Introduction to Negotiating PPO Fees
In the ever-evolving landscape of dental practices, understanding how to effectively negotiate PPO fees can significantly impact your bottom line. Recently, I had the opportunity to negotiate a compelling reimbursement structure for one of my clients, which stands as a testament to making data-driven decisions.
Reimbursement Outcomes Achieved
For this particular client, we were able to achieve reimbursement rates of 87% of UCR for implants, 83% for crowns, 81% for endodontic (endo) procedures, and 80% for prophylaxis (prophy). In comparison, the industry average hovers between 45% and 55%. This makes a substantial difference in profitability and patient care. Utilizing Fair Health Consumer data tailored to the specific zip code ensured that our UCR calculations were accurate and not artificially low. Imagine what it feels like to effectively write off merely 20% of your UCR while still enjoying robust returns.
Benefits of Solid Reimbursement Rates
It’s essential to realize the impact of these reimbursement rates on practice sustainability. The higher reimbursements allow you to retain more income while continuing to provide high-quality care. Additionally, this approach supports increased production without jeopardizing the standard of care — allowing you to see a greater volume of patients. Whether you’re dealing with frequent procedures like prophylaxis or less common ones like implants, achieving a write-off of 13%-20% is a strategic victory that can enhance your practice.
