Analyzing dental insurance reimbursements may increase bottom line: Three tactics to consider

June 2014

By: Angie Walters

PPO insurance is often one of the largest problems in a dental practice. While operating costs are on the rise, dental insurance reimbursements have stayed stagnant. In order to keep your practice on a profitable track, you’ll need to analyze, from time to time, how much of your revenue is based on those reimbursements, and work with the insurance companies to raise them.

As you likely know, working with dental insurance companies can be tricky. Getting through the red tape, especially when you’re asking for more money, can mean a lot of time spent on the phone negotiating. Below are 3 tactics to consider:

1. Review each insurance company’s acceptance rates
Conducting an analysis of your entire practice’s insurance acceptance policies is critical to increasing your insurance reimbursements. Sometimes, you may actually increase reimbursements by dropping insurance providers. If you find that your staff is spending a lot of time negotiating with a specific company without success, ditch that provider and focus your time on attracting patients with plans more likely to pay.

2. Go armed with data and documentation
In order to successfully renegotiate reimbursement rates, it is imperative that you have a detailed analysis of your practice’s most common procedures. While you may have a general idea of your top billing procedures, this analysis will help you accurately determine which services you could and should discuss with the insurance companies. Before you contact the payor, you’ll want to review your current contracts with dental providers to identify the rates you now earn.

Once you’ve determined those rates and procedures, you can approach the insurance company armed with information. The call centers (typically where 1-800 numbers ring) are not the best place to conduct negotiations – these representatives often have little power to change the terms of your agreement. According to one dentist’s experience, the provider retention department is the best place to start, but you should move up the corporate ladder if negotiations aren’t going well.

When negotiating, make sure you use all of the resources available to you, including leverage. For example, if you are the only dentist in a small town that accepts a specific policy, the insurance company has an interest in keeping you in-network. Use this leverage in negotiating a higher reimbursement.

3. Hire professional negotiators if all else fails
Sometimes the insurance companies just aren’t willing to budge. If you find that providers are being particularly stubborn, it may be time to involve professional help. There are a number of companies that specialize in helping dentists and other medical professionals negotiate with insurance companies; their assistance can prove to be invaluable.

Good for you if you’ve recently negotiated increased reimbursements. Just make sure that you continue to evaluate increases on a yearly basis, if not more often. If you simply don’t have the time to do this periodically throughout the year, make it a priority to do so with each provider at the time your contract is up for renewal. You may be surprised by the extra income this can generate.

Receiving appropriate reimbursements is a great way to improve your bottom line without passing on the costs to your patients. The idea of approaching the insurance companies to ask for more money is intimidating, but being prepared can make the negotiations much more successful. If you have any questions, please contact Angie Walters at AWalters@GPPcpa.com or 214-635-2547. To learn more about Angie you can visit her bio or Google+ page.

Note: This content is accurate as of the date published above and is subject to change. Please seek professional advice before acting on any matter contained in this article.

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