Transitioning into ownership of a dental practice is an exciting yet challenging journey, especially when it comes to navigating the complexities of insurance credentialing. If you’re acquiring a practice that is contracted with multiple Preferred Provider Organizations (PPOs), understanding the credentialing process is essential for a seamless transition. One common question dentists often ask is, “When should I begin the credentialing process?” In this guide, I’ll provide valuable insights on effectively managing insurance credentialing during your transition, setting the stage for your practice’s long-term success.
When Should You Start Credentialing for PPOs?
The credentialing process should commence as soon as you’ve signed a letter of intent and have a strong indication that the sale will proceed. Contrary to popular belief, there’s no need to wait until the sale is finalized to begin this critical step. Initiating the credentialing process early can significantly minimize potential complications later on.
By starting the credentialing process ahead of the sale closing, you can hit the ground running once you officially take over the practice. Many dentists mistakenly believe that credentialing must be delayed until the ownership transfer for legal and privacy reasons. However, getting a head start allows for negotiations to begin and reduces your out-of-network (OON) time.
Why Is Early Credentialing Matters?
Credentialing encompasses a range of activities: negotiating fee schedules, completing applications, signing contracts with PPOs, and undergoing thorough vetting to ensure that the provider maintains ethical standards and a clean license. This process can be lengthy, making it imperative to begin as soon as possible.
During an acquisition, it’s common for practices to experience a temporary OON status. Fortunately, many insurance plans offer out-of-network benefits. Furthermore, you can provide patients with legal PPO discounts, easing their financial burden during this period. The sooner you start the credentialing process, the faster you can integrate into the insurance networks and return to maximizing patient benefits.
Credentialing Timelines: What to Expect
Understanding the timelines associated with different types of PPO contracting can help you plan effectively:
Direct Contracting: This involves signing a contract directly with a PPO. Typically, this process takes between 30 to 90 days, depending on the insurer.
Indirect Contracting: This option involves third-party networks that grant access to multiple PPOs. However, this process may extend to 90 to 120+ days or longer due to the additional layers of management involved.
Both approaches have their advantages and challenges. It’s crucial to determine which option aligns best with your practice goals. Partnering with a consultant specializing in insurance credentialing can provide valuable guidance in making informed decisions.
Managing the Transition Period
During the transition to ownership, it’s likely that you’ll be temporarily out of network with some PPOs. However, this status doesn’t have to result in patient loss. Clear communication with patients regarding their temporary OON status and guidance on their benefits can alleviate concerns and foster loyalty.
Providing reassurance and transparency during this phase is essential. Patients appreciate continuity in care and will often remain loyal, even if there’s a brief disruption of in-network status. Educating your team on how to handle these discussions will also be critical to maintaining your patient base while credentialing progresses.
Maximizing Your PPO Contracts
One critical aspect of acquiring a practice is understanding how the seller’s existing PPO contracts will impact your future business. Many new owners mistakenly believe these contracts can be easily transferred, but this is rarely the case.
Instead, this transition presents a valuable opportunity to renegotiate and enhance the terms of these contracts. On average, dentists who proactively collaborate with PPO Advisors during this process can increase their contracted fees by up to 30% compared to the previous owner’s agreements. This increase can significantly enhance your practice’s profitability, allowing you to generate more revenue without needing to see additional patients.
How a Consultant Can Support Your Success
Engaging an experienced consultant during your acquisition can be a game-changer. They will guide you through the intricate world of PPO credentialing, ensuring you make informed decisions at every step. A consultant can also offer insights on which contracts to prioritize and provide strategies to improve your fee schedules over time.
A smooth credentialing process not only safeguards your cash flow but also strengthens the trust and retention of your patient base, positioning your new practice for long-term success.
Navigating the credentialing process during a practice transition may seem daunting, but with the right strategy and support, you can minimize disruptions and unlock your practice’s full potential. Starting early, staying informed about your options, and collaborating with experts in PPO negotiations will streamline your transition. As you embark on this exciting new chapter in ownership, having the right guidance will ensure your practice thrives for years to come.Reach out to PPO Advisors today to learn how we can help make your acquisition a success!