Imagine a world where insurance companies paid your office quickly, your net production and payment ratios were one to one, and your patients delivered raving reviews about your claims assistance.
Follow a proven system and that scenario can be your reality.
Your likely current reality with insurance filing and reimbursement.
It’s not news to you, perhaps, that insurance companies are generally slow and seemingly unwilling to pay on claims. It’s also common to wonder why with a full schedule collections are lagging behind net production. All this (and more) begs the question: is it possible to achieve fewer denials, fewer requests for more information, and faster claims processing? The answer is a solid YES!
A new reality relies on well conceived simple and powerful systems. Here’s what has worked in my group practice for many years.
- Build a strong team. Without the right people on the bus any system will fail no matter how well conceived the system is. This is one of the greatest challenges for dentists, particularly a dentist new to practice. Typically it takes years to develop a team that has a preponderance of intelligent, self-starting, creative, empathetic, etc., etc., team members. Unfortunately, developing a strong culture is also often a relatively slow work in progress. Generally speaking, to increase the chances of building a great team as quickly as possible I subscribe to several hiring guidelines: Hire people who “Want it,” who “Have the Capacity,” and “Who Get It.” Couple it with the “Hiring Slow” and “Firing Fast” (this is particularly hard for many dentists), and you are on the way. Now let’s turn to some practical tips to assist your incredible team in the world of dental insurance. We are on Dentrix G7 if you are trying to understand some of the reports that I mention.
- Before filing – Accuracy and Completeness are Essential.
- Hiring a detail oriented smart person who can do the same procedure over and over again without going crazy is ideal. A larger practice may have someone solely dedicated to handling insurance matters.
- Be careful to double check any insurance information provided by patients to ensure accuracy in the patients’ records. Garbage in – garbage out.
- Cross check every necessary aspect of the insurance plan, using whatever the insurance company can provide online. You do NOT want to end up sending to the incorrect coverage entity is the beginning of a very bad experience for the practice (aged out receivables) and the patient.
- Verify insurance the day before ALL appointments. It is astounding to me to find that some offices do not verify insurance at all! Even though the cost of treatment is ultimately the responsibility of the patient, discussing a shortfall (or outright lack) in expected coverage and corresponding increased out of pocket is not the discussion that builds great rapport or a great reputation. Even with day before or same day verification you can still get burned with “retro-termination” of coverage, where the employee’s company has cancelled insurance coverage but failed to inform the insurance carrier.
- More information is better. Most offices have a good take on the procedures that the insurance company will need additional information for. Use that knowledge to create protocols that will work for most any insurance claim regardless of the carrier. It is dangerous, time consuming, and ineffective to play the guessing game of what you think will be needed. Attaching more information than you might think is needed – X-rays, perio charting, photos, etc., is much more efficient and effective. Concise clinical notes are of great value when a narrative is asked for. We put stickers on our Routers for crowns, endo, implants, etc., that remind the DA’s and hygienists to acquire needed additional information – and annotate on the sticker that the information has actually been acquired. It is too late when an insurance asks for an
- Filing – Don’t Let the claims gather dust.
Too many practices are understaffed or have incompetent team members 9 (or both), leading to an up and down teeter totter flow of claims out and money in. Claims stagnate until someone notices (usually the doctor) that cash reserves are getting low and the team frantically trys to catch up while some other aspect of the practice drops off. I can’t stress enough the need to submit claims same day or next day – at the latest. Most claims are electronic so claim submission is a lot easier these days.
- After filing – Great follow up is imperative.
- The Unsubmitted Insurance Report. A few years ago our claims reimbursement seemed to slow down for no apparent reason. After quite a bit of research we discovered that when procedures are posted to Dentrix those procedures need to be manually submitted to the electronic claims batch. If the admin person does not submit the procedures then a claim cannot be generated. To make sure such “stuck” treatment procedures make it to the claims module we now run the Unsubmitted Insurance Report EVERY DAY.
- The very important Insurance Accounts Receivable report. With lower reimbursement levels and delays in payment, it is very important to have someone review and take action on insurance claims that are aged out 30, 60, or 90 days. We fortunately have a very competent person refreshing the report every week.
- Appeals process. Take advantage of your appeal option. Denied claims can be reprocessed. And be specific in all related communications. 85% of denied procedures are not appealed and of the 15% that are, 75% are reprocessed with payment.
To summarize, your practice can master insurance claim submissions and reimbursement if you have a well integrated competent team on both the clinical and administrative sides of the business. If you can assign the major aspects of the process to a single competent person who runs a well conceived system the chances of success are even higher. Your dental practice can experience a good relationship with your insurance provider network.
I sincerely hope this article provides some value to your practice.
Dr. Pat Cassidy DMD, MPH
CEO, Net32, Inc.,
President, Research Triangle Dental
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Last modified: August 23, 2019