By Nicholas Partridge, President; Five Lakes Dental Practice Solutions

PPO dental insurance is prevalent, but it’s become more complicated. From the shore, the sea looks rough. How can you navigate it safely, efficiently, and profitably?

You can optimize your insurance participation to increase reimbursement rates by using network partnerships. However, managing your PPO participation and addressing reimbursement challenges require a full-fledged effort.

You must evaluate your options regularly.

First, you need to understand dental networks constantly evolve and change; and your practice needs to stay on top of these changes.

Many Texas dentists were affected when Blue Cross Blue Shield of Texas made changes to its network-leasing partnerships several months ago. Late last month, Guardian announced it will no longer access providers from the Careington Platinum dental network in select zip codes in Austin and Dallas-Fort Worth markets.

Many practices took advantage of the opportunity to contract in-network with Guardian while being reimbursed from Careington Platinum’s more financially-attractive fee schedule. If you actively manage your PPO participation, it’s likely you also benefited from the opportunity created by Guardian’s tactic.

Have a plan.

Investment pioneer Benjamin Graham said the best way to measure investing success is not by paying attention to the market, but by having a plan and behavioral discipline to stick to the plan.

The same holds true with managing your dental insurance participation. You need to develop a PPO participation strategy in concert with your longer-term practice goals—what your practice look like in three or five years.

Make data-driven decisions.

Good data is central to developing, implementing, and managing your PPO participation strategy.

A best practice is to develop standards for your practice for how data is recorded and stored. Then, ensure your team is keeping the practice management software updated with current fee schedules and patient demographic information.

Review reports regularly to monitor trends. In addition, invest time and effort in keeping your finger on the pulse of insurance company changes.

With access to clean data from your practice management software and insight into insurance company updates, your practice can successfully carry out your plan.

For 11 years, Five Lakes has helped thousands of growing dental practices develop, implement, and manage a customized PPO participation strategy. For self-implementers, Five Lakes provides monthly insights into payer changes via their newsletter, “Insurance Insights.”
Learn more about Five Lakes.