Let's talk PPO! Often, practices that are in network with many insurance plans tend to have a full chair and a backed up schedule. Although the busyness means collections, of course being an in network provider cuts into those collections greatly. By contracting as an in network provider, you are agreeing to a set fee schedule of maximum allowable fees. Most carrier contracts require a 40%-60% write off. Each carrier typically has a separate fee schedule and some plans may pay better than others.
Doesn't it make sense to strategize? If the patients in the chair are taking up x amount of your time and you are only able to collect 40%-50% of your fee, this is where the plans you take start to matter a great deal. Negotiating your PPO contracts is the starting point to figuring out the most profitable and time/money efficient way to participate with insurance plans.
Simple right? Negotiate and ask insurance companies to "up" your fee schedules. Actually the process is very complex. The PPO industry has evolved so much that you can be in network with each carrier a variety of different ways. This is referred to as PPO leasing, network sharing or fee re-pricing. Any way you call it, basically it means that an insurance carrier can put you in network through other plans you may be contracted with even without you signing up with them directly. The motive for insurance carriers? To get as many in network doctors as they possibly can while selecting a leaser's fee schedule on their own terms. Of course, as you can imagine, insurance carriers can pick between their options and process on the lowest available.
PPO Negotiations & Optimization takes major strategy. Here are the steps that need to be taken for the most successful negotiation project:
Update your UCR fees - Insurance companies don't necessarily use your UCR fee updates as leverage to negotiate, however it is important to ensure your UCRs are not paying too low. If this is the case for your office, insurance companies will only pay what you are asking.
Evaluate your current PPO participation & structure - Identifying what contracts you have, how they are paying and if there is leasing/fee schedule sharing taking place.
Negotiate with leverage - Negotiating with your carriers will increase collections without even changing anything else in your practice. With the proper evaluation, you should be going into negotiations with a game plan and some leverage behind you. The major source of leverage is found by identifying the best paying option for each carrier.
Optimize - At times, participation is greatly increased by changing the way you are in network. Perhaps a leasing arrangement pays better, or a direct contract can exceed an umbrella company you are using.
If your practice is in network with all PPO plans, odds are there is a lot of overlap going on. Companies of relevance may be using your lowest fee schedules for claims and you or your team may not realize this is taking place. Insurance companies can be very clever with their "re-pricing" to get the best deal they can.
In summation, this means you are currently doing MORE work for LESS money. PPO Negotiation services are extremely beneficial for many reasons. The number one result is increased reimbursements which automatically applies to your bottom line. The knowledge of how your plans pay can help you select marketing strategies that increases patient visits within the highest paying networks you are in network with. Coaching and training your staff on how your participation is set up and how to audit claims to avoid loss from default leasing.
You can book with us to have a conversation about your specific practice situation, insurance revenue goals and go through a free analysis of negotiable revenue and accepted plans. We analyze your revenue with negotiable companies and take a look at your current participation before sending your custom proposal. This way we can guarantee a return on investment.
Feel free to reach out with any PPO related questions through our website or email: info@beaconpposolutions.com.
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