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Dental Credentialing in 2022

November 30, 2021

As dental offices begin a new year and leave behind a year of unexpected challenges, many are considering what changes they can implement to grow their practice. Everything from marketing to updated technologies is on the table. In 2021, COVID-19 was feared and ways to control spreading were the first priority. There were limits on treatments provided and on how many patients could be treated. People are trying to make up for the treatments canceled in the previous year. And now is a great time to consider ways to get your practice name in the forefront. One way to produce growth is becoming credentialed.

In-Network Status vs. Out of Network

If you become in-network, you open your dental practice to a whole new influx of patients. Entering an insurance contract with a particular insurance carrier can increase your patient base and business opportunities. Insurance carriers have their own vetting processes for dentists to become credentialed. Which includes providing proof of their dental degree and license, malpractice insurance, law compliance, and other factors.

When considering entering a new contract with an insurance carrier, the plan, fee schedules, and charges allowed to patients must be read carefully. The dentist is agreeing to certain contractual obligations, such as audits of the practice and their documentation and if certain procedures can be billed. It is essential to give their utmost attention to the contract before signing it.

Some dentists remain out-of-network, which results in direct payments and less insurance management but a smaller pool of patients. These patients generally pay higher out-of-pocket rates and fees. They may search for in-network providers to pay less or no out-of-pocket expenses.

How to Start

Look to the top larger employers in your city and county and their insurance carriers. This will put your practice into a large customer base. Review insurance carrier fee schedules before making a decision among the carriers to insure the fairest payout. The front office can assist in this process by making a list of the insurance plans most asked to participate in by patients and calling other practices in the near vicinity. This is a very important decision, so be selective and negotiate fees.

The Dental Credentialing Application

Getting the dentists in your practice credentialed is one of the first things you should do if you decide to accept insurance, whether you are a new practice, new dentist or just hired a new dentist. Dental credentialing is done on individual terms. In a dental practice with multiple practitioners, each must make the decision individually to be in-network or out-of-network and which plans to accept.

To become in-network with a PPO insurance provider, you must enroll with the company, and for each one, complete an application form. Each application takes about 40 hours to complete, so it is quite an ominous task. Also, if an answer to one question is incorrect, you have to start again from the beginning. Credentialing is a very tedious and arduous process because insurance companies want to confirm you are a practicing dentist and in good standing.

Upon completion and submittance of the application, the insurance carrier will review your information and verify it is correct. This is called the “vetting” process. If you do this correctly and ensure all information is submitted, it will save much time. Payments will be processed and arrive much quicker. Only the dentist can make the choice of which plans are in their best interest to participate with. This is based on the companies and competition in the area.

Without proper dental credentialing, practitioners in your office will have delayed claims leading to increased time in getting paid. Insurance changes are occurring almost monthly, so it is very important for your peace of mind to know someone is managing your credentialing making sure it’s accurate and up-to-date. If you choose to hire a third party to handle your credentialing, it would save your front office much time and stress by taking care of relevant forms and documentation. The third party will also keep pace with dental credentialing requirements and any new additions to your office.

Even if you are totally out-of-network, PPO Negotiation Solutions can often negotiate fees higher than your standard fees, putting you in-network and able to attract far more new patients. They help you operate with PPOs from a position of power! Hire PPO Negotiation Solutions to assist your practice with increasing insurance reimbursements and creating a larger patient pool. Their goal is to increase your revenue and increase your practice’s knowledge of insurance negotiations. They work full time on your dental contract negotiations so you don’t have to worry about neglecting other aspects of your dental practice. Save time and money and contact them today!

How to Successfully Acquire Dental Practices

November 12, 2021

There are several ways for dentists to establish their own dental practice as they desire to have more control of their future earnings including acquiring a dental practice. Reasons to begin a sole practice include reducing their student loan debt, having a more flexible schedule, or just working under a different set of rules, to mention just a few. Some may desire mentorship or associate-to-own opportunities until they decide their actual approach to dentistry.

Whichever way you decide to approach ownership is a decision you will have to make based on your desired finances and lifestyle. The core team most important to assist you in making this critically important step should consist of a trusted lender, attorney, accountant, and insurance broker, just to start the process. You will find once you have determined your goals for the practice, experienced professionals can educate you and keep you on track. Owning your own practice is the most rewarding way to meet your career goals.

Consider an ADA Membership

One very important resource to consider is becoming a member of the American Dental Association (ADA). Through this professional organization membership, you have access to publications that will keep you up-to-date on training programs, continuing education courses, and career centers which could be very valuable for the best chance to succeed. Access to discounted products and supplies through this network could prove to be exceptionally valuable.

If you desire for your practice to be a success, make sure to investigate the area where you want your practice to be located. Consider the number of dental practices in the surrounding area and average household income. Make sure there are enough residents in your target demographic to provide a successful amount of business for your practice.

Develop A Business Plan

In order to assure support from the lender you choose, and others who will advise you along the way, consider developing a business plan that goes along with your business objectives. As a part of your business plan, you must decide whether you will purchase, build, or rent your facility. Always allow for expansion and upgrade. You must determine your days and hours of operation and who you plan to employ and their job descriptions. This includes compensation and benefits for these full-time or part-time staff, as well as established personnel policies.

Based upon the goals you have outlined in your business plan considering accessibility, demographics, competition, quality of the facility and equipment, you must decide how to develop a satisfied patient following that will become faithful to your practice to produce cash flow. Determine ways you will make this happen. By expanding your types of services and focusing on the details, you can provide a great patient experience.

How you engage with team members on a daily basis can determine how your staff members create the service and moments you want them to have with your patients. Some other ways to accomplish patient satisfaction to create a faithful patient base is on-going training for staff. Be involved in the community where your practice is located by sponsoring local schools and events in the area.

These are very important things to consider in order to obtain referrals for future patients. Remember other things to consider when opening your practice will be developing and marketing a brand for your practice, a customer-friendly website, and advertising in print and on social media.

In order to obtain the appropriate amount of financing from your lender, you will have to establish the amount of funds necessary to cover operating your practice and covering overhead expenses until you are up and running. Whomever you choose as your financial advisor or CPA will be critical in helping you with the appropriate amount of cash flow needed. Your lender will take all this into account in making the decision to finance your new endeavor.

Importance of a Contract

One of the most critical items to consider when beginning to work in a dental office or when acquiring a practice is to get a written contract. Verbal contracts often lead to misunderstandings. Important things to include in your contract are details of compensation all the way down to payment terms of bonuses. Make sure to include non-compete language and how to transfer ownership in the event you or a partner decide to leave the practice.

“A contract should clearly spell out every element of a practice sale – including penalties for changing the terms.” Just remember, having a written contract protects both sides to reduce future problems and loss of relationships. Contracts need to be read carefully. Your lawyer should read and review your contract and inform you of any concerns. The ADA Center for Professional Success offers an eBook, Dentist Employment Agreements: A Guide to Key Legal Provisions, should you need further advice.

Acquiring the right dental practice, however and whenever you decide is the right moment for you, is based on your experience, lifestyle, and financial position. Make sure you consider your short-term as well as your long-term goals when making this life-changing commitment. For more information regarding the when, where, and why to begin the process of preparing to open your own dental practice, visit PPO Solutions at www.pponegotiationsoltions.com.

How to Increase Patient Volume

October 25, 2021

COVID-19 has been a major game changer for most dental practices. The examination of patient volume and the daily office schedule can help determine how to develop an updated schedule to maximize patient volume. The dental practice’s success or failure depends on the number of patients visiting it. If new patients are being added on a consistent basis, then the practice is considered growing and gaining in popularity. On the other hand, if the frequency of new patients is low, that is an indication something in the plan must not be working.

Appointment Scheduling

The most valuable thing for sale in a dental office is time spent with patients. Therefore, a scheduling policy must be designed to allow for the effective use of this time. This scheduling policy should be written and displayed where the staff has daily access to it. Periodically consider whether the policy is still relevant or needs to be updated or replaced. There are many scheduling plans that exist in dental offices. Appointments must be scheduled in such a way that patients get excellent care and chairs remain full. This should meet the production goals which need to be met on a daily basis. The dentist as well as the staff must be committed to consistently apply the principles involved for the scheduling system to work.

Some dental practices base their scheduling on time slots. The procedures being performed are based on estimated time to complete the treatment and the disinfection and preparation time needed before each procedure. Dental professionals must decide if more complex treatments are taken care of early or later in the day.

Some dentists may rather attend to children first thing in the morning. This scheduling must be coordinated between clinical and office staff to maintain the smooth flow of the office. The dental practice must decide which is the best approach to scheduling for their dental practice.

Use Accelerated Scheduling

The term “accelerated scheduling” refers to the use of multiple dental rooms in the practice. Each room must have it’s own dental assistant as the doctor moves between rooms. When the dentist is not in the room, there is a dedicated assistant to carry out the duties for which they are qualified. This system maximizes the time management and efficiency of the dental office.

Some considerations to be made along with the procedure itself are staffing, absences, equipment availability, and the proficiency of the dentist or dental assistant completing the treatment. The tolerability to certain treatments by the patient must also be figured in as part of the equation. This can be simple or complex, due to the preferences of the dentists and patients. This particular type of orchestrating scheduling may or may not be for every dental practice.

Maximize Available Chair Time

In this uncommon era of the COVID pandemic, it is of the utmost importance to manage the flow of patients, scheduling, and no-shows to utilize available chair time to its greatest capacity. The time the dental chair is not filled due to a patient missing an appointment or not being scheduled can never be recovered. Systems must be implemented to ensure patients will keep appointments. This may include patient confirmations at two weeks, two days, and two hours by text message, for example. There must also be follow-up systems for patients who missed their appointments to get them back into the office as quickly as possible. This will assure no patient slips through the cracks and off your daily production schedule.

If it is noticed that the dentist or dental assistants are continually behind and patients are experiencing longer waits in the waiting room, it may be time to invite another dental assistant or dental partner to join the dental practice team. This will prevent patients from seeking their dental services at another dental office.

Investigate the Use of Teledentistry

“Teledentistry is the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well as store and forward technologies, to provide and support dental care delivery, diagnosis, consultation, treatment, transfer of dental information and education.”

Teledentistry is evolving to be the way to enhance care and education. One of the ways it can be delivered is through the use of live two-way video interactions between a dental provider and a patient using audio/video technology (synchronous). Patient images may be stored and forwarded by a secure electronic communication to a practitioner who can then evaluate a patient’s condition or complete a service outside of a live interaction by a system referred to as remote patient monitoring (RPM). Mobile health (mHealth) is another teledentistry method being exercised for health care or education by cell phones, tablets, or personal digital assistants (PDA).

The ADA believes that examinations performed using teledentistry can be an effective way to extend the reach of dental professionals, increasing access to care by reducing the effect of distance barriers to care. This treatment must be properly documented, as well as include a summary of services to the patient. Insurance patient reimbursement must be at the same rate as in-person care to include the teledentistry codes as appropriate.

Schedules must be prioritized as to the size of the case or patient need. Production must be maximized to keep the practice healthy and strong from a financial standpoint. Due to low patient volume in this particular era, dental practices have to reconsider how they build and manage their schedules.

Want someone to help you increase your dental practice revenue by negotiating your highest fee schedules and claiming reimbursements on your behalf? Visit PPO Negotiation Solutions to get your complementary assessment or schedule a consultation for your dental practice.

10 Tips for Private Equity Stockholders and DSOs to Optimize PPO

October 11, 2021

Insurance negotiations and credentialing are essential parts of maintaining a dental practice. To have the most profit, negotiations for fee schedules will need to be done regularly and by someone who is trained and familiar with the processes. Providers credentialed with a variety of insurance will benefit from the most patient flow and retention. Let’s look at 10 easy tips to optimize these negotiations and, ultimately, guarantee patient retention.

Know Your Current Situation

It is important to understand the importance of PPOs, and how they affect patient retention in your practice. Be well-informed of your current PPO contracts. Review your current fee structure and parameters of all contracts. Are your contracts affecting multiple DSO locations, if applicable? Next, make note of the annual revenue for each PPO in each of your locations. For example, if your dental practice is close to a major company, like a hospital, it would be beneficial to explore their dental provider benefits.

Maintain a Stable Environment

Credentialing and negotiations, while necessary, can be a lengthy process. High employment turnover can affect the process and can drastically impact patient turnover and revenue. It can lengthen the process due to new employees needing to be credentialed or trained on new policies. Try to maintain your workplace and staff, to ensure adequate patient flow during the credentialing and negotiation processes.

Review Standard Practice Fees

The reason to review fees is to maintain the price of services and safeguard against inflation and neglect. Standard fees should be reviewed regularly by someone who values input from different departments. Also, consider factoring in multiple outside data sources to ensure your team has made an accurate assessment. If adequate, then use the data for your pricing model and to renegotiate adequately for new fees when the time comes.

Define Your Desired Outcomes

To be successful, define your objectives and goals early in the negotiation process. Your goals may change throughout the process. As goals change, ensure you are also developing success plans for each goal. It is recommended to have both short-term and long-term goals that are measurable and attainable. Each goal should have objectives or steps to achieve the result. Once goals are set, circle back and monitor your progress frequently to ensure you are staying on track.

Develop a Process to Collect and Analyze Data

Analyze your current process for collecting, processing, and comparing data. How can your current process be improved to be most efficient? Having a goal for analyzing processes is needed to ensure that no time or money is being wasted on insufficient processes. Once you have fine-tuned your process, monitor and periodically reassess for improvements, asking yourself if goals are being achieved in a timely manner.

Be Patient, but Persistent

Like mentioned earlier, negotiation and credentialing processes can be lengthy and time-consuming. Having an expert team working on negotiations can make for a smoother process. Maintain open communication and communicate frequently to ensure the process is running efficiently and to avoid delays. It may be helpful to set benchmarks for responses and follow up with representatives if responses are not received timely. If you do have a specialized team performing these duties for you, make a point to be in frequent communication with them to ensure they are following up on contracts efficiently.

Respect Confidentiality

It is important to honor confidentiality agreements without exception. Using an unrelated organization’s compensations in a negotiation is irrelevant and a confidentiality breach. Promote and emphasize confidentiality to all team members. Breaching confidentiality can negatively impact your DSO contracts and patient retention.

Communicate Proactively

Be prepared for questions from those not involved in the decision-making process, especially when big changes are being implemented. Understandably, the changes may incite anxiety in some team members. Examples of change include adding new plans or becoming out of network with payors. Communicate updates with staff throughout the process and, if necessary, provide training and support to help them adjust and be efficient in their roles.

Keep Track of Agreements

Keep track of all new agreements. The effective dates will vary throughout the year. Every agreement should be honored for at least two years before negotiating again. For example, review monthly which contracts are ending and plan to follow up with negotiations. Staying on top of negotiation contracts will ensure your practice is getting the best fees.

Obtain Adequate Resources

As your dental organization grows, there will be more profits at stake when negotiating with insurances. Use your most educated experts to assist in negotiations. If needed, contact a professional third party for managing the tasks of credentialing and negotiations. PPO Negotiation Solutions can increase your practice revenue and assist in streamlining your processes for improved outcomes. Contact the professionals today and let them help your practice thrive!

Resilient Dental Practices During and After the Pandemic

September 25, 2021

The methods for patient care in dental practices changed drastically in 2020. In March 2020, the CDC released a statement recommending that dental practices postpone elective procedures, surgeries, and non-urgent visits. Although the recommendations have been updated and more elective procedures were allowed, the COVID-19 virus is still present, and it is unknown what the future holds for businesses and healthcare.

Due to the pandemic, dental practices had to get creative with how they cared for patients, with many adopting virtual services to provide care. Let’s talk about some ways that dental practices have maintained their business during the pandemic that are still being utilized today.

Loans and Grants

Due to the need to cancel and postpone many patient appointments, dental practices had to investigate ways to sustain themselves financially for the short term. The CARES Act, introduced in 2020, included financial assistance for businesses, including paycheck protection programs, emergency Economic Injury Disaster Loans (EIDL), delayed payroll tax payments, enhanced unemployment benefits, and more. Small Business Administration loans were available to assist with payroll-related costs, mortgage payments, and even utilities. These financial options were very beneficial to dental practices in 2020, and some benefits are still being used today as some practices still struggle to return to normalcy.

Review of Insurance Plans

Another way that dental practices could help their revenue during the pandemic is to audit their fee schedules with insurance plans. Typically, contracts are due for negotiation after two years. The purpose of reviewing fees is to maintain the price of services and prevent inflation and neglect. Investigate to see which insurance fees are due for negotiation. Before negotiating, review some negotiating tips to ensure you are getting the best fees. Communicate regularly with insurance providers and team members about changes in plans.

Chart Auditing

Understandably, patients over the last year and a half have likely suffered from financial hardships. You may not have been auditing charts as frequently due to giving patients a grace period to bring their accounts up to date. However, now that things are getting back to normal, it would be a good time to audit patient charts for late payments and missed payments. When reaching out to patients to collect a payment, ensure they are aware of your payment plan options, and assist them in working out a plan that will work for them and the dental practice.

Updating Your Dental Practice’s Website

Recently, people have been using the internet more than ever. When businesses were shut down for the pandemic, many began to utilize electronic means of communication. Your business website is especially important to maintain patient contact, educate patients, manage appointments, and receive payment for services. An easy-to-use and visually appealing website is also a marketing strategy to attract new clients. If your website has not been recently updated or is not user-friendly, make some updates to attract new patients and promote better communication with them. Once updated, track your website metrics and monitor for needed improvements and changes.

Promoting a Better Office Culture

Staffing changes, layoffs, and financial hardships have likely impacted your office culture. Take note of your staff’s needs during this difficult time. Promote a positive work environment by being helpful and maintaining a positive attitude. Ask your team what you can do to make their time at work more enjoyable. Review some tips for improving your office culture. Happy staff is more likely to stay with their jobs. And patients will also benefit from the positive and healing environment.

Improve Communication

Communication has changed from in-person to mostly virtual over the last year. Your staff has likely perfected the various forms of virtual communication with the use of telehealth. But some people may be a little rusty with in-person communications now that dental practices have reopened. Review patient communication basics with your team. Encourage clear, detailed, and frequent communication with patients before, during, and after their visit. Notate some important communication tips to share with your team.

Update Procedures and Equipment

Now would be a perfect time to update your systems, equipment, and even protocols for your dental office. Advanced patient care is needed during this time to really recover from possible losses. Patients will be impressed by advanced technologies and improved treatment options. Once necessary improvements and updates are made, promote the changes on your website, social media, and by word of mouth to attract new patients.

Outsourcing

Outsourcing your negotiations and credentialing could be very beneficial as your dental practice recovers from 2020. A team of professionals would assist in the following:

negotiation of PPO fees
credentialing providers,
reviewing your current processes for possible improvement

PPO Negotiation Solutions can also provide education on how to better improve your processes, recover losses and ensure better financial outcomes. Call or click today to let them improve your dental practice and assist with recovery opportunities.

Strategies for Dental PPO Negotiations and Credentialing

September 6, 2021

Negotiations and dental credentialing can seem like a lengthy and time-consuming process. But if you want to increase your profits and provide more services to your patients, they are necessary to keep your practice thriving. Here, we will discuss some strategies for dental PPO negotiations and tips for credentialing, including assessing your opportunities, renegotiating with insurance plans, and contracting your negotiations to a third-party specialist.

Importance of PPO Negotiations and Credentialing

First, let us talk about why PPO negotiations and credentialing are important and can benefit your dental practice. Put simply, credentialing is the process of verifying a dentist’s background for an insurance company. Patients prefer going to dental providers who are in-network with their insurance provider, as it saves them money. Many patients will neglect their dental care, due to not being able to afford regular care. Being credentialed with various insurance plans is important, to service more dental clients. Different insurances have different requirements for applications and credentialing processes.

In addition to credentialing, negotiating contracts with an insurance company can also increase your profits, as well as increase patient satisfaction. By negotiating fees and the reimbursement schedule with insurance companies and increasing your profit margin, you could better serve patient needs.

Assess Your Opportunities

Once you have decided to move forward with new negotiations, the first step is to assess your opportunities for growth. Explore different employers in your local community. What plans are the larger dental practices in-network with? What medical benefits do local organizations offer to their employees? Is there potential for a large gain in clientele if negotiating with that organization’s dental insurance plan?

Enrolling in a large organization’s insurance plan could increase competition between you and other dental practices. Contact the larger organization’s HR department in your area for marketing. Be sure to understand all the details of the plan first, to avoid any unneeded stress on your practice. Evaluate the potential workload and ensure your staff is equipped to handle the increased patient demand.

Let’s look at an example scenario for seizing an opportunity for growth. Assume that there is a large healthcare chain in your local area, and it owns several local hospitals, walk-in clinics, and medical offices. You could contact the HR department of the chain and find that they offer their employees a specific plan with Blue Cross Blue Shield. Enrolling in this plan would make you an in-network provider for all the organization’s employees, thus increasing your potential client gain.

Another way to boost profit for your dental practice is ensuring that you are not underutilizing dental codes. Assess this opportunity for improvement, and ensure your staff is adequately trained to code reimbursement forms effectively. Optimizing your insurance plan’s coding tools is essential to ensure increased revenue and the best patient outcomes. In addition to evaluating your coding process, also consider your cash prices. What are other dentists charging for services in your area? It may be beneficial to adjust your charges.

Do Not Be Afraid to Renegotiate

A general rule of thumb is that if it is not mentioned in the contract, it is not an offered service. Carefully review all contracts. Specify concerns and questions if the contract is not satisfactory, before signing. The ADA recommends dental practices to negotiate. Be aware of some insurance companies that are more difficult to navigate and weigh your pros and cons prior to entering a contract with their insurance.

For example, entering a contract with Medicaid can be a lengthy credentialing process. However, if a large population in your area carries Medicaid, it may be beneficial for your dental practice to accept Medicaid as an in-network service. When re-negotiating with an insurance plan, make sure you are updated on current plans in your area and what your fees should be. Leverage your knowledge of the area, and other dental practice’s fees. Also, contact the plan carrier and request a custom fee schedule based on your selected billing codes. Negotiating will save you time and money in the long haul.

Contract Out Your Negotiations

One helpful option is to contract out your negotiations to a third-party company, like PPO Negotiation Solutions. How can companies like PPO Negotiation Solutions be helpful? They can increase insurance reimbursements, create new patient opportunities and decrease negative impacts on patients. Their goal is to increase your revenue and increase your practice’s knowledge of insurance negotiations.

Outsourcing your negotiations could be helpful if you are a solo practice looking to boost your revenue. It can be difficult to stay up-to-date on the latest information. PPO Negotiation Solutions works full time on your dental contract negotiations, so you do not have to worry about neglecting other aspects of your dental practice. Save yourself the time and money and contact them today.