Three Steps For Efficient Insurance Systems

You have a healthy number of patients coming through the door, but it seems as though the collections are not keeping up with production. The insurance companies are delaying payments on everything from crowns to fillings, which makes collecting on claims more difficult than ever. What is the secret to faster claim processing? The secret is having successful insurance systems in place that will keep your collections at a steady flow. If you follow these three steps, you can decrease the processing time of most claims.

1. Send the Claim Correctly the First Time

Don’t laugh! It happens all the time–offices send off the claim with fingers crossed, but fail to attach X-rays or other information until requested. Who is that really hurting? Dentrix eClaims warns you if an insurance company requires additional information for specific procedures. Heeding these warnings will prevent unnecessary delays and help your claims to be processed faster. Here are some other important tips to follow when submitting claims:

• Verify that you are sending the claim to the right place. (The patient telling you where to send the claim is not verification.) Whether you visit the insurance company’s website, use a verification service, or pick up the phone and call, make sure that you are sending the claim to the right place.


• As a rule of thumb, send X-rays on all crowns, implants, root canals (pre and post), and scaling and root planing (SRP).


• SRP will also require a perio chart.


• Narratives need to accompany major treatment—this information should be in the clinical notes for ease of accessibility. When putting the narrative on a claim, remember that only 80 character spaces will generally be submitted electronically in the Remarks for Unusual Services box even though the Dentrix Ledger allows up to 4,000 characters in this note field. Keep a list of brief, handy narratives that your doctor uses frequently. You can easily accomplish this using the Ledger’s Remarks for Unusual Services feature.


• For all crowns, document if it is an initial or replacement crown; there is a box on the claim form for this information. If it is a replacement crown, what is the date of the initial placement? This is the tricky part. You are not allowed to guess or make up a date. If the initial crown was not completed in your office, you need to ask the patient how long ago the crown restoration was done. By explaining to the patient that their insurance will not pay on the crown unless you give a date of the initial crown, the patient will be more likely to work with you. You may need to jog the patient’s memory by asking questions. (Were you married? How old were your children? Where were you employed at the time?) Ideally, this information should be included in the clinical notes, so make it part of the clinical notes template


• Some insurance companies will only pay on a crown once the permanent crown is seated. Keep track of that so you can submit that information as soon as it occurs. We recommend that you document it on the crown seat appointment. You may want to send the claim in when you place the temporary crown and note the date of the permanent crown seat appointment on the claim; many times they will accept the seat date over the phone later and will then send the claim for final processing.

2. Track Outstanding Claims on a Weekly Basis

We often see Insurance Aging Reports that have several pages—the most we’ve seen is 58, but we’ve heard of reports with hundreds of pages. You need to run and review your Insurance Aging Report on a regular basis, usually weekly. The longer the report, the more overwhelming it is to get a handle on it. To run the Insurance Aging Report, in the Office Manager, from the Reports menu, point to Ledger, and then click Insurance Aging Report. The Insurance Claim Aging Report dialog box appears (Figure 1). Specify what you want included in the report, and then click OK. After you’ve run the report, use the information to follow up with your insurance carriers.

Clearinghouses will usually send a status report following the submission of claims. These reports have valuable information on them, so take a minute to look them over each day. Words like “unprocessed,” “holding,” “zero pay,” or “rejected” should get your attention. You can do the research and find out why the claim is not being processed to your satisfaction. If you simply wait until the explanation of benefits (EOB) comes in the mail, you are typically 30 days into the life of the claim. The insurance websites are also a great source of information for tracking outstanding claims. Sites such as MetLife give you full details. Others may not provide as much detail, but they still have valuable information you can use to get your claims back on track.

Lastly, appeal, appeal, APPEAL! If a procedure is denied that you feel should be paid, send it back for reprocessing; this includes crown buildups that are part of the crown prep procedure. Using a more detailed narrative, explain why you are appealing it. Your doctor or hygienist can help with these details. Statistics show that 85 percent of all denied procedures are not appealed. Of the 15 percent that are appealed, 75 percent are reprocessed with a payment. The odds are in your favor.

3. Consider Using Direct Deposit

Most insurance companies will allow you to sign up for electronic transfer of funds to the practice’s bank account. This speeds up your deposit and prevents checks from being lost in the mail. You are notified by email or fax (your choice) as to which claims have been processed. The best part is the speed of payment. Hygiene claims can be processed in two days, and treatment claims, including crowns, will sometimes have the money in the bank within a week. Dealing with insurance companies may be a challenge, but if you learn how to work with them, you can collect claims faster and with fewer headaches. Don’t let your money linger on their side of the fence any longer than it needs to. Have good, consistent insurance systems in place, and your collections will keep up with your production.

LEARN MORE
To learn more about insurance claims, see the “Processing dental insurance claims overview” topic in the Dentrix Help. See “How to Learn More” on page 2 for instructions on accessing these resources.

*Originally published in Dentistry IQ. Used with permission.

Denise Ciardello is a respected professional in the dental consulting industry and a co-founder of Global Team Solutions, a practice management consulting firm specializing in team building and team training. She can be reached at denise@TagTeamGurus.com or (210) 862-9445.

Author: Denise Ciardello, Certified Dentrix Trainer
Published: 07/31/2014