Thanks For Asking

By: Kathy Edwards, RDH, Margaret Boyce-Cooley and Dana Morano of the Practice Support Team


Burkhart’s Practice Support Team provides support to doctors by answering hundreds of questions that come in through our toll-free number and email. It is our pleasure to provide answers and resources—at no fee—to all of our Burkhart clients. Consider it a value-added service from Burkhart. We’ve compiled the most frequently asked questions and shared some insight on those here:

Q. What can you tell me about PPO fee negotiations?
A. It is critical to negotiate reasonable fees for your PPO participation. Fees can be negotiated at the time the contract is signed and every two years after that. There are several key strategies when negotiating fees with insurance companies, but the two listed here are a great place to start:
1. Evaluate your current fees. Evaluate your current UCR fees and make sure they are in the 75-85th percentile for your geographical area. It could be a wasted effort to attempt to negotiate if your current fee schedule is low for your area. You can contact your Burkhart Account Manager for resources to check your fees against other dentists in your zip code to determine your percentile. If you find your fees are low, it would benefit you to correct this situation prior to your negotiations.

2. Determine your leverage. There are some factors that gain more leverage when you enter negotiations. Take the time to determine if your practice can offer something that makes you more valuable as a provider for the insurance company. Some leverage points include:
a. Geographical location
b. Specialty offered, unique reputation
c. Availability in hours offered
d. Size of your practice (the larger the production, the better for negotiating fees)


Q. I went through Burkhart’s PracticeView Program last month and I wanted to get more clarification on what it means to “re-balance” my fees.
A. In addition to performing a 3-5% annual increase to your office (UCR) fees, we often find that the practice’s current fee schedule will need to be rebalanced. Having a balanced fee schedule ensures that all your fees are in a similar percentile that reflects the experience and technology you offer at your practice. Keep in mind that increasing all of your fees allows you more leverage to negotiate with PPO plans, allows higher reimbursement for out-of-network and dual coverage patients, keeps the fee schedules higher for your area as they are based on practice averages, AND ensures you get the highest reimbursement when plans update fees. It will be worth the extra effort to balance fees and, therefore, ensure you are getting the proper reimbursement for all procedures.


Q. I would love to drop all the PPO companies I’m contracted with but I know that may not be wise. How can I get a better handle on them?
A. There are a number of considerations when examining and managing your PPO participation:
• Are you billing full fees and adjusting off the difference?
• How many New Patients are you seeing per month? (count all 0150 and 0180s)
• Have you reviewed the percentage of New Patient flow coming from each PPO plan for the past 12 months?
Compile this data in a grid like the one below in order to develop a strategic approach to your participation. This data helps determine the true impact of each PPO contract administered by the practice. With this factual data, you can make a more informed decision for each individual contracted plan. Please email or call Practice Support Team and request the Excel spreadsheet to begin your analysis.


The Practice Support Team has years
of combined business and dental expertise!
Reach out to us today at no cost to you as a Burkhart account!

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