PPO fee schedules are one of the most mysterious parts of running a dental practice. They are a requirement to work with insurance providers, but every provider is working from a different one. Things get more complicated when you realize that every provider also has a different method for calculating a fee schedule and that the method is often never disclosed. How can you finally understand PPO fee schedules once and for all?
Fee Schedule 101
If your dental practice operates on a fee-for-service model, you don’t need to worry about PPO fee schedules. Instead, you just need to worry about your own! However, the majority of practices work with insurance providers and need to be mindful of them as a result. PPO fee schedules determine a wide variety of things for your practice, including your budget, how you collect payment from your patients and more.
What Are PPO Fee Schedules Based On?
One of the most frequent questions that we get is what PPO fee schedules are based on. Depending on who you listen to, the answer might be zip code, TIN, provider, county, state or something totally different. In reality, every insurance provider has a completely different, often secret, method for calculating fee schedules. Even in a relatively small state, practices a few towns away could have completely different schedules.
If You Have Multiple Locations, Can You Get the Same PPO Fee Schedule?
Unfortunately, the answer is “not always.” While we always work as hard as we can to get every location in your practice or dental group on the same PPO fee schedule, it is not always possible.
How Can PPO Fee Schedules Be Adjusted?
Fee negotiation is an intense process that can take months to complete. Unless you are trying to negotiate only a couple of codes for a single provider with a single insurance company, it will be very difficult for you to find the time to negotiate. APEX Reimbursement Specialists works with dental practices of every size to negotiate the best possible, most financially-beneficial PPO fee system for each insurance provider. We will work with you to assess existing fee schedules, see where you could improve your bottom line through negotiation and negotiating with each provider on your behalf.
Master PPO Fee Schedules with APEX Reimbursement Specialists
The experts at APEX Reimbursement Specialists can help you to explore the best insurance carrier options and fee schedule for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.