For any dental practice to be successful, a PPO dental insurance plan must be set up in the practice management software that is used by the dental team. There are a few benefits of such an action from a patient's perspective.
All practices need to keep the PPO write-off to a negligible percentage of the full fee, and this is also dependent on the prevailing overhead of the practice. Hence, a systematic and thorough set-up is vital for a smoother process.
The team must integrate the name of the insurance organization, address, and payer ID into the practice management software. These numbers need to be added to your software in case it is not listed in the shared software database. The team must take care not to add a new insurance company in case there is one that has already been integrated with the same data. This can then create problems in reporting, or in case there is an address change.
The team then needs to create a plan that is typically associated with the organization or employer. This plan is needed if there is no shared database in the software. This plan is where all the available data concerning coverage for a particular employer with a specific group number or plan is captured. The negotiated fee schedule with the insurance company also needs to be included. The team must take care not to capture multiple plans for any employer with the same group number or plan. This can create a problem later. The benefits of PPO dental insurance plans for a practice or a patient are as below.
The practice will save a lot of time and effort when it accurately and thoroughly sets up the PPO within the dental practice management software. Dental teams usually notice the issues and confusion much later, especially when they commence computing the estimated patient liability when the PPO fee schedule is not properly set up.
The dental billing team will need to depend on references and notes to figure out the estimate, and also look up the key reference book that outlines all the fee schedules. The patient is also eagerly waiting for the amount owed to the practice for the recommended treatment.
In case the team takes time, the patient might ask for the bill to be sent by mail. In some instances, the dental team might be tempted or compelled to send the bill by mail. It is commonly observed that when a patient receives a bill in the mail, the chances of payment immediately are slim.
The amount of follow-up needs to be high for all outstanding dues to be cleared by the patient. In addition, there is also the postage cost that needs to be borne by the practice. When the PPO is properly set up, the patient responsibility portion can be posted on the software on the same day that treatment is rendered to the patient.
This might sound a bit difficult to believe. But there is more in store for the practice than just setting up PPO. The process is sequential, and every component of the billing process has an effect on the previous step.
A proper set-up can drive revenues because when the dental team is collecting the precise amount. There is no need for the team to issue refund cheques or even send revised patient statements.
To consider any case, if the patient paid $80 to the practice, and the team has not set up the PPO fee schedule in the practice management software. The team then realizes that the amount owed by the patient is only $65 when it receives the reimbursement from the insurance company. The practice now has a credit balance and has to issue a refund cheque.
There could also be cases where the dental team collected a lesser amount from the patient. It now needs to send a revised patient statement. These situations result in additional administrative paperwork, and this could demotivate the dental team or even frustrate the patient.
When the dental team collects the precise amount owed by the patient on the day that treatment is rendered, the patient has increased confidence and trust in the practice.
When the dental team has set up the PPO in the software, it gets an accurate picture of the calculations surrounding the patient’s financial responsibility. When the fee schedules have been integrated and the insurance particulars of the patient have been fed into the software, the dental team can determine the exact amount that needs to be billed to the patient.
This is because the software does the work for the team. Let us consider an example. There can be a scenario when an insurance policy of a patient can cover 50% for a crown. If the cost for a crown is $800, the team might assume that the patient needs to bear $400. The remaining half would be covered by the insurance plan.
It could be possible that because fee schedules have been integrated and PPO has been properly set up, the patient would need to pay just $300 since the permitted amount for a crown is only $600.
When the dental team considers the waiting period, maximums, deductibles, and treatment percentages outlined in the policy, the team will have an extremely precise view of the estimate. Such a simple step can help in determining out-of-pocket expenses and help in driving higher revenues with less collection effort.
When the PPO is not properly set up, the patient could be charged more than what is owed. This is because the patient is viewing the full breakdown of costs without considering the conditions and benefits offered by the insurance organization. Hence, the dental team needs to set up the PPO perfectly while also comprehending the fine print in the policy that could be overlooked.
Proper Dental Insurance Verification ensures that all data related to patient eligibility and fee schedules are accurate. This helps in avoiding claim denials, billing errors, and discrepancies in patient liability.
The key benefit of PPO dental insurance plans is that a patient does not require a referral to visit a dental practice. Patients can check online for services and options that they need. They can then make an appointment with a dental practice of their choice. There is no need to waste time and worry about coverage and costs.
Affordable dental PPO insurance plans have been designed to accommodate individuals or a family with kids. Based on the needs and oral condition, a patient can select from a range of plans that are practical and flexible. Families can opt for plans that ensure all members can visit multiple kinds of specialists under a single plan.
PPO plans usually have a higher premium but can be economically viable in the long run. These plans cover even preventive care and offer lower rates for dental procedures. These dental insurance coverage benefits help to reduce the financial outlay for a patient. It also provides cost-effective treatment to a patient.
PPO plans are widely accepted by practices across the nation. As patients can change cities, jobs, or schools, a PPO dental insurance plan can provide coverage benefits no matter where they go.
PPO plans usually come with a higher premium as compared to regular DHMO plans. Most plans come with deductibles, coinsurance, and annual coverage limits. From a dental practice perspective, setting up of PPO within the practice management software can open up a lot of benefits that include increased revenues and patient satisfaction.
