternative solutions, such as a dental membership plan that can replace the revenue from the PPOs that you're willing to walk away from.
Be prepared to step away from negotiations if the insurance company fails to meet your bottom-line requirements.
Set Clear Objectives
- Determine your objectives. What do you want to achieve through negotiations?
- Prioritize your objectives in order of importance — keeping in mind the long-term sustainability and profitability of your practice.
Be Patient and Persistent
Negotiations can be protracted processes. Take your time, and be prepared for multiple rounds of discussions.
Maintain persistence even if initial negotiations seem unfruitful. Often, patience can lead to better outcomes.
The carrier may provide a future date at which negotiation can be considered. They may have a time limit of one negotiation every two or three years. Be sure to add this to your calendar.
Confidence is a critical component of successful negotiations. Here are some strategies to help you build confidence as you work towards transitioning your dental practice away from underperforming PPOs:
Knowledge is Power
Continuously educate yourself about the dental industry, insurance trends, and negotiation strategies. The more you know, the more confident you will feel.
Stay updated on the financial health and performance of your practice. This knowledge will bolster your confidence when discussing changes.
Practice and Role-Play
Practice negotiation scenarios with a colleague or mentor. Role-playing can help you anticipate objections and formulate effective responses.
Consider enrolling in patient conversation workshops or courses to hone your skills.
Seek Support and Advice
Connect with other dentists or office managers who have successfully negotiated PPO contracts. Their insights and advice can be invaluable.
Consult with experts who specialize in dental practice management and insurance. They can also provide guidance and support.
Maintain a positive mindset throughout the negotiation process. Negative thoughts can undermine your confidence and effectiveness.
Celebrate small victories along the way and take your learnings from each successful negotiation and apply them to the next.
Successfully negotiating with PPOs requires more than just a confident demeanor. It necessitates careful preparation, a clear understanding of your practice's value, and strategic tactics. By emphasizing patient benefits, leveraging your expertise, and seeking fair terms and conditions, you can build confidence in your negotiation approach.
Furthermore, always anchor your negotiation strategy with data that aligns with your practice goals. Data-driven decisions provide a solid foundation for your negotiations and demonstrate to insurance companies that your requests are grounded in the best interests of your practice and patients.
Confidently improving PPO participation is not only possible but essential for the long-term success of your dental practice. Approach negotiations with a strategic mindset, and you'll be well on your way to achieving favorable outcomes and strengthening the financial health of your practice.
This series is produced in partnership with Teresa Duncan.
Teresa Duncan, FAADOM, MS is the author of Moving Your Patients to Yes: Easy Insurance Conversations as well as a contributing author to the ADA’s annual CDT Companion Guide™. Her podcasts “Nobody Told Me That!” and “Chew On This!” provide regular coding and management updates. Teresa was recently presented with AADOM's Lifetime Achievement Award.