Redefining Profitability: Dropping PPOs, Building VIP Programs, and Optimizing Billing Operations
Course Objectives
- Evaluate the Financial and Operational Impact of PPO Participation
Learners will assess their current insurance participation mix using production and patient data to determine the feasibility and timing of reducing or eliminating PPO contracts. - Develop a Strategic Exit Plan from PPO Contracts
Learners will outline the steps required to responsibly transition out of network with insurance companies, including how to assess umbrella networks, renegotiate fees, and avoid coverage gaps for patients. - Train the Dental Team for Patient Communication and Retention
Learners will implement scripts and consistent messaging to educate staff and patients about insurance changes, minimizing confusion and maintaining trust during transitions. - Design a Simple and Compliant In-House Membership (VIP) Program
Learners will structure an easy-to-use VIP or loyalty membership plan that increases access to care, ensures regulatory compliance, and supports profitability for uninsured patients. - Use Software to Automate and Track VIP Plan Discounts
Learners will leverage tools like Open Dental to set up accurate fee schedules, streamline discounts, and reduce manual adjustments and billing errors. - Understand Legal and Compliance Considerations for Membership Plans
Learners will recognize state-by-state restrictions on collecting full membership fees upfront and understand how to align VIP programs with legal and ethical standards. - Set Up a Remote or Hybrid Billing Department
Learners will evaluate when and how to transition to a remote billing model, including key considerations for staffing, trustworthiness, and necessary technology infrastructure. - Onboard and Collaborate with Outsourced Billing Services
Learners will identify best practices for hiring, onboarding, and managing third-party billing and insurance verification teams to ensure transparency, accountability, and consistent follow-through. - Build Internal Systems for Insurance Oversight and Follow-Up
Learners will implement tools like shared spreadsheets, aging report trackers, and status notes to monitor claims and ensure timely collections across internal and outsourced teams. - Shift the Practice Mindset Toward Patient-Centered Financial Models
Learners will reframe their financial systems from reactive insurance dependence to proactive patient care value, prioritizing transparency, flexibility, and sustainability.
