The Surprising Side Effect of a TIN Change: Lower Fee Schedules

Did you know that when your practice undergoes a tax identification number (TIN) change, some insurance companies will offer you a lower fee schedule? Paying close attention during your transition is essential, whether you’re purchasing a new practice and wanting to stick to the last owner’s fee schedule or opening a new location and seeking the same fee schedule.

When Could You Undergo a TIN Change or Need to Update Your TIN?

Most PPO providers require dental practices to submit a new TIN form whenever they open a new office, transition an office to new ownership or during the sale or purchase of a practice.

What to Monitor During a TIN Change

If you are purchasing a practice, you should always start by checking the W9 for accuracy. Then, you should take a look at current fee schedules and UCR fees. Take your time when reviewing the schedule before you approve it, and pay close attention to how many disparities there are between fee schedules and which codes are being impacted the most.

Unfortunately, many insurance carriers offer lower fee schedules during the TIN change process. If you want to keep the same rates that you or the last owner had, you must negotiate or work with a third-party negotiation service to preserve the past rates. Some carriers choose not to work with third parties during the TIN change process, so you should be prepared to put your foot down. Always make educated decisions and remember that this is your first opportunity to ensure reasonable reimbursement rates.

Other Things to Consider During Transition

If you are purchasing a dental practice, there are several hiccups that can occur with billing during the transition process. You cannot bill under the TIN or contract of the previous owner, but some insurance providers allow for retroactive billing within a certain amount of time. Be clear with patients if there will be a period of time when you are out of network, so they understand they will be responsible for a greater amount than normal.

Partner with APEX Reimbursement Specialists

The experts at APEX Reimbursement Specialists can help you to explore the best options for your continued growth and sustained success. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.