Cliff's Notes

The Business of Dentistry

Do You Participate In PPO Plans “What You Don’t Know!”

This past week, along with 30 practicing dentist, I was wowed by the eye opening information that was supplied by Scott Hironaka from Unitas Consulting. They specialize in dental PPO management and negotiations. Red Alert!! Your practice may be losing hundreds or even thousands of dollars per month because of the contract you signed.

The Contract … Did you read all the fine print? Most people don’t. Do you understand the rights you gave away? Probably not. Every PPO contract allows the insurance company to “rent” your procedure codes to other companies. If you have a patient that has ABC Insurance it does not guaranty that ABC is the carrier. ABC may rent your procedure code to a company you never heard of. The patient’s card still has the ABC logo but the real carrier pays you their reimbursement rate and not the rate that you originally contracted with ABC. Also, if that should happen, all of your reimbursement rates with ABC will automatically change because you accepted it. To make it even more complicated, your procedure codes can be “rented” individually to multilabel carriers. Did you ever wonder why your rates change? Now you have to make that phone call to ABC and get it fixed.

Getting it fixed … Did you ever calculate the expense of trying to fix insurance claims? I’m not just talking about the time it takes on the phone, I’m talking about lost productivity and lost patients. Dental insurance management is a full time job and most dental practice owners don’t understand what it takes to do it right. Ask your insurance coordinator how many phone calls are missed because they are on hold with an insurance company. If you put them on hold they hang up and you have to start all over again. It’s a cycle that repeats everyday in the average practice. There are some things that just can’t be fixed because you didn’t read the fine print but you can challenge.

The fine print … Did you know that if you advertise a special (i.e. exam & x-rays $69.95) that special offer will become your new UCR and if the insurance carrier knows it they will reduce your reimbursement and have the legal right to recover the difference of any dollars sent to you during the promotional period. There is so much you don’t know about dental insurance management. Everyone tries to negotiate better rates but unless you have detailed information on your procedure costs it will be an up hill battle.

Your cost per procedure … Do you know what a certain procedure costs? To negotiate with an insurance company you need to be informed. You have to justify why you need an increase in reimbursements and exactly what codes you are calling about. You can’t ask for an overall increase and you certainly don’t want them to chose the codes. You have to be prepared to focus on specific procedures and you have to be able to document the cost. If you can show (document) the contracted carrier that you cannot provide quality healthcare to their participating patients at the current reimbursement rates, you may have a chance. Remember, insurance carriers want you because you service their revenue base and you may want them to help maintain patient (revenue) flow. So, now there is a common ground.

The common ground … In business, everything is a negotiation. Dental offices fix teeth, professional negotiators negotiate. There is so much that you and your team don’t understand about your business relationships both negative and positive. Professional consult and guidance is essential for success in todays complicated world. You should know, you’re a dental professional.


April 29, 2018 Posted by | Uncategorized | Leave a comment

What Effects the Value of Your Practice? You don’t know what you don’t know! Commercial “Professional” Lease Agreements

I recently had an office lease review done for one of my clients and was quite surprised at what was un-covered. The agreement was so top heavy in favor of the landlord that I felt the original professional that reviewed it for the doctor committed malpractice.

Your professional practice … The value of your practice may be a large part of your estate. Imagine this, you have a $1.2M practice that is valued at $875k. All of your ducks are in order including a written quick transition plan that that pro-tects your estate. But, will the lease allow a fast transfer of ownership? What rights does the landlord have to the transition? There is so much in the fine print that unless you are experienced in lease “legalese” there is a good chance there is a paragraph or even a sentence that is missed that directly effects the value of your practice and it’s impact on your estate and your family.

Protecting the value of your practice … So many professionals overlook the fine print when signing documents. We tend to trust our advisors or brokers and there is nothing wrong with that. However, how to those agreement effect other agreements? You want to take on an associate/partner and put there name on the lease for shared liability and the landlord “legally” says no! During day by day operations we negotiate everything from patient payment plans to personal life insurance to a teenagers curfew (those are the tough ones). All agreements must benefit the whole and that’s your job, you are the whole, you are the CEO.

The CEO … It’s time to take full control. Start by understanding the restrictions in all of your signed agreements and how they effect your personal estate. I sug-gest starting with your practice lease agreement and please feel free to contact me with any questions or concerns. Consider attending the free seminar, you don’t know what you don’t know.

Important Commercial Real Estate CE Seminar for Dentists!

Wednesday Evening April 25th … 6:30 PM until 9:00 PM … 2 CE’s

Double Tree by Hilton Hotel, Fort Lee, NJ

If you are buying/building a practice, have a lease that is coming up for renewal or is expiring in 24 months or less, or would like to understand how the lease impacts the sale and valuation of your practice, then you must attend this CE event! 2 CE’s Light meal served 

For Free Attendance use Promo Code: Grassroots!

By Phone: 1.800.459.3413 … By Email: … Online:


April 22, 2018 Posted by | Uncategorized | Leave a comment

Dental Business Risk Management

Your exposure to litigation depends on your ability to defend yourself or your team against a legal assault on your practice. The stories I have heard and seen are countless. Patients, team members, pedestrians, tenants, all ages, all demographics, the potential for a legal disaster is only around the corner. The key is to be ready to defend yourself by creating an updated risk management program. You may want to start with a “Patient’s Bill of Rights”.

Patient / Practice Bill of Rights … What is it exactly? A printed statement informing the patient of what they can expect form your office with regard to privacy, professionalism, diagnostic opinion, clinical options, referrals, liabilities and payment options. It also states what the practice expects of the patient such as scheduling, cancellations, payment terms, etc. The “Bill of Rights” should be prepared by a professional familiar with healthcare law. A signed & dated document is gold to any defense team representing a well organized facility. Signed and dated documents are your first line of defense.

Defense Wins Games … When I coached baseball I believed in defense. Offense (your marketing & treatment planning) sells tickets, but your defense will save a close game. You’re your business and clinical teams are the on the front line everyday so training and consistency are critical. Every patient must be processed according to practice protocol. Train your team on people skills so they know what to say and when to ask a supervisor. Prevention is the best form of risk management.

Risk Management … Every business has an offence & defense. In the real world your defense won’t stop litigation, it will only minimize your out of pocket expense. Litigation can come at you from any direction so a professional consultant is strongly recommended. Yes, it will cost you some money but it’s part of your business investment and figured into your quarterly budget. Unfortunately, most people that read this rant won’t want to spend $350.00/hour on legal advise. I can’t tell you how big of a mistake that can be. A couple of thousand dollars now may save a couple hundred thousand down the road if you have to go to court.

Court of Law … A person is innocent until proven guilty but when the plaintive is a general consumer and the defendant (you) is a professional business the rules tend to change. It’s not that the law changes, it opens more doors for the plaintiff’s legal counsel as far a business ethics and the Consumer Protection Act. Most litigation is settled out of court but “settlement” costs money regardless of right or wrong. I know it is hard to believe, but quality documentation can be the difference between a $10,000.00 settlement and $100k. A Risk management program must also include disaster recovery.

Disaster Recovery … What is considered a disaster and I don’t mean a day full of cancelations. A disaster can be a flood, fire or death. The one thing we never really plan for is what happens after we die? Sure, there is money for the family, but what about everything else. Anticipate disasters, they will happen. Please feel free to contact me with any questions or concerns.

April 11, 2018 Posted by | Uncategorized | Leave a comment