Insurance, PPOs, Medicaid, Managed Care…who has time or skill to figure this all out and if it is

Jan 23, 2017 | Management

Insurance, PPOs, Medicaid, Managed Care…who has time or skill to figure this all out and if it is the best for your practice?  Joe Gordon and his team at Sikich LLP, a leading professional services firm, has more than 550 employees throughout the country.  From corporations and non-profits to state and local governments, Sikich clients can use a broad spectrum of services and products that help them reach long-term, strategic goals.  In a Q&A with Joe, we address their insurance analysis process with clients:

DDSmatch: What are one of Sikich’s specialties when working with dental practices?

Joe Gordon: Sikich specializes in analyzing a dental practice’s involvement with PPOs. If the client is currently participating with PPOs, we look at the client’s practice to see which insurance plans are in-network for him or her, the fee schedules and profit associated with each one of the plans, and how many patients are involved with each PPO.

DDSmatch: Can you explain your process for reviewing fee schedules?

Joe Gordon: We examine which plans may be eligible for a fee schedule increase, give a detailed recommendation on which codes to focus and even negotiate fee schedules on the client’s behalf. After maximizing fee schedules, we then determine which plans, if any, the client should consider adding or dropping.

DDSmatch: Will you provide an analysis of your recommendation?

Joe Gordon: Yes. Because insurance pays at a reduced fee and the dental practice has fixed and variable cost, we perform a detailed analysis of how the overhead would be affected by the addition or termination of a PPO plan.

DDSmatch: What happens if you recommend terminating a PPO plan?

Joe Gordon: If we determine that the client’s practice is in a position to drop a PPO plan, we’ll make recommendations about which one(s) to drop and outline the process and timing to follow. It will vary depending on the client.

DDSmatch: What happens if you recommend adding a PPO plan?

Joe Gordon: If a client is currently trying to increase new patient flow or production by considering the addition of PPOs to the practice, we present a detailed view of which plans to consider adding and which ones would not be beneficial to the practice’s growth.

DDSmatch: What’s the bottom line for these recommendations?

Joe Gordon: We want the dentist to make an informed choice. We do not want him or her to choose participation in a plan that will end up increasing overhead and reimbursing at rates below the cost of doing business.