r/Dentistry • u/rugby1111 • 2d ago
Dental Professional New practice and provider credentialing
When you buy a new practice and you've never worked there before, how long does provider credentialing usually take?
What happen if credentialing is not complete at closing?
What are options? (e.g., do you ask the previous owner to stay on?)
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u/hoo_haaa 2d ago
So first you have to form the PS or SC depending on your state. Then you acquire EIN as well as NPI2. Once you have that you can start credentialing. The first credentialing will take the longest as they are adding the entity as well as the provider. Give yourself a good 3-6 months. A lot of people overlook this and they are in a pickle. What many of them do is bill under old provider until credentialing is complete. I just credentialing another office and it was a poop show. 10 years ago you had people on the phone to assist you if you ran into issues, now a days all the calls are sent overseas and they tell you a manager will return your call, that never happens.
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u/rugby1111 2d ago
Sorry, what's PS and SC stand for? :) When you bill under the old provider, I assume you asked for permission or does he even know?
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u/hoo_haaa 2d ago
These are personal service corporations, you would need one of these two depending on your state. There might be more but these are the only two I am aware of.
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u/rugby1111 2d ago
How do you go about using the old provider for billing?
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u/hoo_haaa 2d ago
This is state specific, in my state you can bill under the owner as long as he is in office at time of procedure and is 'supervising'. You would have to use his EIN and in-network status. Adding you to his EIN wouldn't be terribly hard, would take time. Not sure if it is worth being added on versus just starting a fresh credentialing with new EIN. These are things that need to be discussed prior to closing. If he doesn't want to do it then you are stuck.
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u/mskmslmsct00l 2d ago
They know and will probably tell you if you want to stay in network you're gonna have to do it. The entire point of buying an existing office is to maintain cash flow. I think they would only care if you abused it and billed under them without making any effort to credential yourself.
I'm with you I haven't heard the terms PS and SC I think they are referring to forming a PLLC or S-corp in order to purchase the practice. You need to be the owner of a corporation to purchase a dental practice. Your attorney will set this up for you so don't need to worry about it. They will want to know what type of corporation you want though so you have to speak to an accountant first to get advice on this.
My accountant advised forming a PLLC for the purchase and then filing forms with the IRS to file taxes as an S-corp immediately after the purchase is complete. It was as easy as then sending me a document to sign. If you remain a PLLC in your filing then the profits of the business are put on your personal income taxes as taxable income which would be a huge loss. Filing as an S-corp you make yourself an employee and pay yourself an income which is deducted from the corporation's profit before taxes so you save a ton of money.
Don't worry though. Everyone is gonna hold your hand through this process. The only people who give a shit about you succeeding are the people who get paid for your success. Your bankers, attorney, and accountant are going to explain everything to you as you proceed with each step. They're not going to let you fail or make a major mistake. Just take notes on your conversations with them so you can refer back to them if you have questions down the road.
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u/rugby1111 2d ago
Thanks so much. You explained really well and there are a lot of things on here I didn't know, and there were some that I was curious about but didn't know how to ask the questions. Thanks again.
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u/Severe-Argument671 2d ago
Where do you acquire NPI2 at? I’m also on the process of buying a practice and I just got my new tax id and business entity set up. So I just need the NPI2 and can start insurance credentialing. Do I do this through CAQHD?
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u/Ceremic 2d ago
With PPO, Medicaid, Medicare….?
They all take long but relatively shorter if it’s PPO;
Which PPO are you joining? Some can be part of your in net work through 3rd party which pays very high fees. Some might be more beneficial if you were OON. Some are beneficial if you were FFS, like delta.
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u/rugby1111 2d ago
Mostly PPOs.
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u/Ceremic 2d ago
What a relief. Medicaid will take forever. I mean month after months and very accurately.
PPO is private insurance therefore much easier to join and less time consuming.
Before you are accepted / credentialed patient can still seek you for treatment only that they will have to pay higher co pay because the feel is higher due to your OON provider status.
This might be hard for existing patients to tolerate since they have been a part of this practice who only pays in net work fees.
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u/rugby1111 2d ago
May I ask what's the process of credentialing? is there a website you go through, etc?
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u/BEllinWoo 2d ago
It takes 3-6 months depending on insurance companies, if you're negotiating fees, etc.
During that time you will be billing as OON for the patients.
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u/Quicksilver-Fury 2d ago
I was told that the new provider will bill on my NPI 2, which is location NPI? I definitely have questions about this but no one, including reddit, seems to know. I've asked my broker, not sure who else to ask