We offer two types of packages
1. Our Start-Up Package is designed for the general dentist or specialist who is doing a scratch start. Most dentists in this category are well aware that the initial contracts that they sign with insurance companies are important because cash flow is most critical in the early days of a practice. We will do demographic research of your area to determine what the top employers are in your area and what insurance companies are tied to those employers. We will help you predict what your top codes will be in your new practice so that we can negotiate on your behalf on the codes most likely to impact your future profits. We will also assist you in determining what your initial UCR fee schedule should be with a third party fee analysis. This can have a significant impact on negotiations and too often start up practices guess at fees or borrow an old fee schedule from another office. This simply takes poor fees from another office and shifts them to yours. We want you to be as successful as possible when you open your doors and we’ll help guide you through each of these steps. Once we have fees set and top codes defined we then will begin collecting fee schedule options for your area and negotiating on your behalf. Not only do we attempt to get customized fee schedules for your office based on your anticipated top codes, we also carefully guide you on HOW to be contracted. Many dentists do not realize that there can be multiple ways to get paid on a particular patient base and the way in which you are contracted determines the fees you will be paid. These choices matter only to you, the dentist. Patients are not impacted at all based on how you are contracted however as the dentist, you can get paid differently for the exact same production with many companies depending on how you are contracted. We also will handle your credentialing and make sure your effective dates are verified. You’ll get a final report of our work with you and a copy of your contracts and fee schedules in an online account that is accessible at any time. We’ll even send you a reminder when your fee schedules are negotiable again so that you don’t miss out on any future increases. We take the guess work out of those decisions, allowing you to focus on the other challenging details of starting a practice. Once you sign your initial contract you will not be eligible for negotiations for 18-24 months, depending on the contract. We have worked with far too many practices who realized they signed horrible fee schedules at the start of their practice and now they are locked in to low fee schedules without the ability to negotiate for many more months.
We will supply you with a list of the companies we work with and handle on your behalf. Note that we do not handle Medicaid or HMOs at all so if you are interested in a product outside of PPOs you’ll want to contact those companies directly.
Also be aware that you’ll need a phone number for applications that is NOT your cell number. If you will not have an established land line prior to needing to submit applications we suggest you get a Google number for use on applications in the short term and then forward it to your established number upon opening.
We’ve had multiple clients tell us that our services in getting signed up for select PPOs where they knew they were making smart decisions was the smoothest part of their entire start-up. It will take 90+ days to negotiate in most cases so call well before your opening date as customized negotiations take a little longer but are well worth it. Our start-up division is directed by co-owner Lisa Weber and her attention to detail guarantees you will make smart decisions about PPO participation as you start your new practice. For more information and pricing on our start up package please use our Contact Us form and we’ll be happy to email you information.
2. Our Established Practice Package is designed for the dentist that already has an established practice and and is seeking to either add PPOs, drop PPOs or renegotiate current fee schedules. We first do an anlaysis of your current practice to determine your top fee codes and to see how the PPOs you currently participate with compare to your full fee. We’ll also do a fee analysis which will help determine if any fee adjustments would be a good option for your practice so that you are well balanced for your area. We want to get solid benchmarks of where your practice is now and then determine how we can consider shifting any participation to increase your profits. For some practices this may mean adding a few select PPOs that are willing to negotiate to pull in new patients. For other practices it may mean dropping some poor paying PPOs to free up chair time for higher paying patients. For many offices it’s a matter of renegotiating current contracts to get paid more for the work already being produced. Regardless of your situation, our goal is to guide you to making smart decisions about contracting so you realize the highest profits on the codes you utilize the most.
If you are unaware of which companies you are currently contracted with or if you do not have any current fee schedules available you will want to call and get a copy of your current fee schedules before proceeding with us. We will need to know who you have contracts with and what your current rates are before we can contact insurance companies on your behalf for increases. For more information about our Established Practice Packge please use our Contact Us form and we’ll email you some information about package details and pricing.
As always, give us a call for a free phone consult at 855-327-9125 to schedule a time with Sandi Hudson, one of our co-owners, and we can answer any questions pertaining to your specific situation.
Q: How do you gather the information for the analysis?
A: We will ask you for some reports from your software to be sent to you along with copies of your current fee schedules.
Q: What if I don’t know what companies I’m contracted or what my fee schedules are now?
A: Take some time to first research who you are currently contracted. If you don’t know where to begin, ask us! We will get you a list of contact numbers that you can call. You can also check the insurance companies You will need to gather fee schedules so we know what you currently have in place and so that we have a starting point of which companies to contact. This will require a bit of time for your front office staff but it’s the first step in getting on track with your insurance participation! Know that we can’t tell you who you are contracted with, you will need to let us know who you signed contracts with but we can get you a list of contact numbers to make for a faster process if some research is involved.
Q: How much time will it take to get the analysis?
A: Our analysis is typically done within two weeks after we get your data. The data will be condensed into an easy, one-page summary and sent to the dentist for review. You will see insurance information ranked both according to write-offs as well as revenue generated. Group practices take slightly longer due to having multiple providers and more data to examine. We email you the information and then schedule a phone conference with you and/or your staff to discuss your office’s individualized report.
Q: What happens after I get the review done?
A: Many dentists are shocked to see the detailed write-offs when they are analyzed individually and presented in order from best to worst. When the review is done we make recommendations on which fee schedules we believe would be good ones to ask for a fee schedule increase from the insurance company. We handle this process for you and negotiate on your behalf to obtain the best offer available in your area.
Q: How to you obtain better results for negotiations than I can do on my own?
A: We are careful to tell our clients up front if they are participating only with plans that are unlikely to negotiate. For companies that are likely to negotiate we can typically obtain stronger results than an office can get on their own. We don’t have a magic wand to make insurance companies negotiate with us but we do understand the parameters that insurance company reps have to work within. We work within those parameters to shift increases to the codes that matter the most to your particular office’s profit and attempt to have customized fee schedules created when possible. We have also worked very hard to create good relationships with insurance company reps. We work with the same reps over and over and they know when we call that we have our facts straight, are specific in what we are looking for, will respond quickly and will represent you, our client, in a manner that is likely to create a positive reminder for them when the next negotiation opportunity comes around. Just knowing which rep to call directly rather than calling the 1-800 number and hoping to get routed correctly can save your staff hours! We spend many hours with reps discussing industry changes. We strive to be a voice for dentists in how to create a better system of insurance participation that reps may be responsive to with the right information.
Q: How long do fee schedule negotiations take?
A: We tell our clients to plan on about 90 days (120 in some situations). Can we get an offer faster? Yes, but our goal isn’t to get you an offer, it’s to get you the best offer available for your area. We may go back and forth with the insurance company reps multiple times to get the largest increases on your top codes. It is always worth the wait to maximize your fee schedules as much as possible because most insurance companies will no longer negotiate more than once every 18-24 months. Whatever fee schedule you agree to will be what you have to work with for many months so we want it to be the best option available before you accept.
Q: How do I determine when it’s time to consider going out-of-network?
A: After our initial analysis, we will have solid data to help you determine if it is a good time to consider going out-of-network. We will already have looked closely at your current schedule with the idea that keeping a full schedule is the priority. While write-offs are painful to consider, we want to be exchanging PPO revenue for full revenue not NO revenue! Practices who already have holes in their schedule will find it hard to drop insurance without additional marketing plans in place. For those ready to begin dropping plans, we typically recommend a gradual approach based on criteria we have found to retain current patients when going out-of-network and also creating a plan to keep new patient numbers steady. Even if it turns out you are not quite ready to begin dropping any PPOs you will be well on your way to making informed decisions as your practice continues to grow. With a plan in place the next steps become much easier. Our standard package is designed to help you realize this doesn’t have to be a scary process!
Q: What if I want to Add PPOs?
A: We are talking to more and more dentists who are debating on adding PPOs as a way to jump start their practice. We have found that many fee-for-service practices saw revenues plateau the past 2-3 years due to the economy and many of those dentists are wondering if they should now add in more insurance participation. In these situations we target our analysis to be sure the office considers only the plans that make sense to increase the bottom line, not just add busy work. Not only are we wanting to increase new patient flow, we want to be sure that there isn’t such a discount with the current patient base that the office signs up only to end up working harder for the exact same profits. When adding in PPOs to an established practice it’s very important to choose plans that will negotiate to a workable fee schedule and to carefully analyze the impact on the current patient revenue to make strategic choices. We are often able to find some smaller, negotiable options that will give a bump to new patient flow without jeapordizing current patient profits.
Q: How much do you know about fee schedules in my particular area and how much can you share?
A: We have extensive experience in all US markets including saturated areas as well as rural communities with less competition. We maintain the confidentiality requests and/or requirements of the insurance carriers we work with on behalf of individual dentists and will not share the content of fee schedules with anyone other than the dentist the carrier has specifically offered it to, and will not republish any schedule for outside use. Each insurance carier’s preferred fee schedule comes with a caution clearly noted by the individual insurance carrier to keep the content confidential and to avoid publishing it in any form and we strongly recommend this caution be followed by our clients. In other words, we have the knowledge to negotiate clearly in your market and will let you know when we have achieved the insurance companies best offer but won’t release any other provider’s fee schedules in the area due to confidentiality requirements. We take this confidentiality very seriously as it’s our reputation on the line with insurance company reps that we work with daily.
Q: What if I want to consider Medicaid or HMOs?
A: We do not handle Medicaid or HMOs and would recommend you contact them directly to request paperwork.
Q: Do you handle Recredentialing Requests?
A: No. Recredentialing requests are not tied to negotiations, they are information requests required to keep your current contracts in good standing. You will receive recredentialing requests from insurance companies asking you to update your information every 2-3 years. You must return these by the deadline dates issued or you will be bumped out of network. These must be sent from your office directly to the insurance companies as requested and we recommend you also verify, in writing, that the information was received by the insurance company.
Q: Do you offer packages to credential new associates?
A: No, we credential our clients when adding new contracts during our work with the office however we do not offer a stand-alone package for only credentialing. Our company is geared towards strategic planning of how to utilize PPOs and negotiate rates but credentialing itself as an ongoing service isn’t something we offer separately.
To see if our Analysis Services may be right for your practice Contact Us.