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TAKING BACK CONTROL OF YOUR PRACTICE
Optimizing Fees and PPOs
March 3, 2017
HOUSEKEEPING:
Introduction
•Housekeeping
•Why Optimizing Fees and PPOs?
The Power of Numbers: Optimizing Fees and PPOs
Tak...
Your co-hosts today:
DANIEL RHOTEN WILLIAM J MOORHEAD, DMD
Director Customer Success
SIKKA SOFTWARE
Founder
STREAMDENT®
AN...
WHY OPTIMIZING FEES and PPOs?
4 KEYS WITH DENTAL FEES:
• Fees “drive” practice revenue
• Updating fees can boost practice profitability
• Fees vary wide...
Ask neighboring
dentists?
Add same dollar
amount to
select fees?
Add 5% to
all fees?
No way!Too risky?
No need, I’m
“in ne...
I didn’t raise fees for 2-3 years at a time, but
found I was getting too far behind - and the
increase was then too large ...
In today's economy, it doesn't seem right to be
raising fees, however…
LAST TIME DENTISTS
RAISED FEES?
- From Wealthy Dentist Survey
120K Within Past Year
50%
More Than 1
Year
31%
More Than 2
Y...
HOW MUCH MONEY DO
PRACTICES IN THE U.S.
LEAVE ON THE TABLE EVERY
YEAR BY NOT UPDATING
THEIR FEES?
A. $50 Million
B. $350 M...
HOW MUCH MONEY DO
PRACTICES IN THE U.S.
LEAVE ON THE TABLE EVERY
YEAR BY NOT UPDATING
THEIR FEES?
A. $50 Million
B. $350 M...
THE POWER OF NUMBERS
Optimizing Fees and PPOs
March 3, 2017
The Power Of Numbers
To Raise Or Not To Raise… Your Fees
• Tracking is Essential
• Think Big Business (every number is lif...
The 4 P’s:
1. Pricing
2. Product
3. Place
4. Promotion (that form the marketing mix)
How Do You Set Your Fees?
Ask your friends?
Hire a consultant?
Buy a fee schedule?
Have your business manager do it?
Just ...
How Do You Set Your Fees?
After having reviewed thousands of practices:
THE COLLECTION OF DATA FOR ANALYSIS IS
CRITICAL, F...
Optimize your practice and your fees will come into line.
OPTIMIZE YOUR PROCEDURES & YOUR SERVICES
= FEES TO MAXIMIZE YOUR...
IS YOUR PATIENT A RAVING FAN?
Relationship is more powerful than price.
Relationship is more powerful than delivery.
Relationship is more powerful than ...
PATIENT SATISFACTION
IS WORTHLESS,
PATIENT LOYALTY
IS PRICELESS
Patient Matrix Service / Product
Relationship
Fugitive
Subversive Second Chance
Fans
What do you need to evaluate your Fees?
DATA, DATA, DATA
Fee Tables & Spreadsheets Average you out!
• 70th, 80th, 90th per...
Customize Fees to the Dentist, Not Just the Zip Code
Optimize
Your
Fees
Maximiz
e
Your
Profits
Network Data
Local CPA Surv...
A. Procedure Optimization
B. Know Which Procedures Drive
Your Practice
How can Sikka’s Practice Optimizer benefit you?
We take Fees Seriously!
0%
20%
40%
60%
80%
100%
Income
80% 75% 70% 65% 60% 55% 50%
Overhead Percentage
Net Income Increase with Fee Increase
5%
10...
Tips from Dr. Charles Blair:
“Some Delta Dental plans are now lowering fees, while others are
requiring new providers to j...
The PPO's UCR fee should never be submitted on the claim. Always enter your
full fee.
Entering an old PPO fee, after the P...
TAKING BACK CONTROL OF YOUR PRACTICE
Optimizing Fees and PPOs
March 3, 2017
• Do the math!
• How much are we actually making?
• How do PPOs affect my overhead?
Reality Check
• Learn how to negotiate...
Facing Reality
Step 1: Optimize Your Fees
Your Fees The
"Competition"
Comparables
Step 2: Select Codes to Negotiate
MORE codes
negotiated
LESS increase
in allowances
per code
LESS codes
negotiated
HIGHER
increase
per code
Negotiating
Allo...
Step 3: Reduce Paperwork
Step 3: Reduce Paperwork
Co-Leasing
Umbrella Networks
CAQH.org
Step 3: Reduce Paperwork
Automatically Calculate Patient’s Balance
Add Legitimate Billables & Alternatives
Rethink
Giving Away
Procedures
Add Procedures
Not Covered
By PPOs
Offer Your
Patie...
DentalWarrantyCorp.com/StreamDent
Signed Consent Acceptance or Refusal
We like our patients to be informed about the various procedures involved before star...
 Set up extra procedure codes and multi-codes
 Example:
 D5110 Maxillary Complete Denture Allowable fee $900
 D5110.A ...
Non-Covered Services Legislation
Have a plan
Use tools like Sikka’s
Fee Optimizer
Follow through
step-by-step
Use fee services to
establish your UCR
D...
TAKING BACK CONTROL OF YOUR PRACTICE
Optimizing Fees and PPOs
Q & A
VALUABLE RESOURCES
TO EXPLORE MORE, OR DECIDE TO DO MORE
StreamDent.com/Free-Resources
•PDF of today’s PowerPoint
•Systems...
VALUABLE RESOURCES
TO EXPLORE MORE, OR DECIDE TO DO MORE
store.sikkasoft.com
•Practice Optimizer
•Fee Schedule
Daniel Rhot...
Taking Back Control of Your Practice: Optimizing Fees and PPOs
Taking Back Control of Your Practice: Optimizing Fees and PPOs
Taking Back Control of Your Practice: Optimizing Fees and PPOs
Taking Back Control of Your Practice: Optimizing Fees and PPOs
Taking Back Control of Your Practice: Optimizing Fees and PPOs
Taking Back Control of Your Practice: Optimizing Fees and PPOs
Taking Back Control of Your Practice: Optimizing Fees and PPOs
Taking Back Control of Your Practice: Optimizing Fees and PPOs
Taking Back Control of Your Practice: Optimizing Fees and PPOs
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Optimizing your Fees and Working With PPOs can be a huge drain or a huge success for your practice...
Did you know that over half of all Dentists in the U.S. haven't updated their fees in over a year?
Did you also know that many PPOs, when included with your overhead expenses, can decrease your profitability in half?
Join us for a webinar with experts William J Moorhead, DMD, Founder of StreamDent and Antonio Bojorquez, Product Manager & Director of Training Sikka Software, and discover how you can once again own the power and control of your practice's profitability.

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Taking Back Control of Your Practice: Optimizing Fees and PPOs

  1. 1. TAKING BACK CONTROL OF YOUR PRACTICE Optimizing Fees and PPOs March 3, 2017
  2. 2. HOUSEKEEPING: Introduction •Housekeeping •Why Optimizing Fees and PPOs? The Power of Numbers: Optimizing Fees and PPOs Taking Back Control of Your Practice: Optimizing Fees and PPOs Q & A Resources
  3. 3. Your co-hosts today: DANIEL RHOTEN WILLIAM J MOORHEAD, DMD Director Customer Success SIKKA SOFTWARE Founder STREAMDENT® ANTONIO BOJORQUEZ Product Manager Director of Training SIKKA SOFTWARE
  4. 4. WHY OPTIMIZING FEES and PPOs?
  5. 5. 4 KEYS WITH DENTAL FEES: • Fees “drive” practice revenue • Updating fees can boost practice profitability • Fees vary widely between providers (even within the same practice location) • Fees should always change over time
  6. 6. Ask neighboring dentists? Add same dollar amount to select fees? Add 5% to all fees? No way!Too risky? No need, I’m “in network”? HOW DO YOU UPDATE FEES?
  7. 7. I didn’t raise fees for 2-3 years at a time, but found I was getting too far behind - and the increase was then too large to do at one time.
  8. 8. In today's economy, it doesn't seem right to be raising fees, however…
  9. 9. LAST TIME DENTISTS RAISED FEES? - From Wealthy Dentist Survey 120K Within Past Year 50% More Than 1 Year 31% More Than 2 Years 15%
  10. 10. HOW MUCH MONEY DO PRACTICES IN THE U.S. LEAVE ON THE TABLE EVERY YEAR BY NOT UPDATING THEIR FEES? A. $50 Million B. $350 Million C. $2.25 Billion
  11. 11. HOW MUCH MONEY DO PRACTICES IN THE U.S. LEAVE ON THE TABLE EVERY YEAR BY NOT UPDATING THEIR FEES? A. $50 Million B. $350 Million C. $2.25 Billion
  12. 12. THE POWER OF NUMBERS Optimizing Fees and PPOs March 3, 2017
  13. 13. The Power Of Numbers To Raise Or Not To Raise… Your Fees • Tracking is Essential • Think Big Business (every number is lifeblood) • Acquisition (give it weight) • Precise Tacking Is Important (no “gut” decisions) When’s the last time you updated your fees?
  14. 14. The 4 P’s: 1. Pricing 2. Product 3. Place 4. Promotion (that form the marketing mix)
  15. 15. How Do You Set Your Fees? Ask your friends? Hire a consultant? Buy a fee schedule? Have your business manager do it? Just do it? Do a survey? Wait till next year, the economy is down, slow, stalled, up…?
  16. 16. How Do You Set Your Fees? After having reviewed thousands of practices: THE COLLECTION OF DATA FOR ANALYSIS IS CRITICAL, FOCUS ON THOSE PROCEDURES THAT HAVE WEIGHT WITHIN YOUR PRACTICE!
  17. 17. Optimize your practice and your fees will come into line. OPTIMIZE YOUR PROCEDURES & YOUR SERVICES = FEES TO MAXIMIZE YOUR PROFITS
  18. 18. IS YOUR PATIENT A RAVING FAN?
  19. 19. Relationship is more powerful than price. Relationship is more powerful than delivery. Relationship is more powerful than quality. Relationship is more powerful than service. - Sales Guru Jeffrey Gitomer
  20. 20. PATIENT SATISFACTION IS WORTHLESS, PATIENT LOYALTY IS PRICELESS
  21. 21. Patient Matrix Service / Product Relationship Fugitive Subversive Second Chance Fans
  22. 22. What do you need to evaluate your Fees? DATA, DATA, DATA Fee Tables & Spreadsheets Average you out! • 70th, 80th, 90th percentile may be irrelevant • 2 dentists in the same area, with different profitability indexes, should have different fee schedules - NOT THE SAME • Don’t Average out  Optimize!
  23. 23. Customize Fees to the Dentist, Not Just the Zip Code Optimize Your Fees Maximiz e Your Profits Network Data Local CPA Surveys Local level, County level, Lab cost, Salary Surveys, Census Demographics, COLA Dentist Data From Practice Management System Procedure codes Frequency, Revenue, Current Fees, Time Units
  24. 24. A. Procedure Optimization B. Know Which Procedures Drive Your Practice How can Sikka’s Practice Optimizer benefit you?
  25. 25. We take Fees Seriously!
  26. 26. 0% 20% 40% 60% 80% 100% Income 80% 75% 70% 65% 60% 55% 50% Overhead Percentage Net Income Increase with Fee Increase 5% 10% 15% 20%
  27. 27. Tips from Dr. Charles Blair: “Some Delta Dental plans are now lowering fees, while others are requiring new providers to join the lower-fee Delta PPO Network as a prerequisite to becoming a Delta Premier Provider. When the new buyer must participate in the lower-fee Delta PPO network, practice values have dropped.” “Remember, fees are always "high" in the patient's eyes. Even so, fees should be raised at least annually -- even if just a small percentage. For the last several years, dentists have been reluctant to raise their fees. A 1.5% raise was common and PPOs followed suit. Regardless of the past, in most practices, fees need to be rebalanced.”
  28. 28. The PPO's UCR fee should never be submitted on the claim. Always enter your full fee. Entering an old PPO fee, after the PPO has raised its fee schedule, means you would not benefit from the increase. Another reason to have a full, rebalanced fee schedule is that when a husband and wife have two plans, the practice may receive its full fee. When secondary insurance benefits coordinate with primary, the practice can receive up to the full fee.
  29. 29. TAKING BACK CONTROL OF YOUR PRACTICE Optimizing Fees and PPOs March 3, 2017
  30. 30. • Do the math! • How much are we actually making? • How do PPOs affect my overhead? Reality Check • Learn how to negotiate with PPOs • Learn what tools are most helpful Develop a System: • Legitimate add-ons • Alternate Procedures Optimize Your Profits: Today’s Game Plan:
  31. 31. Facing Reality
  32. 32. Step 1: Optimize Your Fees
  33. 33. Your Fees The "Competition" Comparables
  34. 34. Step 2: Select Codes to Negotiate
  35. 35. MORE codes negotiated LESS increase in allowances per code LESS codes negotiated HIGHER increase per code Negotiating Allowable Fees
  36. 36. Step 3: Reduce Paperwork
  37. 37. Step 3: Reduce Paperwork Co-Leasing Umbrella Networks
  38. 38. CAQH.org Step 3: Reduce Paperwork
  39. 39. Automatically Calculate Patient’s Balance
  40. 40. Add Legitimate Billables & Alternatives Rethink Giving Away Procedures Add Procedures Not Covered By PPOs Offer Your Patients Alternatives
  41. 41. DentalWarrantyCorp.com/StreamDent
  42. 42. Signed Consent Acceptance or Refusal We like our patients to be informed about the various procedures involved before starting their treatment. The technique you have selected for your complete dentures is an advanced technique that requires a large amount of time, expertise, special materials and handling, and much more expensive laboratory bills than for conventional complete dentures. The technique accomplishes extremely life-like results, with the best fit available with a non-implant denture. Because of these factors, they are not the same as a standard complete denture covered by your Dental PPO insurance. While your dental PPO insurance may cover complete dentures, you have the right to select something different from your basic dental PPO benefits. As such, if you choose to have Dr. Moorhead treat you with the full branching technique, you understand and agree that we may bill you separately for the additional lab costs involved in fabricating your denture(s). By signing below, I understand these additional costs will be my responsibility.
  43. 43.  Set up extra procedure codes and multi-codes  Example:  D5110 Maxillary Complete Denture Allowable fee $900  D5110.A Additional custom denture characterization $250 Protect Yourself from Audits
  44. 44. Non-Covered Services Legislation
  45. 45. Have a plan Use tools like Sikka’s Fee Optimizer Follow through step-by-step Use fee services to establish your UCR Delegate to team or use a third party Putting It All Together
  46. 46. TAKING BACK CONTROL OF YOUR PRACTICE Optimizing Fees and PPOs
  47. 47. Q & A
  48. 48. VALUABLE RESOURCES TO EXPLORE MORE, OR DECIDE TO DO MORE StreamDent.com/Free-Resources •PDF of today’s PowerPoint •Systems for Negotiating with PPOs William J. Moorhead, DMD Dr.M@StreamDent.com 502-509-1570
  49. 49. VALUABLE RESOURCES TO EXPLORE MORE, OR DECIDE TO DO MORE store.sikkasoft.com •Practice Optimizer •Fee Schedule Daniel Rhoten daniel.rhoten@sikkasoftware.com 866-856-7119 x221 practicemobilizer.com •Free App with fee optimization Tony Bojorquez tony.bojorquez@sikkasoftware.com 866-856-7119 x204

Optimizing your Fees and Working With PPOs can be a huge drain or a huge success for your practice... Did you know that over half of all Dentists in the U.S. haven't updated their fees in over a year? Did you also know that many PPOs, when included with your overhead expenses, can decrease your profitability in half? Join us for a webinar with experts William J Moorhead, DMD, Founder of StreamDent and Antonio Bojorquez, Product Manager & Director of Training Sikka Software, and discover how you can once again own the power and control of your practice's profitability.

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