Introduction: The Hidden Risks Buyers Inherit When Purchasing a Practice
When buying a dental practice, most potential owners and investors focus on the big picture: production numbers, hygiene performance, number of active patients, and reputation.
Those matter, of course. But there is one area of due diligence that quietly determines whether your acquisition will be a profitable dream… or a financial headache:
The practice’s PPO contracts.
As a buyer, you aren’t just inheriting patients, equipment, and staff.
You’re inheriting every contract the seller signed, every reimbursement rate they accepted, every discount they agreed to—and every mistake they made dealing with PPOs.
This guide breaks down the critical PPO factors buyers must evaluate, the red flags that signal financial trouble, and how to compare two practices to determine which one is the better long-term investment.
- Why PPO Evaluation Is Essential When Acquiring a Practice
Buying a dental practice is essentially buying a stream of future cash flow. The question is:
How predictable, profitable, and stable is that cash flow under the current PPO structure?
Many buyers look at gross production and operating costs… yet overlook the biggest revenue determinant of all:
- Contracted fee schedules
- Write-off percentages
- Participation mix
- Credentialing status
- Third-party leasing arrangements
These factors shape real-world collections, which in turn shape EBITDA—the primary metric used to determine whether the practice is worth the price.
If the PPO landscape is weak, the practice may be:
- Overvalued
- Riskier than it appears
- Dependent on low-paying plans
- Requiring significant post-acquisition renegotiation
- Prone to long-term profit suppression
If the PPO structure is strong, the practice becomes:
- A lower-risk investment
- Easier to scale
- More profitable on day one
- Faster to pay off acquisition debt
- More attractive to future buyers or DSOs
Understanding PPOs is not optional—it’s essential.
- Comparing Two Practices: PPO Strength vs. PPO Weakness
Let’s contrast two hypothetical acquisition opportunities.
Both have similar revenue on paper… but they are not equally valuable.
Practice A: Strong PPO Environment
- $1.1M in production
- Average write-off: 24%
- Updated fee schedules
- Recently renegotiated with major carriers
- Clean credentialing
- Clear participation structure by provider
- Minimal leased network involvement
- High schedule efficiency
Real-world collections: ~$836,000
EBITDA: Strong
Risk level: Low
Practice B: Weak PPO Environment
- $1.1M in production
- Average write-off: 41%
- Fee schedules outdated by 5+ years
- No history of renegotiation
- Associates credentialed under incorrect NPIs
- Leased networks driving down reimbursements
- Participation unclear or undocumented
Real-world collections: ~$649,000
EBITDA: Suppressed
Risk level: High
Impact on Buyer Decision
Two practices with identical production can differ by $187,000 in annual collections purely based on PPO structure.
If your acquisition loan is based on revenue you think the practice is earning—but that revenue evaporates due to low reimbursements—you’re walking into an expensive surprise.
- The Top PPO Red Flags Buyers Should Look For
When evaluating a dental practice for acquisition, be on the lookout for these warning signs. Each one can significantly impact your return on investment.
❌ Red Flag 1: Outdated or Unnegotiated Fee Schedules
If the seller hasn’t renegotiated their PPO contracts in 3–7 years (very common), you can assume:
- The practice is under-collecting
- Hidden revenue is being left on the table
- Post-purchase renegotiation may be needed
- Some reimbursements may be below breakeven
This impacts your first year of ownership immediately.
❌ Red Flag 2: Excessive Write-Off Rates
Write-offs above 35% are a major buyer concern.
Why?
Because they indicate the practice is performing dentistry at deeply discounted rates.
High write-offs reduce:
- Collections
- Profit margin
- EBITDA
- Valuation stability
- Cash flow for loan repayment
Buyers should analyze write-offs by carrier, not just as a global percentage.
❌ Red Flag 3: Credentialing Errors
Credentialing problems can delay or disrupt your revenue for months.
Common issues include:
- Providers billed under incorrect NPI
- Missing CAQs
- Expired documents
- Delegated credentialing missing
- Associates credentialed only under the owner
- Owner credentialed in plans they don’t know about
If claims suddenly start paying at out-of-network rates, you inherit a revenue gap at the worst possible time—right after funding the purchase.
❌ Red Flag 4: Unnecessary Third-Party Leased Networks
Many practices are unknowingly contracted through leased networks such as:
- Careington
- Connection Dental
- Dentemax
- Zelis
Leased networks often undercut your reimbursement by 10–30% without your consent.
If a seller isn’t aware they belong to these networks, it’s a sign that their PPO landscape hasn’t been properly managed.
❌ Red Flag 5: Overreliance on a Single PPO
If one carrier represents 40–60% of the practice’s patient base—and that carrier pays low reimbursement rates—your risk level skyrockets.
If that carrier reduces fees, changes network structure, or delays credentialing, your cash flow takes a major hit.
❌ Red Flag 6: No Documentation or Clarity
If the seller cannot provide:
- Updated fee schedules
- Participation list by provider
- Negotiation history
- Explanation of leased networks
- Credentialing documents
…it often indicates deeper operational issues.
Buyers should not rely on verbal assurances.
Demand documentation.
- Key PPO Data Buyers Should Request During Due Diligence
Before finalizing an acquisition, buyers should request (and thoroughly review):
- All Current Contracted Fee Schedules
You need:
- Accurate, current contracts
- Clear identification of primary vs. leased rates
- Comparison between contracts and actual EOBs
- A Participation List by Provider
This ensures:
- Each provider is correctly credentialed
- No ghost participation
- No providers credentialed under the wrong NPI
- No unexpected “gaps” in participation
- Payer Mix Breakdown
This tells you:
- Dependence on low-paying plans
- Health of insurance diversification
- Risk level if fees change
- Write-Off Percentages by Carrier
A global write-off percentage is not enough.
You need carrier-level insight.
- EOB Samples for Top Procedures
This helps verify:
- Actual reimbursement (often different from contracted rates)
- Payment inconsistencies
- Hidden leased networks
- Credentialing Documentation
Critical to avoid payment delays when you take over.
- History of PPO Renegotiations
If none exist… plan on doing them yourself.
- The Buyer’s Advantage: How PPO Optimization Improves Post-Acquisition Profitability
The good news?
Even if a practice has PPO red flags, that doesn’t mean you should walk away.
It simply means you should:
- Adjust your offer
- Plan a post-acquisition optimization
- Work with PPO experts quickly
Here’s the upside for buyers who partner with PPO Negotiation Solutions:
- Immediate Revenue Recovery
Many buyers start seeing increased collections within 60–180 days after optimization.
- Rapid EBITDA Improvement
Since EBITDA drives long-term practice value, improved reimbursements:
- Pay off acquisition loans faster
- Increase profitability
- Strengthen future sale price
- Reduced Operational Risk
A cleaned-up PPO environment reduces:
- Denials
- Payment delays
- Credentialing gaps
- Billing errors
- Staff stress
Your new practice becomes smoother, more predictable, and easier to grow.
- Stronger Long-Term Asset Value
A PPO-optimized practice:
- Has higher cash flow
- Commands a higher valuation multiple
- Attracts stronger buyers or DSOs
- Increases future exit value
You are not just improving profitability—you’re building long-term equity.
- How PPO Negotiation Solutions Supports Buyers
Buyers partner with PPO Negotiation Solutions for:
- PPO due diligence audits
- Fee schedule verification
- Leased network identification
- Credentialing cleanup
- Post-acquisition renegotiation strategy
- Assistance integrating new providers
- The first 12-month PPO optimization plan
We help buyers avoid inheriting the seller’s PPO problems—and maximize the profitability of their new investment.
Conclusion: PPOs Determine Whether Your Acquisition Is a Smart Buy or a Risky Bet
When buying a dental practice, PPO performance is not a small detail—it’s a major financial determinant.
If you want:
- predictable cash flow,
- stable revenue,
- long-term profitability, and
- a stress-free transition…
…you must evaluate PPOs with the same rigor as production or overhead.
A strong PPO environment adds value.
A weak PPO environment suppresses it.
Knowing the difference helps buyers negotiate the right price—and walk into ownership with confidence.
Want to Avoid Overpaying for a Practice?
Before you buy, get a Buyer’s PPO Risk Review.
👉 We’ll analyze the practice’s PPO performance
👉 Identify risk factors hidden in the contracts
👉 Provide a clear valuation impact report
👉 Show you how much profit you can recover post-acquisition