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7 ideas to move to higher-reimbursement patients

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A common strategy for building practice is to sign up for every Medicaid, health maintenance organization (HMO), and preferred provider organization (PPO) plan available.  Cash flow is cash flow, and when you have to pay your bills, maintain payroll, and keep your lab coming to pick up your cases, you need to get those dollars rolling in. But there does come a point when the cash flow is steady and the schedule is overloaded with patients, which may mean your reimbursement per-hour rate is lower.  You want to go from controlled chaos to cohesive, efficient scheduling that will yield higher profits. Here are 7 ideas to move higher reimbursement patients in your dental practice.

7 ideas- Higher Reimbursement Patients

Here are some of the steps–albeit some difficult and not popular–you can take to start shifting your practice from low-reimbursement chaos to a cash-flow leader.

Stars on route slips

The first suggestion is to put a star on the top of the route slips so everyone knows if the patient participates in a PPO plan or pays with cash.  This is not because your practice would treat patients differently because of their insurance type, but because your practice can offer different services because of their membership in a PPO plan.

Color-coded scheduling

In your scheduling program or book, use a color-coded key to identify the patients.  For instance, all your PPO patients would be highlighted in light pink, HMO patients in dark pink, Medicaid patients in blue, and those who pay cash in green.  I recommend a minimum of 70% pink on your schedule, with a goal of 100% of the pink being light pink.

The reality is either you want to achieve your production and collection goals or your don’t. A private practice won’t meet its goals with a schedule full of low-reimbursement patients.  An office that depends on HMO and Medicaid patients will need to be run and managed differently.

I tell clients that there is no sense stressing out over not meeting practice goals if they are not going to be intentional with their scheduling.

The reality is either you want to achieve your production and collection goals or your don’t.

Priority Scheduling

Schedule all PPO participants and cash-paying patients within five business days for a new-patient appointment and within eight business days for treatment.  This means that you might need to reschedule an existing patient who has a lower-reimbursing plan. It might feel uncomfortable to reschedule really wonderful patients because of their insurance, but it is necessary if your goal is to produce and collect more per hour.

Patient reviews

All patients in a PPO program and those who pay with cash should be asked to leave a review.  This is so their family, friends, and co-workers can see it, along with the rest of the marketing world.

Referral programs

I suggest creating an in-office referral program in which all patients can participate.  However, those patients who refer other PPO plan or cash-paying patients receive a special thank you.

Trust but verify

Make sure all PPO insurance is accurately verified at least two days ahead of a patients’ appointment. This reduces any roadblocks to presenting a treatment plan.  Verifying PPO insurance should become a priority over verifying other insurance.

Schedule filling

If your staff is making follow-up calls to fill the schedule, start with the patients with a PPO plan or those who pay cash.  It may sound simple, but it can be effective.

Should the business of dentistry come down to playing the insurance game?  No, it shouldn’t and yet it does.  This, however, doesn’t mean the practice of dentistry is concerned with insurance at all.  You still provide the same exceptional care to all patients.

Often the business of dentistry and the practice of it contradict each other and pull at our conscience.  If you are one of the offices where the money is tight, reimbursements low, and chaos is common, looking at the above steps may help change that.


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