Every dental practice must maintain a regular revenue flow to stay sustainable and profitable. An important element in this process is dental insurance verification. The dental team needs to focus on a patient's insurance eligibility to facilitate smooth billing and reimbursement by insurance companies.
Insurance eligibility for every patient needs to be verified and confirmed before rendering any treatment or service. This will help reduce or avoid claim rejections or other delays.
If a dental practice faces several denied claims, there is an imminent threat of putting the revenue pipeline at risk. When a crunch in cash flows becomes imminent, the dental team must understand why claims are being denied so that necessary action can be taken to get reimbursements and ensure that revenue flows are as per expectations.
As generally observed, nearly all dental practices consider dental insurance verification as a cumbersome process, and despite creating clean claims, the practice is still faced with claim denials and appeals. Insurance claim submissions are a repetitive task. If faced with a denial, there needs to be a resubmission and follow-up with insurance companies will the practice receives the payment.
Such tasks consume time, and this means time taken away from patient care. For a practice that is in-network, a large volume of revenue is dependent on efficient eligibility verification. Hence, the team needs to comprehend why dental claims are getting rejected. One needs to understand how expert handling of the eligibility process can help in curtailing errors and reducing claim denials.
There are multiple reasons why dental insurance claims can get rejected. Data entry errors, such as entering the wrong birthdate of a patient, can adversely impact acceptance by the insurance company. Lack of frequent audits or inefficient billing processes can also lead to claim denials.
A few points to consider that can spike the acceptance of dental claims are as below.
The dental team needs to do a thorough analysis of insurance claim data that includes tracking denials by type, volume, insurance organization, and frequency. The team can gather relevant details such as claims denial percentage on initial submission, the amount of time between the dates of denials and subsequent appeals. It is also vital to check the percentage of reworked claims sent by the team that got paid versus those that had to be written off.
Such an analysis can offer the practice a few insights into recognizing the source of errors that lead to denials. The causes could be human, process-related, data entry, technology, etc. It is observed that claim denials can be due to revisions in the policies of the insurance company.
Regular monitoring and audits can recognise the source of these errors, and remedial measures can be implemented to prevent claim denials in the future. AI applications and big data analysis will make a strong impact in the future. The dental team must also be prepared on how it can harness technology to streamline and enhance the billing and claim submission process. This would help lower claim denials and boost cash flows.
Once the source errors and discrepancies have been identified and evaluated, the team needs to have robust denial management plans in place. The team must maintain a record of denied claims to identify reasons and common issues. Processes need to be followed to handle each type of claim denial.
A structured process workflow to manage each kind of denial is critical. This helps to handle claim denials efficiently. For example, coding-based errors can be sent to the billing and coding team for assessment and action.
The team needs to keep a note of the timelines involved in resolving issues and resubmitting claims. Insurance companies have different windows for submissions of claims and appeals. Based on the rules of the insurance company, the reason for accepting the claim may have to be given in writing.
A precise documentation of treatment rendered, relevant documentation, etc, can be submitted again to support any resubmitted claim.
As simple as it sounds, incorrect data filled in claim forms can be a cause of worry.
Many practices have received claim denials due to incorrect data being filled in application forms. The team must note that even a slight error can lead to claim rejection by the insurance company.
A few careless errors include a spelling error in the name or a wrong insurance policy number. While an input error can be a cause, the team must also make sure that the policy details and terms have not been revised or changed. Besides careless errors, such as a name or policy number, policy details also need to be frequently verified.
The team must craft a structured process for filing appeals for denied claims. There are possible options that are available to the team.
The submission of a claim on time is critical, and all possible causes for a delay must be addressed by the practice. The team also needs to create a follow-up process for overdue payments and pending claims. If the team is proactive and keen on avoiding denials, then the possibilities of sending accurate claims to insurance companies are very high.
The dental team must confirm the insurance policy details of a patient before a visit to the clinic. All details, including demographic information and insurance details, must be
confirmed by the team. The team can ask patients about revisions and updates in the policy, or any other relevant details related to the policy, in every visit.
The practice must have periodic audits as a vital denial prevention strategy. These audits can identify and curtail errors in billing and coding, or other possible errors, before they are sent to the insurance company. Other regular errors can also be detected and rectified during these periodic audits. The practice can seek the services of a specialist third-party billing agency to provide an objective review of the billing process and suggest suitable recommendations.
The team must stay updated on the billing and claim submission guidelines of different insurance companies. This will help to avoid errors and prevent claim denials. The team must also be aware of the process for appealing any claim denial.
The team must be aware of the insurance company’s contracts and the patient's coverage plan. Meeting representatives from the insurance company often will boost the quality of the relationship and help address any issues easily.
Inaccurate or incomplete dental insurance verification can not only affect the quality of services that the practice provides to patients, but it can also affect cash flows. The practice can consider outsourcing the task of billing and claims to a third-party specialist. Verification of dental insurance eligibility ahead of time is important and saves a lot of stress for the patient and the practice while also ensuring smoother cash flows. A few steps taken by the dental team can ensure a more efficient billing and claims submission process with minimum claim denials.
