By: Angela Holland
Purchasing a dental practice is a significant milestone in any dentist’s career. It’s an exciting time, full of opportunities for growth, patient care, and building a long-lasting reputation in your community. However, the transition from being a practitioner to a practice owner involves much more than just managing day-to-day operations. One crucial area that new dental practice owners must pay close attention to is insurance credentialing.
Insurance Credentialing
Insurance credentialing may not be the first thing that comes to mind after buying a practice, but it is vital to ensuring a smooth financial transition and maintaining consistent revenue streams. Credentialing refers to the process of obtaining approval from insurance companies to allow a dentist to provide services to patients covered under their plans. Without proper credentialing, you may not be reimbursed for treatments, or worse, your ability to accept patients from certain insurance providers could be compromised.
Understanding the Importance of Insurance Credentialing
One of the first things to remember after purchasing a dental practice is that you will likely inherit an existing insurance provider network, which may or may not align with your practice’s goals. Credentialing ensures that you can continue billing insurance companies for the services you provide.
When you take over a practice, there are several key factors you need to address in terms of insurance credentialing.
Update Your National Provider Identifier
First, you’ll need to ensure that your NPI1 (National Provider Identifier) and NPI2 (Group NPI) along with any other credentials required by insurers are properly updated to reflect your new role as the practice owner. Insurance companies will need to verify that you are legally able to provide the services your new practice is offering, and this requires a smooth transition of the practice’s credentialing status. If this process is not managed correctly, it could delay payments or lead to payment denials, which can have serious consequences for your practice’s cash flow.
Are the Insurance Contracts Transferable?
Another critical issue is whether or not the insurance contracts held by the practice are transferable to you as the new owner. In many cases, the contracts with insurance companies may need to be reassigned or renegotiated under your name, as they were originally made in the name of the previous owner. If these contracts aren’t updated and re-credentialed under your name, you might lose out on reimbursement for services rendered to insured patients, which can severely affect your revenue.
Review Existing Fee Schedules
Additionally, as part of the transition, you will need to review the existing fee schedules with various insurance companies. Insurers frequently update their reimbursement rates, and the rates under the old owner’s contract may no longer reflect the current market conditions or your practice’s needs. Updating and renegotiating these fee schedules can help ensure that your practice is getting the best possible reimbursement rates for the services you provide.
The Challenges of Insurance Credentialing After a Practice Purchase
The insurance credentialing process can be complex, time-consuming, and often frustrating. It involves detailed paperwork, communication with multiple insurance companies, and following up on applications that may take months to process. As a new practice owner, this process can feel overwhelming, especially when you’re already juggling the transition of day-to-day operations and patient care.
1. Understanding the Nuances of Insurance Networks
One of the most significant challenges is understanding the nuances of insurance networks. Dental insurance companies often have different requirements for credentialing, including varying forms, timelines, and procedures. Some insurers might require additional documentation, such as proof of malpractice insurance, while others may have specific guidelines about the types of procedures you are allowed to perform under their plans. Navigating these differences can take considerable time and effort, potentially delaying your ability to start receiving payments for services provided.
2. Ensuring Continuity of Care for Patients
Another challenge is ensuring continuity of care for patients. If your insurance credentialing isn’t sorted out quickly, patients who are part of specific insurance plans might find themselves unable to see you as their primary care provider. This can lead to dissatisfaction, patient churn, and, ultimately, lost revenue.
Why Hiring an Expert is Essential
Given the complexity and time-consuming nature of insurance credentialing, hiring an expert is one of the best decisions a new dental practice owner can make. An expert in dental insurance credentialing can navigate the often-confusing landscape of insurance requirements, ensuring that the process is handled efficiently and effectively.
1. The Ability to Manage the Paperwork & Ensure Accuracy
One of the primary reasons to hire a credentialing expert is their ability to manage the paperwork and ensure accuracy. With a deep understanding of the credentialing process, they can ensure that all forms are filled out correctly, all necessary documents are submitted, and follow-ups are made in a timely manner. This reduces the risk of errors or delays that can cause your practice to miss out on critical reimbursements.
2. Established Relationships
Additionally, a credentialing expert has an established relationship with many insurance providers and can expedite the process of getting your practice credentialed under the necessary plans. Their knowledge of the specific requirements of each insurance company can save you valuable time and ensure that everything is done according to protocol. They are also well-versed in how to handle complications or setbacks, such as missing or incomplete information, which can often arise during the credentialing process.
3. Renegotiating Fee Schedules
An expert can also assist in renegotiating fee schedules with insurance companies. If the previous owner had a different fee structure, the expert can help you negotiate more favorable terms that better reflect your practice’s needs, patient demographics, and the services you provide. This can lead to higher reimbursements and improved cash flow, which is especially important when you’re taking over a new practice.
4. Understand the Importance of Timing
Moreover, credentialing experts are familiar with the importance of timing in the process. Delays in credentialing can have a significant impact on your practice’s revenue, but with an expert managing the timeline and ensuring that you’re enrolled in insurance networks as soon as possible, you can reduce the gap between acquiring the practice and being fully credentialed.
Key Takeaways
In Conclusion, when purchasing a dental practice, ensuring that your insurance credentialing is up to date and properly transferred under your name is a crucial part of a successful transition. The process can be complex and time-consuming, with the potential for significant financial impact if not handled correctly.
Hiring an expert in dental insurance credentialing not only ensures that the process is managed efficiently but also helps protect your practice’s cash flow and revenue streams. By entrusting this vital task to an experienced professional, you can focus on growing your practice, providing excellent patient care, and ensuring that your transition into practice ownership is as smooth as possible.
Tips for all Dentists During the Credentialing Period
You can and should start seeing patients during the credentialing period! It usually works BEST for negotiations if the selling Doctor can stay onboard for at least 6 months with you at ANY capacity and to reap this benefit we must credential them under your new TIN.
It’s important to start credentialing right away because credentialing can take quite some time.
It is important to keep in mind a few tips:
- Delta Dental and BCBS do not reimburse the office for out of network providers if possible, allow the already credentialed selling Doctor to see these patients to ensure reimbursement comes to the office and does NOT get sent to the patient directly.
- If this is not an option you can collect 100% of contracted fee upfront from the patient and then insurance will reimburse the patient directly. This can create concerns or hesitation from patients.
- You may be recommended to hold some insurance company claims temporarily to ensure reimbursement is as smooth as possible.
- When out of network, you can still choose to honor in-network fees to ensure patients feel as little impact as possible.
- It is important to keep in mind that TPAs (Third Party Administrator) will take additional time past the initial networking for them to all go in network.
- Please submit your W9 and the short letter provided (on your letterhead) with all claims. This helps claims process more seamlessly during the credentialing time period.
- It is insurance fraud to submit claims under a provider other than the rendering provider for any period of time.
- Insurance verification is a necessary task always; however, it is even more important to verify if patients have out of network benefits during this credentialing period to ensure reimbursement prior to treatment being completed.
Keep Reading: Why Submitting Claims to Dental Insurance Under a Provider Not Rendering Treatment is Insurance Fraud
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