By: Angela Holland
Hiring a dental associate is an exciting milestone for your practice! As your practice grows, it’s essential to keep several key insurance-related aspects in mind to ensure smooth operations. One of the most important points to remember is that all claims where the associate is the rendering provider must reflect their credentials. Submitting claims with any other provider listed as the rendering provider, such as the owner doctor, is considered insurance fraud.
But don’t worry, I’ve got some pro tips to guide you through the credentialing process and set your practice up for success.
Start the Credentialing Process Early
The credentialing process can take time, and the sooner you begin, the better. According to the American Dental Association (ADA), the credentialing process typically takes between 90 to 180 days. Starting the process as soon as you know the associate’s start date gives you a significant head start, and it can help avoid delays once the associate begins treating patients.
When credentialing your associate, it is recommended to hire an expert who specializes in this area. Credentialing professionals are familiar with the nuances of insurance networks, fee schedules, and the paperwork required to ensure your associate is fully credentialed. They’ll also help avoid common mistakes that can result in claim rejections or delayed reimbursements.
Why Consistent Insurance Setup Matters
It’s crucial to ensure that your associate is set up the same way as your owner doctor when it comes to insurance networks, plans, and fee schedules. According to the ADA’s Health Policy Institute, nearly 80% of dental practices in the U.S. participate in some form of insurance plan, and managing these plans effectively is essential for maximizing reimbursements. Discrepancies between how the associate and owner doctor are set up can create confusion for both your team and your patients, especially when it comes to billing and insurance verification.
Having an expert handle the setup ensures your associate is properly enrolled in the correct insurance networks and fee schedules. This is vital for ensuring your practice is optimizing reimbursements from day one. The ADA also reports that practices that do not strategically negotiate their insurance fee schedules can lose out on up to 15% of potential reimbursements, making this a critical area of focus.
Insurance Verification Is Key
Another essential step is insurance verification (IV), which must be done for every patient, especially when an associate starts. IV determines if a patient has out-of-network (OON) benefits, which is crucial for scheduling patients with the associate in a way that ensures maximum reimbursement.
As per the ADA, approximately 55% of patients in the U.S. have some form of PPO dental coverage. For those with PPO plans, verifying their OON benefits helps your team confidently schedule appointments with the associate or direct patients to the owner doctor until the associate becomes credentialed and in-network. This step is crucial for managing patient expectations and minimizing any billing issues related to insurance.
Pro Tips for Successful Credentialing and Claims Submission
To help you navigate the credentialing process smoothly, here are some pro tips:
1. Submit Your Office W-9 with Claims
When your associate starts, make sure to submit your office W-9 with all claims. This is important because until your associate is officially credentialed and in-network, claims will be processed as out-of-network (OON). However, by submitting your W-9, you ensure that the claims are processed promptly, and you can still honor the in-network fee schedule for patients. This can make a big difference in how quickly your practice receives reimbursement while waiting for the credentialing process to be completed.
2. Insurance Verification for Out-of-Network Reimbursements
As previously mentioned, insurance verification is a must for all patients, especially when you have a new associate. The verification process helps determine if a patient has OON benefits. If they do, your billing team can confidently schedule the patient with the associate, knowing how the insurance will reimburse. If the patient doesn’t have OON benefits, your team can schedule them with the owner doctor until the associate is fully credentialed.
3. Standardizing Insurance Networks and Fee Schedules
While it’s usually recommended to set all providers in your practice with the same insurance networks and fee schedules, this is a conversation best had with a qualified insurance expert. Every practice is different, and an expert can evaluate whether the same networks and fee schedules are the best option for your practice’s goals. A strategic insurance setup helps ensure the best possible reimbursement rates, especially in PPO practices where maximizing insurance reimbursements is key.
The Importance of Ongoing Monitoring
Once your associate is credentialed, it’s essential to keep a close eye on reimbursements. According to the ADA, the average dental practice collects approximately 60-70% of its total revenue from insurance reimbursements. Monitoring reimbursements ensures that both the owner doctor and the associate’s claims are reimbursed according to the agreed-upon fee schedules and active dates. This monitoring process helps ensure that your practice isn’t leaving money on the table and that both doctors are fairly compensated for their work.
Conclusion
Credentialing a dental associate may seem like a complex process, but with careful planning, the right expertise, and a focus on timely claims submission, it can be a seamless experience that sets your practice up for success. Remember to start early, use professional help when needed, and ensure that your insurance setup is aligned across all providers. By doing so, you’ll not only avoid potential legal issues like insurance fraud but also maximize your reimbursements and ensure your associate’s smooth integration into the practice.
Investing in a robust credentialing process, insurance verification, and effective claims submission practices will help your practice thrive as it expands, benefiting both your team and your patients.
Keep Reading: What Many Dentists Do Not Know About Insurance Credentialing as a First Time Owner
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