Dental Insurance Tag Archive

By |

Hygiene Codes to Maximize Insurance Benefits

Picture this: your hygienist has a full day of patients. A couple of S/RPs, a couple of new patients, and some nice recalls. Ahh… it’s a beautiful thing.

But wait! What’s that I see here? She hasn’t been using the correct CDT codes for her procedures. Oh no! Poor coding is about more than just lost revenue; it can lead to benefit claims bouncing back and over- or under-treatment.

We should periodically sit down with our hygiene teams and discuss treatment philosophies, like when to refer to a periodontist or how often a full mouth probing should be done. A super important part of this conversation is which codes can be used and when.

Continue Reading

Read more »

file insurance claims

By |

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.

Read more »

By |

Changing dental insurance with a connected toothbrush

bluetooth-toothbrush
From Fortune:

…a dental insurance company, giving connected toothbrushes to policy holders makes all the sense in the world. Knowing that your policyholders brush their teeth on the regular means they are less likely to develop cavities and other issues associated with high claims. The insurer might even be able to promote more brushing or even flossing using incentives from the app associated with the connected toothbrush.

Source: Beam will change dental insurance one connected toothbrush at a time – Fortune

I have very mixed feelings about this. On the one hand I think it is a creative and exciting way to use advanced technology to improve dental health and ultimately to improve the human condition.

On the other hand I am not at all happy to have an insurance company monitoring my brushing and adjusting my benefits based on how often I brush my teeth with their bluetooth toothbrush. Way too creepy like the “Big Brother” dental plan is watching. 1984 was supposed to be a cautionary tale not an instruction manual.

Read more »

By |

Increase your bottom line: Analyze dental insurance reimbursements

analyzing dental insurance

Analyzing dental insurance reimbursements may increase your bottom line: Three tactics to consider

PPO insurance is often one of the largest problems in a dental practice. While operating costs are on the rise, dental insurance reimbursements have stayed stagnant. In order to keep your practice on a profitable track, you’ll need to analyze, from time to time, how much of your revenue is based on those reimbursements, and work with the insurance companies to raise them.
As you likely know, working with dental insurance companies can be tricky. Getting through the red tape, especially when you’re asking for more money, can mean a lot of time spent on the phone negotiating. Below are 3 tactics to consider:

1. Review each insurance company’s acceptance rates

Conducting an analysis of your entire practice’s insurance acceptance policies is critical to increasing your insurance reimbursements. Sometimes, you may actually increase reimbursements by dropping insurance providers. If you find that your staff is spending a lot of time negotiating with a specific company without success, ditch that provider and focus your time on attracting patients with plans more likely to pay.

2. Go armed with data and documentation

In order to successfully renegotiate reimbursement rates, it is imperative that you have a detailed analysis of your practice’s most common procedures. While you may have a general idea of your top billing procedures, this analysis will help you accurately determine which services you could and should discuss with the insurance companies. Before you contact the payor, you’ll want to review your current contracts with dental providers to identify the rates you now earn.

Once you’ve determined those rates and procedures, you can approach the insurance company armed with information. The call centers (typically where 1-800 numbers ring) are not the best place to conduct negotiations – these representatives often have little power to change the terms of your agreement. According to one dentist’s experience, the provider retention department is the best place to start, but you should move up the corporate ladder if negotiations aren’t going well.

When negotiating, make sure you use all of the resources available to you, including leverage. For example, if you are the only dentist in a small town that accepts a specific policy, the insurance company has an interest in keeping you in-network. Use this leverage in negotiating a higher reimbursement.

3. Hire professional negotiators if all else fails

Sometimes the insurance companies just aren’t willing to budge. If you find that providers are being particularly stubborn, it may be time to involve professional help. There are a number of companies that specialize in helping dentists and other medical professionals negotiate with insurance companies; their assistance can prove to be invaluable.

Good for you if you’ve recently negotiated increased reimbursements. Just make sure that you continue to evaluate increases on a yearly basis, if not more often. If you simply don’t have the time to do this periodically throughout the year, make it a priority to do so with each provider at the time your contract is up for renewal. You may be surprised by the extra income this can generate.

Receiving appropriate reimbursements is a great way to improve your bottom line without passing on the costs to your patients. The idea of approaching the insurance companies to ask for more money is intimidating, but being prepared can make the negotiations much more successful. If you have any questions, please contact Angie Walters at AWalters@GPPcpa.com or 214-635-2547. To learn more about Angie you can visit her bio or Google+ page.
Note: This content is accurate as of the date published above and is subject to change. Please seek professional advice before acting on any matter contained in this article.

Read more »

× Close