As a dental practice, you are likely investing ample time and energy in your patients, to ensure the best patient outcomes. But are you also investing enough time and energy to ensure you are getting the most opportunities for growth and profit? Why is credentialing important and how can it help my dental practice? Since organizational growth and development equals positive patient outcomes, let us look at some successful tips to negotiate dental insurance credentialing contracts.
The Importance of Credentialing
First, it is important to understand why credentialing is important. In short, credentialing is the process of verifying a dentist’s background for an insurance company. Patients are now more likely to choose services from dental providers that are in-network with their insurance company due to costs. It is very important to be credentialed with various insurance plans. By credentialing with a wide number of popular plans, your client base can be greatly increased. Different insurance companies require different applications and processes to become credentialed with their organization. Weighing the pros and cons with each insurance provider is essential before entering a contract.
Assess your opportunities for growth with different payment options and insurance companies. Explore in-network vs out-of-network opportunities. If your dental practice is in a populated area, explore different employers in your local community. Are there large organizations that carry a particular plan? If you were to enroll in their plan, is there potential for a large gain in clientele? Becoming in-network with that plan may be a good financial move.
Consider other competing dental practices in the area, as well. Enrolling in a large organization’s plan could increase competition between you and other practices. Contact the large organization’s HR department for marketing and insurance. But 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 increase in workload.
Here’s an example scenario for seizing an opportunity for growth. There is a large healthcare chain in your local area, and it owns several local hospitals, walk-in clinics, and offices. You contact the HR department of the chain and find that they use a particular insurance plan for the entire healthcare organization. Enrolling in this plan would make you an in-network dental provider to all employees of this chain, increasing your potential client gain.
Using a skilled negotiator to negotiate fees and credential scheduling can be a useful tactic. Stay up to date on the latest information about popular insurance plans. Even though some insurance companies advertise that they are non-negotiable, ask to negotiate. Some plans will only offer negotiation if you are a specialist, so be mindful, and consider hiring a negotiator.
Be aware of third-party companies. They may have better scheduling, but there could be hidden costs. If needed, consider outsourcing negotiations until your staff is up to date. The American Dental Association posted an article on their website encouraging dental companies to negotiate with insurance companies for higher reimbursement rates. The article stated that companies used to negotiate with insurances were “on the rise,” and a doctor in the article mentioned that it allowed her more time to focus on her patients. Carefully consider which negotiation specialist is right for you and your company.
Read the Fine Print and Renegotiate
It is safe to say that if it is not mentioned in the contract, it is not an offered service. Do not make assumptions. If you feel like there is something missing from the contract, investigate whether or not it is an offered service and request clarification in the contract. Be aware of some insurance companies with contracts that are more difficult to navigate and weigh the pros and cons of entering a contract.
For example, Medicaid can be difficult to navigate and typically requires a lengthy credentialing process. However, if a large population in your area carries Medicaid, it may be beneficial for your dental practice to offer Medicaid as an in-network service. If you are looking to re-negotiate with an insurance plan, make sure you are updated on current plans in your area and what your fees should be. Determine the leverage you can use by knowing what services you can offer in your area and the patient demand of the services. Contact the plan carrier and request a custom fee schedule based on your selected billing codes.
Consider contracts with companies to do negotiations for you. How can companies like Strategic Practice 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 dental practice’s knowledge of insurance negotiations. They work full-time on your dental contract negotiations, so you can be free to better serve your patients. Save yourself the time and money and contact them today.