file insurance claims

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Obnoxiously Detailed Insurance Narratives

file insurance claims

Your Secret Weapon…Obnoxiously Detailed Narratives

You’ve experienced it before…the dreaded letter from a patient’s insurance company: We need more information, there is not enough evidence of need, please send us a diagnostic film (after you have initially sent one!). Several things are critical when submitting dental claims on behalf of your patient:

  • Most patients are unaware that employers set the boundaries and limitations on their employee’s dental benefit plan
  • Initially writing a good “obnoxiously detailed” narrative is imperative to resolving your patient’s claim early
  • Diagnostic films are two-dimensional and don’t necessarily tell the whole story. A detailed narrative and/or attaching a photo should always accompany the claim

This article will deal with the challenges dental practices face when attempting to gain dental benefit payment on behalf of their patients. Whether you accept assignment of payment or are completely “insurance free”, it is important to supply enough information for the patient to receive benefits on their claims.

First and foremost, fill out the claim form correctly. Just because you supplied the insurance company with a diagnostic film doesn’t guarantee they will acknowledge receiving the attachment unless you mark the box on the claim form that you supplied the film. The same thing applies for the diagnostic photo. The most recent ADA claim form has a place to check notifying the insurance company that this information has been sent. When a narrative is attached to the claim form, mark directly on the form that you included a detailed narrative. Draw attention to your claim by highlighting any pertinent information. Most often, when a claim has a narrative attached, it must be referred to a live person for review therefore reducing the risk of requesting more information.

There is a wonderful tool available to dental practices now that allows the financial coordinator to send supporting information electronically. An electronic claims attachment service can allow you to send your attachments electronically. Note, not all insurance companies are accepting electronic attachments. However, there are enough insurance companies that will accept electronic attachments which can help to de-stress your environment greatly. Just remember to make full use of the tools available to you and you will have greater success!

Below is a sample narrative which can be uniquely detailed to each patient’s dental condition warranting the need for treatment.

Narrative Sample for insurance claim

Date___________________________
Patient_________________________
Insurance Co.___________________
Group #________________________
ID#___________________________

Dear Dental Consultant:

A ______________________ has been prescribed for restoration of tooth #____ because:

_____1. The _______________________________cusp(s) has/have been destroyed by caries or fracture and require restoration.
_____2. The _______________________________cusp(s) has/have been undermined by caries and/or previous restorations.
_____3. The tooth has a symptomatic crack or fracture on the ________________________________surface(s).
_____4. The tooth has had endodontic treatment.
_____5. There is recurrent decay under the present ___________________.
_____6. Other: ________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Note: Prosthesis/or restoration is/is not an initial placement.

Date of prior placement ____________________________.

Extraction date ___________________________________.

A Bitewing ______ , or periapical(s) _______ x-ray(s) is /are enclosed.

Sincerely,

_________________________________________________

Attending Dentist

One stumbling block which dental practices face is creating a narrative claim form that is too generic. The insurance industry calls this “not patient specific”. So, a word of caution…always be sure to design your narrative form in a way which allows the patient’s unique condition to be conveyed on the form.

Make sure that the treatment rendered matches what is listed on the claim form. If a dental benefit plan has an “alternate benefit” clause on the contract, there can be an opportunity to ask for an alternate benefit. For example; a fixed bridge is recommended but, the dental benefit plan has a “missing tooth clause”, which means if the tooth was missing prior to the effective date of coverage then the fixed bridge would not be a covered benefit. An alternate benefit equal to individual crowns on the abutment teeth can be requested. Please remember, it is imperative to bill for the procedure(s) that were actually performed. Therefore, bill for a fixed bridge utilizing the fixed bridge codes and in the detailed narrative, request an alternate benefit for individual crowns on the abutment teeth. A benefit for the pontic will most likely not be available if the tooth was missing prior to the effective date of coverage regardless of the available benefit for individual crown. Never promise the patient that their insurance company will cover an alternate benefit. Let your patient know that you will give it your “best attempt”. Patients want to know you cared enough to try.

Always be prepared to involve your patient in the process. They are your “squeaky wheel” and can always go to their employer to have the decision on their claim reversed and considered for benefit. Have your patient use the information available to them to make them your best weapon in resolving claims issues.

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Message from my mentor

Message from my mentor

Message from my mentor:
One of the greatest influences in my professional experience was way back in the day, in the early 1990’s. At that time my 3 children were young, under the ages of 7, and my mental state was mostly a blur. My husband and I had purchased a dental practice in Raleigh/Durham, North Carolina which began the journey of discovery regarding dental practice management methods.

We were by no means novice to the ownership of dental practices but we were novice to its success. So I began to do what had worked for me in the past when faced with raising kids with little experience, I began to read. At the time there was no internet, no twitter, no blogs to follow, you had to learn the old fashion way – either go to a seminar or read a book. Seminars were expensive and quiet time to read a book very difficult to find.

So, the family vacations became dental seminars, which is where I was first introduced to Dr. Rick Kushner. His advice regarding methods, policies, procedures, and structure of the business relationship has been tremendous to the foundation of the success my husband and I have experienced. I feel so fortunate that I was exposed to his wealth of knowledge at such a critical time in my business development as a professional.

At last Dr. Kushner has written a new article which I am pleased to share with you, dated on September 9th, 2015, titled 3 Keys to Success in Life, Dentistry and Comfort Dental. Comfort Dental is a chain of dental offices that follow Dr. Rick Kushner’s setup guidelines and methodologies.

Please read the whole article, the value is in staying with the subject matter long enough to gain a valuable read. So much of his advice is about living and having a successful life. We all can use advice in that department.

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DICOM

Dicom

DICOM stands for Digital Image Communication in Medicine. It is an international standard for digital radiography that covers everything from hospital CAT Scans to dental periapicals. It is the DICOM standard that assures the reliable transfer of images from one system to another.

The DICOM standard also calls for the transfer of essential data along with the image. This includes the patient name, the date the image was acquired, the tooth number, the orientation and more. By arranging these critical data elements in a standard format they can now be transferred along with the image in a reliable manner.

To understand the concept, relate it to our old photographic system. A radiograph is just the image. Data elements in the form of the patient’s name, the date and tooth numbers are attached to the image by writing them on a mount or an envelope that holds the x-ray. As long as the mount and the image stay together we know about the film. However sometimes they are separated. Virtually every dental office has found an orphaned x-ray stuck behind the file cabinet at some time. With the data elements removed, in other words with the mount missing there is no way to ever determine whose x-ray it is and when it was taken. DICOM standards are the equivalent of permanently attaching the x-ray mount, and all the data it contains, to a digital image.

DICOM enhances interoperability. That is the ability of users to use different manufacturer systems with each other. The opposite of interoperability is proprietary.

Manufacturers like proprietary systems. Consumers prefer interoperability. Experience has shown that vendors will attempt to maintain control unless consumers demand interoperability.

Interoperability protects the dentist’s investment. If your brand leaves the market or another much better option comes along you can replace components as needed with other brands. The addition of DICOM to a digital radiography system does not make it more complex to the user. All the DICOM functions are invisible to the user; it does not require any additional steps to use. In fact the number of steps will be reduced when transferring or importing images as the user will not have to type in any patient data.

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From Dentist to Small-Business Owner: Tips and Options

grand-opening

You learn how to fill cavities and keep teeth clean and healthy in dentistry school. What you don’t learn is how to raise capital and manage business debt.

“That can make life after dentistry school challenging,” says Genaro Romo, who started his career in Chicago in the 1990s. He quickly realized that being a successful dentist meant being a successful small-business owner.

“We were trained to be dentists,” Romo tells NerdWallet. But “you need to know how to run a business.”

Choose your path: group practice or solo

After graduating from school, dentists essentially have three options. One is to join a practice as an associate and “work your way up,” Romo says. That’s what he did, and it was a successful strategy. He eventually struck out on his own, setting up his own practice; today, he has a 20-person office in Chicago.

There are two other major options:

  1. Build your practice from scratch. This can be exciting, but it’s expensive. A dentist launching a startup practice typically requests a loan in the range of $350,000 to $500,000, says Gavin Shea, a senior director of sales and marketing at Wells Fargo, where he’s worked with hundreds of dentists.

    Between 50% and 60% of the funds goes toward building out an office, which usually involves big investments related to specialized plumbing and electrical needs, he tells NerdWallet.The basic dentistry workspace is called an operatory. A fully equipped setup, which includes cabinetry, dental chair, lighting and digital X-ray equipment, can cost “anywhere from $25,000 to $50,000 for each operatory,” Shea says.

    The startup route can also be tricky; Romo notes the importance of having a clear business plan. Overspending based on a fuzzy growth strategy is a common mistake, he says, though he adds: “Make sure you have room for growth.”

    Some dentists are overly cautious with investment only to find that, as their business grows, “you have nowhere to go,” Romo says. “They maximize their space and they have to start over in a new location.”

    And just as with buying a home, location is key, Romo says. “You really need to do research,” he says. The key question: “Is there a need for a dentist in that location?”

  2. Buy an existing practice. Acquiring an existing practice, such as one owned by a dentist who’s about to retire, is a common route taken by new dentists. As with buying a house, it’s important to accurately appraise the value of the practice.It’s easy to make a mistake. For example, Romo says, “You could be buying an office that may not be as busy and the equipment is very outdated.”

    “Most independently owned dental practices will sell [for] between $500,000 and $750,000,” Shea says. A dentist requesting a loan usually also factors in “some short-term working capital to cover the first few months of ownership.”

Choose your financing: bank vs. alternative lender

While Wells Fargo declined to disclose interest rates related to dentistry practice financing, the financing it offers includes SBA-guaranteed loans, which typically carry low interest rates. An SBA loan is usually based on the current prime rate plus an additional markup rate, known as the spread, of 2.25% to 2.75%. At the current prime rate of 3.25%, a typical loan would charge 5.5% to 6% interest.

Bear in mind that the SBA has strict requirements and the application process can take months. But a traditional bank is not your only option; alternative lenders tout the speed of their application and approval processes, which may range from a few hours to a few days.

Some alternative lenders now also offer financing specifically for new dentists. However, interest rates are higher than those offered by banks. Check out the different small-business loans options on the NerdWallet Best Business Loans page.

At DealStruck, for example, a borrower could get a three- to four-year term loan to finance dental equipment at interest rates ranging from 12% to 18%, says Steve Freshour, the lender’s director of credit.

“These are fully amortizing term loans,” he says. “A standard 4% origination fee would be charged and netted from the loan proceeds.”

When making financial plans for a dental practice, “Everybody’s situation is different,” Romo says. But, he stresses, “You have to remember you’re investing in your practice.

“If you’re investing in technology, it builds stronger patient relationships,” he says. “It’s not a luxury. If everything works out, it’s probably paying for itself.”

Get help from the experts

Whether you start a brand-new dental practice or buy an existing business, Romo offers two key tips:

Find a financial advisor who specializes in dental practices

Some professionals specialize in giving dentists financing advice for starting or expanding a practice. “There are CPAs who specialize in dental offices,” Romo says. “There are dentists who also have accounting degrees” or other kinds of training that qualify them to offer guidance.

And the best way to find an advisor is through professional organizations of dentists. Which leads to tip No. 2:

Join professional associations

Romo urges new dentists to reach out to other dentists from the beginning. He did so by joining the Illinois Dental Society and the American Dental Association, and was so impressed with the ADA’s work that he became one of the organization’s spokespeople.

The ADA’s Center for Professional Success website offers information and tips for dentists, including a calculator for managing business debt. The California Dental Association has a practice support page with information and tips related to the business side of a dental practice.

Some dental associations also have relationships with banks. The ADA, for example, works with Wells Fargo, which has a practice finance page dedicated to serving the financing needs of dentists, optometrists, doctors and veterinarians. It offers information on key aspects of starting and growing a dental practice, including opening a new location and buying new equipment.

Source article: From Dentist to Small-Business Owner: Tips and Options 

 

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3 Ways to Help Keep Your Dental Office Staff Happy

happy-employees
Happy staff, happy life? Quite possibly. Although there’s no guarantee that a happy staff leads to a happy dentist, you can be sure that a happy staff strengthens your practice. When your staff is unhappy, that unhappiness manifests itself in the form of turnover, which is something you don’t want to see with any level of frequency.

Turnover is bad for your practice for a few reasons. First, it costs you money. You’ll have to recruit new staff and train them. You may even have to turn down appointments because you don’t have enough staff on hand.

Turnover also hurts morale in both your employees and your patients. Employees see the turnover and start to wonder whether they too should look for a new job with another practice. Patients see frequent turnover among your staff and wonder why their favorite hygienists or receptionists are no longer around.

You can limit turnover by making your office an enjoyable place to work.

3 Tips to Keep Your Staff Happy

  1. Give praise. Study after study has shown that employees – regardless of industry – view praise as the single most rewarding benefit they can receive. In a recent study, 83 percent of all surveyed employees said that individual praise was more rewarding than any form of bonus or gift.

    There are a few ways in which you can offer praise. You can do it in a standardized way that’s open to all employees. Popular forms of this kind of praise include an Employee of the Month award or contests that are tied directly to some performance metric.

    Another good way to praise is in one-on-one conversations. Performance reviews present a perfect opportunity to offer praise. You can also do it when it’s not expected. Pull a high-performing employee aside and let them know how they’re doing. Tell an improving employee that you notice and appreciate their efforts. These actions may seem small, but they pay big dividends.

  2. Help them with retirement. Your employees are worried about retirement. They’re concerned that they won’t have enough saved and that they’ll have to continue working long past their desired retirement date.

    You can show your appreciation for their efforts by helping them save for retirement. A 401k plan can be an effective way to do this. It gives your staff the opportunity to save money for their own retirement and it gives you a vehicle to contribute. If your office is small and you think a 401k may be too complex or expensive, you could talk to your financial advisor about alternatives like SEP IRAs.

    Many employees expect some kind of group benefit plan at their place of employment. If you don’t have one, you may have difficulty recruiting quality talent. Similarly, your employees that you do have may view their benefits as being inferior to those offered at other practices.

  3. Create a bonus plan. Your staff knows that you make significantly more money than them. They’re likely fine with that. After all, they also know that you bear all the risk of owning the practice.

    However, they also know that they contribute a great deal to your success. When your business is operating at full speed, they like to be recognized for their contributions – and not just in praise.

    A bonus plan can foster the feeling that you’re all working for the same team. It can create a direct link between your employees’ performance and their compensation. You can tie the bonuses to the practice’s overall performance or you can tie it to specific job functions.

    One note on bonuses, though. Whatever system you put in place, be sure to make the system easy-to-understand and transparent. If employees feel that bonuses aren’t fair, bitterness and resentment could develop.

It’s easy to get caught up in the day-to-day management of your practice. However, always remember that your staff is a crucial part of your practice’s success. Invest in their happiness and you’re likely to see the benefits.

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