According to the American Dental Association, 65% of Americans enjoy the dental benefits with any dental insurance irrespective of the challenges associated with dentistry billing. The room for improved billing procedures to maximize dental claim reimbursement is essential for the cash flow, RCM, and practice collections.
The quality of dental billing procedures, clean submissions, and how to deal with appeals will decide the trajectory. The journey of RCM begins when the patient schedules an appointment and ends when the patient pays for the rendered services. Each step is key, and missing any detail can result in a negative downfall. However, eliminating the hurdles and implementing the five ways shared by Capline streamline the dental billing process and collect quicker payments.
It seems the claim submission is a back-end process. The clean submission starts with gathering the complete details before the patient visits the clinic. Implementing a pre-appointment system guarantees accurate details, timely insurance verification, and an updated management system before the patient's arrival. This approach reserves valuable time and resources, leading to clean submissions and higher collections.
Recurrent errors, incorrect patient names, whether the patient has medical or dental insurance, and listing insurer location are the main reasons for claim denials and payment delays. According to the ADA, one-third of the adult population lacks coverage, which is emptying their pockets. The initiative can identify the prevalent causes of denials in the practice and refine the plan to tackle the problem from scratch. This commitment enhances the success rate.
The practice can confidently serve the patients when they have accurate insurance information. Accurate information maintains a consistent RCM and prevents potential interruptions. In the dental industry, the ethical rule is to always code for the services provided. Unbundling and overbundling are costly.
However, this can sometimes be challenging, as one must keep up with the coding changes, additions, and deletions updated annually by ADA and even mid-year. That adds up to 160 changes over the years. The latest coding resources are helpful for clean submissions. Without them, dental practices face payment delays, claims denials, and lost revenue due to incorrect or lower reimbursements.
Additionally, inadequate coding increases the chances of insurance audits. Correct coding leads to higher revenue. The practices also obtain reimbursements for outstanding claims because of misunderstandings or misreported codes. Investing in comprehensive coding references and current materials in a year optimizes treatment planning and quicker reimbursements. Consider partnering with a reputable billing company like Capline to achieve higher revenue. Regular training updates for the team benefit them in understanding the latest standards.
Thus far, we have seen how crucial proper coding, accurate patient and insurance details, and appropriate providers are, but they are not the only necessary elements for error-free submissions. Detailed clinical notes and accurate documentation recorded during the patient visit are imperative for quicker reimbursement rates and maximizing revenue.
Utilizing clinical note templates at the time of service is one strategy to ensure claims remain impeccable. There is another way the American Dental Association endorses the SOAP format for documenting dental records to guarantee that clinical notes provide comprehensive details about the patient's diagnoses, dental needs, and treatment plans.
This tool reduces the risk of omitting essential details and creates a customized note in the patient's chart. For the insurer to reimburse quickly, the practice can attach supporting documentation that explains the treatment but does not create confusion.
Incorrect coding and wrong information are the common causes of claim rejections or denials. Every detail has to go through stringent checks to have clean claims. When the practice submits the claim to the insurer by fax or electronically, this approach allows for more timely billing of the patient for any outstanding balances. Daily submissions optimize revenue, likely the first thing in the morning, getting all the details right. Daily submissions increase the chances of clean submissions and help keep patients with the practice for future needs.
For secondary claims, attach a copy of the primary EOB that reflects the amount paid by the primary payer, ensuring proper coordination of benefits. Collect the date of birth for the patient and the subscriber, especially when a child is under a parent policy or addressing dual insurance. Most payers stick to the DOB rule to determine the primary and secondary within the plan.
A dental coding expert quotes that one-third of denied claims never go through the appeal process. It shows a gap between how to file and a lack of understanding. The big issue is whether the dental biller can predict when to file an appeal. Rejected claims require correction and resubmission after the review for reimbursement. Disallowed procedures are not billable claims. That is disappointing for patients who have an unexpected balance due. However, some claims are worth appealing.
There are specific reasons mentioned on the EOB for denied claims. If missing data or filing errors are the reason for denials, the practice must appeal. The denied claims follow a pattern such as consistently missing information, frequent misuse of exact CDT codes, inadequate documentation, or missing signatures. Correcting these fixes the leaks in the RCM.
Insurers deny numerous claims, considering them unnecessary despite their value to patients. Here are some mentioned below:
In conclusion, the practice can significantly boost claim reimbursements and profits by outsourcing to Capline Dental Services. Dental insurance billing is a complex and time-consuming task that requires expertise.
