News & Tech Tips

Silent PPO – Dental News Client Alert

For many years, the ODA has reported on their vigilant attempts to silence the “silent PPO.” Also known as ghost or blind PPOs, these revenue-stealing entities are disallowed in Ohio (Moore, 2015; 2024). Under Ohio law (Ohio Revised Code 3963), PPO’s are prohibited from giving, renting, or selling their participating dentists’ services unless one of the following conditions apply:

  • The PPO provides either administrative or claims processing services to an employer or other entity that offers benefits to its employees or members or
  • The PPO has an administrative services agreement with one of its affiliates or subsidiaries or
  • The actual contract signed by the dentist states that the contract allows network rental agreements and that the PPO intends to sell, rent, or give its rights over the dentist’s services to other PPOs or provider entities. In exchange, the secondarily contracted PPO must comply with the terms and conditions of the original PPO contract with the dentist and follow the original PPO agreements regarding patient lists, timeliness of payment, and manner of reimbursement.

If a PPO rents, sells, or gives its rights to another PPO, the entity must maintain a web page or set up a toll-free number for participating dentists to use that provides access to the lists that the PPO plans to contract with, which must be updated every six months to maintain its accuracy. Providers may not share information about the other PPOs on the list with anyone since this information is considered proprietary.

One of the most irritating aspects of the silent PPO is that dentists and patients find out about its existence only after treatment is done and the payment received is less than anticipated and capped such that the dentist cannot collect any additional monies from the patient. The dentist is forced to offer a discount to the patient that was not anticipated since the dentist was not aware of the relationship between the contracted payors. Remember, silent PPOs intend to take advantage of dentists without their knowledge. Patients have likely been informed by the front staff that the office is not on their list of providers. The dentist is unaware of any obligations to the secondarily contracted PPO and is surprised to receive payments from this unknown entity. The patient is surprised that their original out-of-pocket estimate is suddenly much lower than anticipated.

Two other considerations about silent PPOs are the following:

  • The silent PPO is not motivated to steer patients to the dentist, so patients arrive at an office without help from the silent PPO; therefore, the dentist gets no benefit from the relationship with the entity.
  • PPOs cannot require dentists to agree with their plan to distribute the dentist’s services to other PPOs; however, with 180 days’ written notice, the plan may terminate a network agreement with the dentist who refuses to participate in future PPO additions, which soils the relationship with the primary PPO.

Dentists should carefully read any contract they sign to protect themselves, looking for suspicious language. Contract language that indicates the PPO can “assign” the agreement “at any time” with all its rights and privileges to affiliated companies is a red flag that should cause dentists to pause and think through the agreement more carefully. If in doubt about contract language, consult an attorney or use the ODA or ADA contract analysis services to help you understand the contract better. The ODA offers this service free of charge. Use the contact information below to learn more.

If you think you have been disadvantaged by a silent PPO, contact the ODA via email at dentist@oda.org or call (614) 486-2700.

References

Moore, C. (2015, Apr 13). Leased PPO networks and silent ppos. ODA.org. https://www.oda.org/news/leased-ppo-networks-and-silent-ppos/

Moore, C. (2024). ODA working to ensure silent ppos don’t become a thing in Ohio. ODA Today. ODA WORKING TO ENSURE SILENT PPOS DON’T BECOME A THING IN OHIO – Ohio Dental Association

Is your home office a tax haven? Here are the rules for deductions

Working from home has become increasingly common. The U.S. Bureau of Labor Statistics (BLS) reports that about one out of five workers conducts business from home for pay. The numbers are even higher in certain occupational groups. About one in three people in management, professional, and related occupations works from home.

Your status matters

If you work from a home office, you probably want to know: Can I get a tax deduction for the related expenses? It depends on whether you’re employed or in business for yourself.

Business owners working from home or entrepreneurs with home-based side gigs may qualify for valuable home office deductions. Conversely, employees can’t deduct home office expenses under current federal tax law.

To qualify for a deduction, you must use at least part of your home regularly and exclusively as either:

  • Your principal place of business, or
  • A place where you meet with customers, clients, or patients in the ordinary course of business.

In addition, you may be able to claim deductions for maintaining a separate structure — such as a garage — where you store products or tools used solely for business purposes.

Notably, “regular and exclusive” use means consistently using a specific, identifiable area in your home for business. However, incidental or occasional personal use won’t necessarily disqualify you.

The reason employees are treated differently

Why don’t people who work remotely from home as employees get tax deductions right now? Previously, people who itemized deductions could claim home office expenses as miscellaneous deductions if the arrangement was for the convenience of their employers.

However, the Tax Cuts and Jobs Act suspended miscellaneous expense deductions for 2018 through 2025. So, employees currently get no tax benefit if they work from home. On the other hand, self-employed individuals still may qualify if they meet the tax law requirements.

Expenses can be direct or indirect

If you qualify, you can write off the total amount of your direct expenses and a proportionate amount of your indirect expenses based on the percentage of business use of your home.

Indirect expenses include:

  • Mortgage interest,
  • Property taxes,
  • Utilities (electric, gas, and water),
  • Insurance,
  • Exterior repairs and maintenance, and
  • Depreciation or rent under IRS tables.

Note: Mortgage interest and property taxes may already be deductible if you itemize deductions. If you claim a portion of these expenses as home office expenses, the remainder is deductible on your personal tax return. But you can’t deduct the same amount twice — once as a home office expense and again as a personal deduction.

Figuring the deduction

Typically, the percentage of business use is determined by the square footage of your home office. For instance, if you have a 3,000 square-foot home and use a room with 300 square feet as your office, the applicable percentage is 10%. Alternatively, you may use any other reasonable method for determining this percentage, such as a percentage based on the number of comparably sized rooms in the home.

A simpler method

Keeping track of indirect expenses is time-consuming. Some taxpayers prefer to take advantage of a simplified method of deducting home office expenses. Instead of deducting actual expenses, you can claim a deduction equal to $5 per square foot for the area used as an office, up to a maximum of $1,500 for the year. Although this method takes less time than tracking actual expenses, it generally results in a significantly lower deduction.

The implications of a home sale

Keep in mind that if you claim home office deductions, you may be in for a tax surprise when you sell your home.

If you eventually sell your principal residence, you may qualify for a tax exclusion of up to $250,000 of gain for single filers ($500,000 for married couples who file jointly). But you must recapture the depreciation attributable to a home office after May 6, 1997.

Don’t hesitate to contact us. We can address questions about writing off home office expenses and the tax implications when you sell your home.

03:Whalen Wisdom Hub – Interview with Dr.Bez – Niche Practices and Ownership

Key Points from Dr. Bezbatchenko’s Interview

Career Transition and Specialization

  • Motivation: Dr. Bezbatchenko specialized in TMJD and dental sleep therapy to provide more comprehensive care to his patients.
  • Continuous Learning: He actively pursued additional education and certifications to stay up-to-date in his field.

Business and Practice Management

  • Referrals: Building relationships with other healthcare professionals was crucial for attracting new patients.
  • Billing Challenges: Dr. Bezbatchenko faced challenges related to medical and dental billing for specialized services.
  • Practice Growth: His practice experienced growth during the COVID-19 pandemic as more people sought treatment for stress-related conditions.

Patient Care

  • Holistic Approach: He emphasized the importance of addressing both TMJD and sleep disorders for optimal patient outcomes.
  • Patient Education: Dr. Bezbatchenko educated patients about the connection between these conditions and the importance of lifestyle factors.

Industry Trends

  • Evolving Landscape: Dr. Bezbatchenko highlighted the changing landscape of dentistry, including advancements in technology and the increasing demand for specialized care.
  • Advice for Young Dentists: He recommended a gradual approach to building a practice and emphasized the importance of gaining experience and developing strong clinical skills.

Overall, Dr. Bezbatchenko’s journey showcases the value of specialization, continuous learning, and adapting to the evolving needs of patients.

CFO candidates need more than accounting skills

Is your company planning to hire a new CFO? A recent survey found that hiring managers look for more than financial acumen when vetting CFO candidates. In fact, only 38.5% of CFOs at Fortune 500 and S&P 500 companies were licensed CPAs in 2023, according to executive recruiting firm Crist Kolder. What other skills may be needed to fill these shoes?

Financial know-how opens doors.

The Pennsylvania Institute of Certified Public Accountants recently surveyed over 320 hiring executives about what skills matter most for the CFO role. Not surprisingly, “2024 Corporate Finance Report: CPAs in the C-Suite” found that the top must-have for CFO candidates is the ability to manage the company’s finances effectively.

The top 10 financial skills identified in the survey include:

1.Capital management and strategy,

2.Financial forecasting,

3.Operations and financial reporting,

4.Critical thinking,

5.Financial reporting compliance,

6.Strategy creation,

7.Industry/product forecast and outlook,

8.Tax compliance,

9.Accounts receivable, and

10.Networking and industry relationships.

The survey draws two key findings. First, CPAs aspiring to become CFOs must expand their skill sets beyond traditional accounting to include strategic planning, risk management, and technology oversight. Second, today’s CFOs must “strategize for growth and stability, not just report past results.”

Nonfinancial skills seal the deal.

Today’s hiring managers are looking for more than finance and accounting skills when filling CFO positions. They prefer candidates with the following general competencies, listed in order of importance:

  • Leadership/strategic aptitude to develop high-performing teams and strategic goals,
  • Compliance and regulatory expertise to ensure organizational adherence to laws, regulations, and internal policies,
  • Technology and analytical proficiency to make data-driven decisions and use cutting-edge tools,
  • Industry-specific knowledge to understand market conditions and how they influence the organization, and
  • Communication skills to build effective relationships with internal and external stakeholders to maintain alignment with corporate strategy.

In addition, respondents emphasized the need for CFO candidates to possess “general business acumen” and “emotional intelligence.” However, the survey cautions that most hiring managers assume candidates who apply for executive positions have already mastered these general skills.

What’s the right fit for your executive team?

Finding the right person to head up your company’s finance and accounting department can be challenging in today’s tight labor market. The CFO’s main responsibility is to provide timely, relevant financial data to other departments — including information technology, operations, sales, and supply chain logistics — to help improve the business’s operations. He or she also must be able to drum up cross-departmental support for major initiatives. So, it’s important that you choose a candidate who’s a team player. You might even want to outsource the position to a skilled professional. Contact us for help evaluating CFO candidates to find the right mix of skills and experience for your company’s finance and accounting department.

Strong internal controls and audits can help safeguard against data breach

The average cost of a data breach has reached $4.88 million, up 10% from last year, according to a recent report. As businesses increasingly rely on technology, cyberattacks are becoming more sophisticated and aggressive, and risks are increasing. What can your organization do to protect its profits and assets from cyberthreats?

Recent report

In August 2024, IBM published “Cost of a Data Breach Report 2024.” The research, conducted independently by Ponemon Institute, covers 604 organizations that experienced data breaches between March 2023 and February 2024. It found that, of the 16 countries studied, the United States had the highest average data breach cost ($9.36 million).

The report breaks down the global average cost per breach ($4.88 million) into the following four components:

  1. $1.47 million for lost business (for example, revenue loss due to system downtime and costs related to lost customers, reputation damage and diminished goodwill),
  2. $1.63 million for detection and escalation (such as forensic and investigative activities, assessment and audit services, crisis management, and communications to executives and boards),
  3. $1.35 million for post-breach response (including product discounts, regulatory fines, legal fees, and costs related to setting up call centers and credit monitoring / identity protection services for breach victims), and
  4. $430,000 for notifying regulators, as well as individuals and organizations affected by the breach.

A silver lining from the report is that the average time to identify and contain a breach has fallen to 258 days from 277 days in the 2023 report, reaching a seven-year low. One key reason for faster detection and recovery is that organizations are giving more attention to cybersecurity measures.

Implementing cybersecurity protocols

Cybersecurity is a process where internal controls are designed and implemented to:

  • Identify potential threats,
  • Protect systems and information from security events, and
  • Detect and respond to potential breaches.

The increasing number of employees working from home exposes their employers to greater cybersecurity risk. Many companies now have sensitive data stored in more places than ever before — including laptops, firm networks, cloud-based storage, email, portals, mobile devices and flash drives — providing many potential areas for unauthorized access.

Targeted data

When establishing new cybersecurity protocols and reviewing existing ones, it’s important to identify potential vulnerabilities. This starts by inventorying the types of employee and customer data that hackers might want to steal. This sensitive material may include:

  • Personally identifiable information, such as phone numbers, physical and email addresses, and Social Security numbers,
  • Protected health information, such as test results and medical histories, and
  • Payment card data.

Companies need to have effective controls over this data to comply with their obligations under federal and state laws and industry standards.
Hackers may also try to access a company’s network to steal valuable intellectual property, such as customer lists, proprietary software, formulas, strategic business plans, and financial data. These intangible assets may be sold or used by competitors to gain market share or competitive advantage.

Auditing cyber risks

No organization, large or small, is immune to cyberattacks. As the frequency and severity of data breaches continue to increase, cybersecurity has become a critical part of the audit risk assessment.

Audit firms provide varying levels of guidance, both when assessing risk at the start of the engagement and when uncovering a breach that happened during the period under audit or during audit fieldwork.

We can help

Contact us to discuss your organization’s vulnerabilities and the effectiveness of its existing controls over sensitive data. Additionally, if your company’s data is hacked, we can help you understand what happened, estimate and disclose the costs, and fortify your defenses going forward.