A dental practice needs to handle patients with priority and care. A satisfied patient leads to a repeat visit and a source for potential patients. A practice, however, also needs to prioritize the billing and collection process to stay financially viable and profitable.
The submission of dental claims for reimbursement by the insurance company is vital for boosting collection rates and cash flows. Many dental practices face rejection in claims by insurance companies due to incomplete or wrong information entered on the forms. It is important to note that minor typographical errors or omissions can lead to a dental claim being denied. Dental insurance verification is critical and a few mistakes to avoid are as below.
A dental practice needs to select between a dental or medical claim form. This is based on the type of treatment rendered to the patient. Based on the treatment and services recommended by the practice, one might need to file a medical insurance claim or a dental claim.
Medical claims may arise when a practice needs to undertake any oral surgery, trauma-related tasks such as broken teeth, or pathology jobs. In such cases, medical insurance would be filed as the primary claim while the dental claim would be considered as secondary.
The dental staff can confirm any doubts and resolve all clarifications by contacting the respective dental and medical insurance companies. In these cases, an understanding of the Coordination of Benefits would be very helpful.
Many patients can be covered by multiple insurance policies and the practice needs to decide which policy will be determined as a primary policy and which policy will be considered as secondary.
Here is where an understanding of the Coordination of Benefits (COB) can be of great help to a dental practice. There are multiple rules and various conditions that can determine the order by which a practice needs to file insurance claims.
These rules are dynamic and evolving and keeping up with these changes can be a challenge. Hence, incorrect filing can lead to a claim denial thereby creating a delay in the dues that are owed to the practice. Keeping the dental team updated and COB rules can help in filing the primary or secondary claims accurately.
The filing of any dental claim needs to be accompanied by relevant attachments or supporting documentation. These are required at the time of submission as they offer proof and the necessary evidence for all the treatment and services that were rendered to the patient.
The attachments or supporting documents that are generally needed by an insurance company can include clinical notes, narratives, photographs, x-rays / radiographs,
periodontal charting, etc. Letters from specialists, pathology reports, and even historical data of treatment borne by the patient may be needed.
The above is evidence and proof that the solutions and services offered to patients were needed by them at the practice. This enabled the insurance company to compensate the practice for all services rendered to the patient.
The dental team also needs to attach relevant attachments required for different procedures along with their respective procedure codes (CDT).
An ideal practice for a dental practice is to submit all dental insurance claims within 24 to 48 hours of service rendered. This will help to input information that is fresh in the mind, but more importantly, a faster submission of claims can help the practice enjoy the benefit of faster turnaround times on claims that are submitted. This habit of quick claim submission also enables the practice to get quicker cash flows.
Insurance companies can take weeks to approve and reimburse an insurance claim submitted by a dental practice. To cut this possible lengthy timeframe, the practice needs to submit claims with a bit of urgency. Handling a quick turnaround with precision needs expertise and the dental team needs to focus on this requirement to improve speed and eliminate errors.
In addition to the prompt submission, the dental team needs to take utmost care not to commit any careless mistakes or inadvertent errors. The task of dental claim submissions calls for a large quantum of data entry points.
There will also be pressure on time and turnaround. As a result, errors can inadvertently creep into the claim thereby leading to unwanted human errors. The errors can range from personal information being entered incorrectly as well as errors such as incorrect details of the insurance policy being captured.
The dental team needs to juggle between deadlines and the time taken to complete submissions. One must also cross-check all patient and claim data being captured for complete accuracy.
Assigning the task of handling claims to a team member along with other tasks can create a rush job due to time pressures. This can lead to mistakes. The practice can assign a dedicated billing executive to handle insurance billing and insurance claims. This can create in-house expertise and focus when it comes to claim submission and reduce possible errors.
The process of claim submission is intense and time-consuming. The dental team can be pressed for time, and this could lead to errors. This leads to a longer turnaround for the practice to receive reimbursements. The practice can also consider hiring a specialist company like Capline Dental Services to offer the necessary support and expertise to collect claims. They are trained and experienced experts who can avoid unwanted errors and help boost cash flow.
Coordination of Benefits comes into play when a patient gets covered by multiple insurance plans to cover the treatment cost. A practice can prevent issues arising out of the Coordination of Benefits by confirming primary and secondary insurer information every time a patient visits the practice.
The dental team needs to be familiar with payment plans and the insurance company rules so that all claims are submitted to the primary payer first. A copy of the first payer’s EOB or Explanation of Benefits will be required by the secondary payer for processing and settling the claim as the EOB offers the payer complete and precise details.
Insurance plans have limitations and exclusions. There are maximum limits for coverage and eligibility verification is key before any service is rendered to the patient. These coverage limits will determine how much the insurance company will cover for services in a year.
There can also be frequency limitations, and it is possible a patient can get coverage for a particular treatment a few times a year. Such constraints need to be checked by the team and the patient informed. Costly procedures must be preceded by a predetermination request sent by the dental team to the insurer company as this will determine the coverage amount and the balance amount that the patient needs to pay.
The claims submission process is laborious and involves many cumbersome steps. A few simple errors by the dental team can lead to a claim denial and this can cause a disruption to the cash flow. The practice can assign a dedicated member from the team to focus on billing and claim submission as dental verification is a vital cog for a practice to stay financially healthy.
