PAGD Keystone Explorer Summer 2021

16 www.pagd.org Q dentistry issues Production Howmuch production is attributed to each insur- ance company and then compare that value to your revenue from fee-for-service (FFS) patients? Another important data point to consider is how much production is attributed to each network within your practice and also how much is attributed to FFS patients. When trying to make decisions about adding or dropping networks, a practitioner must understand how much of his/her practice is being influenced by in-network and FFS patients. If a network makes up 90% of the production value of your practice, you are much more beholden to that company until fundamental changes can be made. Understanding how much influence a particular company has on your practice will improve your ability to make decisions moving forward. Patients How many patients are attached to each insurance company and how many patients are FFS within your practice? It is important to understand not only the production value of each insurance company in your practice but also how many of your existing patients are participating in that network. This is especially important if you are intending to add a network. Existing patients in your practice that are insured by a network you may add will receive the immediate discount on your contracted fees. This discount will occur before you have ever seen your first new patient by joining the network. If the network you are considering has 20% market share in your practice, your loss of income on those existing patients may not outweigh the new patient flow that may result by going in network. With all of these data points in mind, you are ready to take your next steps in understanding PPO network negotiations. You are prepared to either hire a company to help manage that process efficiently or continue on this path on your own. Either way, you will be much wiser and better prepared for the more challenging conversations ahead. Remember, there are lots of other nuances when trying to understand insurance networks and how they are operating together. The best we can do as practitioners is understand our practice, its composition, financial parameters, and suite of services so we can make the best choices possible for its future success. “If the network you are considering has 20% market share in your practice, your loss of income on those existing patients may not outweigh the new patient flow that may result by going in network.” Dr. Jennifer Bell is a native of Lexington, NC. She earned her undergraduate and dental graduate degrees from the University of North Carolina at Chapel Hill. Upon graduation, she completed the Advanced Education in General Dentistry program at the Veterans Administration Medical Center in Fayetteville, NC. In 2010, Dr. Bell along with her business partner started a general dentistry practice in Holly Springs, NC. They opened their second practice in Angier, NC in 2017. Dr. Bell has earned fellowship from the Academy of General Dentistry where she has served the North Carolina state chapter as president, committee chair, national delegate, and most recently as executive director.