Making Sure Insurance Makes Sense for Your Office
Course Objectives
- Understand the Strategic Considerations Behind Dropping or Renegotiating PPOs
Learners will assess when it makes sense to drop, negotiate, or remain in-network based on patient mix, financial goals, and market conditions. - Analyze Key Factors Before Making Insurance Decisions
Learners will evaluate fee schedules, claim processing complexity, staff resource demands, and local demographics to determine the viability of remaining in or leaving PPO networks. - Clarify the Differences Between Fee-for-Service and Out-of-Network Models
Learners will distinguish between truly fee-for-service models versus being out-of-network yet insurance-friendly, and what patient communication shifts are required for each. - Use Reports and Data to Guide Insurance Decisions, Not Emotions
Learners will learn how to pull payer mix reports, active patient counts, and new vs. existing patient statistics to make objective decisions on insurance participation. - Explore Strategic Use of Umbrella Networks and Fee Negotiations
Learners will assess options for using umbrella companies like Carrington to maintain patient retention while improving fee schedules and out-of-network reimbursement rates. - Prepare a Communication Plan for Transitioning Patients
Learners will develop scripts and communication strategies to help patients understand out-of-network benefits and maintain loyalty during insurance transitions. - Maximize Existing Insurance Reimbursements Through Smarter Coding
Learners will identify underused procedure codes (e.g., D0180, D4346, diagnostic scans) and billing strategies that can boost revenue without dropping insurance. - Decide When and How to Renegotiate PPO Fee Schedules
Learners will understand when it's possible (and worthwhile) to renegotiate directly versus using a third-party expert or service to achieve higher reimbursements. - Plan for Transitional Financial and Operational Impacts
Learners will prepare their practice financially and operationally for a short-term transition period if dropping or changing insurance participation. - Design a Long-Term Insurance Strategy Aligned With Practice Vision
Learners will create a 3–5 year plan for insurance participation, balancing patient access, profitability, and the clinical and lifestyle goals of the practice owner.
