The fastest growing segment of our company is helping start up practices establish themselves with the best possible fee schedules to get their new practices off the ground. We can’t stress enough how happy we are that you are here because we know you have all kinds of work on your plate with your office build out, staffing, equipment choices and all the other details of launching your new practice. In the midst of all the other decisions, do not underestimate the importance of your PPO contracts. By looking ahead to the impact insurance participation will have on your immediate cash flow and longer term profits you are already well ahead of the curve! Many start-ups sign the first PPO contract offered and realize too late that they are not eligible for re-negotiations for a couple of years. Congratulations for doing your due diligence on this important issue before signing contracts. This is the best opportunity to secure good fee schedules and we talk with far too many practices who regretted the initial fees they agreed to, often with no negotiations.
Note that it usually takes 90 days for negotiations. Once you have accepted a contract and your application has been submitted it can take 3 weeks to 4 months to be considered in-network by the insurance company so start early! Plan well ahead so that you will be in-network with as many of your choices as possible when you open. And also remember that it’s better to be out-of-network for a short period of time than it is to accept an inferior fee schedule because you are making rushed decisions.
How do we work with Start Ups?
1. We do a third party fee analysis to help set your fees properly and discuss this with you during our first call. We will need to submit a copy of your full fees to the insurance companies as part of the negotiations process. If your fees are set too low it can impact negotiations. If your fees are exceptionally high the insurance companies may assume your fees have been artificially inflated for the purposes of negotiations. We want your fees to be set strategically to ensure the best negotiations outcome and will help you with our recommendations.
One question we are commonly asked is if you can set your fees high at the beginning then lower them later. The answer is no, do not attempt to artificially inflate fees upfront thinking that you’ll get better negotiations and then drop them later. When we are negotiating we are representing to the reps what your real fees are and reps will remember offices who tried to play the system when renegotiations roll around. Part of the reason we get good results for our clients is because we’ve developed a good reputation with reps for being strong advocates for the doctors we work with. This reputation always works in our client’s best interest, both from a pure ROI standpoint as well as from a long-term relationship standpoint. There is too much money at state for the long run to risk putting any future increases at risk. Start your contract off right with these carriers and then require them to live up to their end of the contract as well.
During this first call we will also work with you to define your top codes that you want us to focus negotiations on. We will provide a template to help guide the process but want to be sure that your top codes are a custom reflection of your new office so it will be tailored specifically to your practice.
2. We’ll be doing a demographic anaysis of your area to pinpoint largest employers and what corresponding dental insurance companies are tied to them. What is an important insurance company to consider in one market will be different from another based on local employers. Strategic decisions need to be made to choose the best mix of participation for your specific area.
3. We’ll get you the credentialing paperwork to begin working on right away. We want to get all of your documentation at the front end of the process so that any non-negotiable companies can be started right away and so that we can immediately submit your applications when you accept an offer. This will keep the process moving as quickly as possible. Remember to plan on 90-120 days to be in-network under your new tax ID number.
3. Let the negotiations begin! If you are currently an associate and your current office is in-network, that’s ok. Your new fee schedules will be tied to your new office and your tax ID number, not your associate position (with the exception of United Concordia which is tied to the dentist’s name). We will negotiate a customized fee schedule wherever possible so that we focus negotiations on the codes that will be the most relevant.
5. Once we have the best offers, have made our recommendations and you have made your final decisions we’ll coordinate the paperwork, have you sign off and then we will let you know your effective dates to be considered in-network with each plan.
6. Copies of all final fee schedules and contracts will be place in a permanent online account for you to access at any time. We’ll also send you a reminder of when you are eligible for the next round of negotiations so that you don’t miss out on any future increases.
7. We’ve coordinated a special arrangement with Odyssey Management to provide 6 requests/30 days of eSupport for all of our start up clients. Our job is to get you the best mix of insurance contracts in place but chances are you or your new staff may have follow up questions about filing insurance, how to enter fee schedules or initial EOBs. Teresa Duncan, owner of Odyssey Management, has put together a special program for our clients to provide initial eSupport to help launch your practice quickly and efficiently!
We have had many of our start up clients say that our services were the one thing that went smoothly in their start up practice. We hope you will feel the same way and will come back to us again when it’s time to re-negotiate your fee schedules down the road. But even if you decide to fly solo on renegotiations at your renewal time we make it easy on you. You will get a packet with the paperwork and your fee negotiations so that you are well positioned for the future. Our process is transparent and our goal is to share as much of our knowledge with you so that you start off your practice on the right foot.