The start of a new calendar year is an important opportunity for dental practices to review PPO performance, confirm that billing practices are accurate, and evaluate whether existing insurance participation continues to support the practice financially. Rising expenses and stagnant reimbursement make it increasingly important to understand how PPO contracts affect collections.
This page outlines practical planning steps PPO-based dental practices should consider as they enter 2026.
Review Prior-Year PPO Write-Offs
Before making decisions about PPO participation, practices should review prior-year performance by insurance carrier. Reviewing write-offs in aggregate can mask contracts that are underperforming.
Recommended actions include:
Running end-of-year write-off reports by carrier
Reviewing total annual write-offs for each PPO
Identifying contracts with disproportionately high write-offs
This analysis provides the baseline needed to evaluate which PPO relationships remain viable.
Bill Full Cash Fees on Insurance Claims
Dental practices should submit full cash fees on all insurance claims rather than PPO-discounted fees.
Billing discounted fees can create several issues:
Write-offs cannot be accurately measured
Insurance carriers may interpret submitted fees as standard cash fees
Negotiation leverage may be reduced due to artificially low reported fees
Submitting full fees allows practices to clearly measure the gap between cash fees and PPO reimbursement.
Configure Practice Management Software Appropriately
Billing full fees does not interfere with treatment planning or patient estimates when practice management software is configured correctly.
Most systems allow:
Full cash fees to be billed on claims
PPO fee schedules to be assigned at the patient level
Accurate copay and estimate calculations for treatment planning
Practices may need to contact their software vendor for assistance with proper setup.
Evaluate and Maintain Appropriate Cash Fees
Cash fees should be reviewed periodically to ensure they align with local market conditions.
Key considerations include:
Fees should reflect actual charges to cash-paying patients
Artificially inflated fees can distort analysis and negotiations
Fees that gradually drift too low can weaken PPO positioning
When benchmarking fees, a 5-digit ZIP code analysis is typically more precise than broader regional comparisons.
Make Practice-Specific PPO Decisions
PPO decisions should be based on the specific financial and operational realities of the practice rather than industry anecdotes or external pressure.
Important factors include:
Current production and collections
Capacity and staffing constraints
Overhead and labor costs
Long-term practice goals
Many practices are experiencing rising expenses without corresponding increases in PPO reimbursement, making proactive planning essential.
Summary
Entering 2026 with a clear understanding of PPO performance, billing accuracy, and fee positioning allows dental practices to make informed decisions and reduce financial risk throughout the year.
