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.
1. Have a Contract
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.
2. Associate versus Independent Contractor
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.
- use the equipment and supplies of the practice
- treat existing patients
- have their schedules managed by the office staff
- have the practice submit claims and process payment
- receive benefits from the owner doctor
- receive a W2
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.
3. PPO Claims
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.
4. Getting the Associate Contracted/In-network
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.
5. Associate PPO Reimbursements
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.
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Current Unitas client? Reach out to your Practice Representative today to find out how we can help you with adding a new Associate to your practice.