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January 10th, 2023

Episode 44 – 3 Things You Need to Know Before Dumping Your PPOs

“Play the game well. Don’t get sloppy.”
– Dr. Victoria Peterson

Are you frustrated and ready to toss your PPOs out the window? 


Believe me I get it. When I owned and operated my own dental practices, dealing with insurances was one of the most frustrating parts of my – and my team’s – job. 

The reality is, it feels like our emotions and our wallet are connected but as savvy, intelligent business owners we work really hard to disentangle those two pieces so we make decisions that are best for our patients and business, and not just because we or our team are frustrated. 

This is what I loved about my conversation last episode with Nicholas Partridge from Five Lakes Dental Practice Solutions: To accomplish our goals we must set aside our emotions so we can craft an insurance participation strategy that fits our business goals and patient needs.

While this episode today is short, it’s very important that you integrate this information into your decision-making as you direct your office KPIs and the goals you set for your Investment Grade Practice. Tune in as I dive deeper into this conversation about insurance participation strategies and share:

  • My top 3 takeaways from my conversation with Nicholas 
  • Big red flags you need to watch out for
  • Why a long-term mindset must prevail over current frustrations

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Hi, Dr. Regan, Robertson CCO of Productive Dentist Academy here and have a question for you. Are you finding it hard to get your team aligned to your vision, but you know, you deserve growth just like everybody else? That’s why we’ve created the PDA productivity workshop. For nearly 20 years PDA workshops have helped dentists just like you align their teams get control of scheduling and create productive practices that they love walking into every day. Just imagine how you will feel when you know your schedule is productive. Your systems are humming, and your team is aligned with your vision. It’s simple, but it’s not necessarily easy. We can help. The demand for these workshops is so high that our March 2023 workshop is completely sold out but there are still seats available for the only remaining workshop in September 2023. Visit that’s to secure your seats now.

Victoria Peterson
What a great conversation with Nick from Nick Partridge from five lakes, a couple of phrases that he had said that I just loved and you heard me repeat them a lot. Having an insurance participation strategy, being agnostic about payer type, and knowing how insurance plays a part in your marketing. Those were three really big takeaways for me and my time with Nick this week. So when we think about building an investment grade practice, and I’ll keep harping on this, and someday I’ll get my book out and you’ll see it in writing.

There are four quadrants to this equation. Number one, the quality of revenue, the quality of earnings, that’s our business value sector and insurance certainly is a mix in that the other is our quality of systems and process. That’s operationally what we think about in practice management. So our coding, when we’re billing, how we’re handling rejections, our auditing our systems, what we’re looking at, quite honestly, for embezzlement, and another thing like that, the quality of our systems is important. The quality of our messaging that comes with marketing, and insurance has a role in that where we sit in the community where we sit in our attraction strategy, and keeping our patient base growing and then the quality of relationships.

That’s our culture index, that’s the fourth box, and how we speak about insurance, how it motivates, or D motivates our team. All of this comes into play and I can see why insurance participation is such a hot topic in our industry, we get emotional about it. Now, when Nick and I were talking, it’s pretty black and white. You know you do a little research to have a plan. You’re agnostic, you move forward but the reality is, is that I don’t know, it feels like our mouth and our wallet are somehow connected. We work really hard to disengage that but for patients, you know, what is the experience, and that’s my takeaway, if we can put insurance in the appropriate house of this was designed to do two things for you.

Number one, encourage you to come to the dentist so thank you very much for your insurance benefit. You’re here. Number two, support your reimbursement and that’s the key to it right there. This may not cover and it will not cover all your dental needs depending on how much-delayed care you have. So let’s use your insurance as a down payment towards getting you healthy and I hope that all of you have those types of strategies. A couple of big, big red flags came out of that conversation. I’m so glad that he let me just shoot some questions from the hip. If you are not filing your UCR and balancing your fee schedules every year every six months and being fair across the board, you may be inadvertently breaking some insurance regulations so work with your coaches on that and make sure that you are consistent in your fee schedules and your reporting. Number two if you offer a courtesy you must offer the courtesy to the insurance company and I can hear the screams already.

This isn’t about what’s fair. This is about compliance and risk management. So if you’re in the game, of accepting insurance as part of your payer mix, then play the game well, because playing it sloppy, being inconsistent, one, it could throw you in jail but two, it’s really going to decrease the value when you go to, to sell and the last five practices I evaluated they had huge AR, they’re over 90 days was one to two times their current monthly production. With the thinking that has value accounts receivables have very little value. When you go to market, it’s going to be your EBITA and how clean and simple, and easy are your systems. Having AR to clean up is not going to bring you anything more at the time of sale. In fact, you probably won’t collect it. So if you’re sitting there and your AR is above one and a half times, or even one times your current production, start working on it and start automating it if you’re still licking envelopes and putting stamps and yes, I’ve met people this week who are still doing that. Update your systems automatically.

Anywhere there is human interaction, there is a chance to slow down the system and decrease its efficiency. Automating your revenue cycle management by automating and looking for money leaks by having a revenue cycle management system that has checks and balances for these money leaks. What that does is it frees up your mind, and it frees up your heart to be with your patients doing the thing that a computer can’t do, which is loved the people that walk through your door. So Zig Ziglar already said people don’t care what you know until they know how much you care. So having a well-managed participation strategy as part of your overall marketing plan and I love taking a five-year horizon, will you be the same clinician five years from now? If not, if your clinical skills are upgrading your service mix is upgrading your server, or your fee schedule upgrades, the plans you’re in today may not be the plan you need to be in five years. So thank you for joining us today that was in an incredible new look for me at how we can create a participation strategy.

So thank you, Nick, for that viewpoint, and for helping all of us go from a short-term view up. I really hate this plan. I’m frustrated with the company, too. How does it impact me as a business owner? And how does this play into my overall business plan of expansion and participation in my community? My top three takeaways are number one, right-size your fee schedule if it’s been a while since you’ve looked at it and you’re still in the 40th percentile for reimbursement start there a 10% increase could bring another 75 to $80,000 a year of personal wealth to you in your paycheck. So right size your fee schedule number two, submit your fee schedule. Don’t play games with this just submit it be done with it, take the write-offs and understand what’s happening, and then number three, use tools and dashboards that do help you track this our team does this quite well help you track what your write-offs are and where the biggest offenders are so that you can start managing and planning your future. Until we meet again, I hope that to stay on your journey of building an Investment-Grade practice.

Narrator 8:55
Thank you for tuning in to this episode of the Investment Grade Practices podcast. If you find value in this episode, help us spread the word by passing it along to a dental friend. Subscribe and give us a Like on iTunes or Spotify. Learn more about building your Investment Grade Practice at today

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