By Christi Billquist
Busy dental practices often reach a point where they are looking to grow their practice by hiring additional providers and/or adding specialties. Here are answers to frequently asked questions that will get you started on the right foot.
Both parties should understand the roles and responsibilities of the owner and the associate in the contractual relationship. A written agreement should clearly outline all expectations for both the employer and employee, including intentions for PPO and DHMO participation.
An Associate/employee is a dentist an owner hires (for a salary) who will be a treating doctor but not the billing dentist. The associate is an employee contracted with PPOs under the owner's Tax Identification Number (TIN), not their personal Social Security Number or other TIN.
An Independent Contractor (1099) is a provider who bills under their TIN and treats their own patients. Governmental agencies scrutinize employers that misclassify associates as independent contractors. Typically, an employer/employee relationship will exist when the associate is not truly independent and the practice controls (or could control) the treating dentist. Federal and state agencies will seek to collect lost tax revenues, fees, and penalties for payroll taxes and Social Security for wrongly classified providers.. Sometimes, penalties may even be applied retroactively.
An associate employee who provides treatment is considered the treating dentist while the owning doctor of the practice is the billing dentist. It is generally copacetic to have mixed participation in a practice where some providers are in-network with PPOs and others remain out-of-network. However, it is a violation of the insurance contract to bill out treatment under an in-network provider who did not perform the work.
With some exceptions, dental plan provider contracts are by provider and by location. For a dentist who is contracting with a plan for the first time, the process may likely take longer than for dentists who have already been vetted and approved to be a preferred provider.
The process to contract a first-time enrollee with that company requires a PPO specific contract, agreement, and attestation along with the doctor's W.I.L.D.E. attached (W9 for the practice, Malpractice Insurance dec page, License, DEA (or explanation of why no DEA and who will prescribe medication), and Employment history (by month/year, and an explanation for any gaps in work). If your associate has been contracted in your state in the last three years, in many cases, a PPO's Add Location form is sufficient.
If a GP adds a GP to his/her practice, it is a good idea to submit current fee schedules with the applications to ensure the associate is placed on the office's reimbursements. Make sure you understand your current participation (ie plan level participation, direct contracts vs. leasing arrangements) to mirror the same with your associate.
If, for example, a GP adds a Periodontist, then some reimbursements will differ since some insurance companies and network umbrellas have separate fee schedules for specialists.
Are you looking to add an associate to your practice? Unitas Dental has helped credential thousands of dentists with PPOs across the country.
Schedule a complimentary consultation with us today to discuss how we can help take this stressful task off your plate.
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Christi Billquist is the Director of Operations at Unitas PPO Solutions. Christi began a career working in the insurance industry while completing her Bachelor's degree at Utah State University. Christi spent 15 years working for a national insurance company focusing on fraud investigations. In 2012, Christi decided to leave the corporate insurance world to join Unitas. Over the past 10 years, Christi has become a dental insurance industry expert and has been instrumental in Unitas's growth in providing PPO negotiation, optimization and credentialing services to thousands of dental practices across the country. Christi genuinely loves helping dental offices understand and increase their PPO revenue, and especially enjoys helping new business owners navigate the transition from associate to practice owner.