How Dental Teams Can Better Manage PPO Participation
In Part 1 and Part 2 of our Navigating Participation series, we helped identify the most important benchmarks to measure PPO performance. And explored how practices can confidently improve their participation through negotiation.
From strengthening your coverage foundation to setting standards for the approval of new PPOs, in the final installment, we'll explore four ways to manage PPO participation moving forward.
Strengthen your coverage foundation with a dental membership plan
Whether you're fully fee-for-service or participating with one or many types of insurance — we know and respect that every practice and its relationship with conventional coverage is different. But how you offer coverage impacts everything important to you — how often patients visit, the amount of treatment they accept, and how you get paid.
Building a solid coverage foundation doesn't start with simply eliminating insurance. It begins by:
- Ensuring care is greatly accessible and transparent for all patients,
- Having greater autonomy over business decisions that impact your cash flow, and
- Simplifying administrative processes for your team.
Offering an alternative to traditional coverage is crucial if you plan to disengage from any insurance plan. This will ensure that your patients can still access essential services and that revenue generated will circumvent any possible loss in earnings.
Unlike insurance or dental discount plans, a membership plan lets dentists and DSOs provide customized subscription-based coverage directly to patients.
Implementing a dental membership plan involves a bit of planning and strong communication. Start by identifying the preventive services covered under the program, such as regular cleanings, exams, and X-rays. Based on your fee schedule, clearly outline membership plan pricing and benefits to ensure the best outcome for your practice while adding unique value for patients.
Consider offering additional savings on restorative and cosmetic procedures to incentivize enrollment. Promote your plan throughout the year through various marketing channels, such as social media, email newsletters, and in-office signage, to encourage patient participation and retention. More significant promotional pushes during certain times of the year, like open healthcare enrollment, can also help generate interest.
It's highly recommended that you collaborate with your entire team to effectively communicate the plan's details to patients and address any questions or concerns they may have. The successful implementation of a dental membership plan can significantly strengthen your coverage foundation and put you in the best possible position to disengage from underperforming PPOs.
Check out these examples:
Determine organizational goals for PPO participation
Clear organizational goals are the root of a successful PPO management strategy. As with any initiative it's best to have specific objectives clearly defined.
These goals may encompass financial considerations such as increasing patient volume and revenue, and negotiating favorable reimbursement rates. Additionally, the pursuit of enhanced patient satisfaction, improved network visibility, and the cultivation of strong provider-insurer relationships could be integral aspects to help define your practices goals.
Set standards of approval for new PPOs
When setting standards for the approval of new PPOs, consider the local companies that are covered by the carrier as well as your bandwidth as a provider. Adding a plan should only be considered if you can accommodate new patients profitably. Develop an evaluation process that includes input from key practice stakeholders such as your clinicians and administrators.
Stay up-to-date with the latest continuing education sessions (CE)
For dental providers and administrators, ongoing education is crucial for adapting to changes in reimbursement models, regulatory requirements, and patient expectations. By staying informed, your dental practice can proactively address challenges, implement innovative solutions, and provide the highest quality of care to your patients.
Here's a few we recommend:
1. Dental Insurance Design and Management use code KLEER for a $75 courtesy
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.
Get started, today.
Our experts will show you how our advanced, cloud-based membership plan platform—coupled with resources, tools and support from the experts at Kleer, can bring your practice phenomenal results.
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