How you are reimbursed now for your services has drastically changed from how it used to be five years back. Reimbursement for claims is ever changing. To keep pace with the changing dynamics, dental providers need to keep working on their revenue cycle management and keep improving.
The percentage of claims over 120 days tells you that you have a lot of your money still hanging in limbo in the form of uncollected claims. Proper monitoring and management of each step of pre-billing services can help lower down the turn around time of claim reimbursement and also claim denials to a large extent.
In this article, we discuss a few points which will help you improve revenue cycle management to get faster reimbursements.
Thorough Dental Insurance Verification of a patient’s eligibility is one of the most important steps in ensuring clean claims. However, this step is highly prone to errors too. Each insurance policy has its own specific standards and protocols when it comes to the approval of claims for rendered treatments. The dental staff has to check the patient’s age, insurance validity & dependency, active benefits, medical history, correct information, less expensive treatment options, etc. when scheduling any treatment plan. Each of these information, if not verified prior to the treatment, can lead to high insurance reimbursement turnaround time and even claim denials. Therefore, in-depth knowledge of every patient’s policy becomes of utmost importance for the person handling all this information. Additionally, one has to stay up-to-date with every change & update in the policy and cross-check in case of any uncertainty.
Insurance companies have bifurcated dental treatments in three categories: preventive, basic, and major. Annual and Semi-annual dental appointments come under the preventive category. Procedures like gum disease, extractions, fillings, and root canals come under the basic category. Similarly, procedures like crowns, bridges, dentures, and inlays are encapsulated under the major category. While most of the insurance policies pay 100% for the procedures categorized under preventive categories, only 80% is paid for the basic category, and 50% is paid for the major category procedures. However, the percentage of coverage differs with every significant policy. The remaining percentage of the procedure fee (coinsurance) has to be paid by the patient. However, in many cases, patients are not aware of the cost bifurcation and coinsurance terms of the policies when applying for dental claims. Such scenarios create disputes and disagreements, which can further hinder revenue generation and the claim submission process. Therefore, it becomes necessary to aware the patients about the details of the insurance policy before going forward with the treatment. It is also a good idea to charge the patient right after treatment completion to avoid any requirement of further follow-up.
The primary goal of the whole billing process is to process clean claims. Submitting clean claims ensures a lesser turnaround time of the dental claim reimbursement. Any mistake or error in the claims can drastically impact the revenue collection.
The first step of clean claim submission is accurate coding for treatments. One has to ensure the precise code for the given treatment as codes can differ even in case of minor anomalies.
The second step is forming a proper narrative of the provided treatment, along with the self explanatory reason for the required treatment. Additionally, ensuring the presence of every required and supported documents along with x-rays has to be taken care of when submitting the claim.
The third step is submitting the claims on time. Delay in the claim submission is one of the major reasons for claim denials. On-time claim submissions can be achieved by submitting the claim right after the completion of treatment. However, one should not be hasty for the same, as precipitous dental claim handling can also contribute to claim rejections.
Claim denials can’t be avoided fully even after taking every possible precaution while submitting the claims. However, claim denials do not necessarily mean revenue loss. Reimbursements on the denied claims are possible, given that the reasons behind the same are not irrevocable. Filing an appeal, fulfilling all the requirements along with constant follow-ups on the claims can lead to claim approval.
Another option that can lead to claim approvals is PDA. PDA can conduct an evaluation procedure with the help of member dentists (peer review). If the conclusion of the evaluation is in favor of the dental practitioner, it can persuade the insurance company to approve the claim.
Following these steps can ensure claim approval within the expected time. Handling such a tedious process meticulously requires a profound knowledge of various insurance policies along with an ample amount of time. However, managing the complete revenue cycle by themselves can be overwhelming for dental practitioners and can hamper the treatment quality.
What could be done to make the complete procedure more manageable?
The first option could be hiring some dedicated employees to handle all the dental office’s finances. However, this decision could be cost burdening. Furthermore, any mistake in document handling will ultimately be the responsibility of the dental practitioner.
Another prominent option could be outsourcing dental billing services. Dental billing support companies have a prolific team for each of RCM tasks such as patient verification, insurance handling, claims coding and submissions, denial management, and follow-ups. Delegating your finance handling tasks to reliable and experienced dental billing support companies can save a great deal of time and effort, along with making the dental office’s functioning smooth and efficient.
Even trivial mistakes in dental claims can lead to their denials and thus causing decreased collections and high accounts receivables. Therefore, the attainment of “clean claims” requires prolific knowledge of the complete procedure and a meticulous approach towards it.
By understanding and thus avoiding the below mentioned reasons can decrease or even eliminate the dental insurance claim denial ratio.
1) Insufficient Knowledge of the Process:
According to a recent study, almost 50 percent of the dental claims get rejected due to insufficient documentation or failure in following the updated protocols related to dental billing and RCM.
Each insurance plan requires a set of specific documents, along with a thorough description of the provided treatment. Additionally, the dental insurance rules standardized by the government undergo several periodic updates and changes.
Furthermore, codes of insurance claims differ for each treatment. Even a minor difference in treatment requires different code to file its insurance claims. Therefore, coding of the diagnosis demands high accuracy and precision. Additionally, many dental procedures require pre-authorization. Similarly, insurance payers require a proper narrative of the provided treatment, which includes:
Absence in any such documents leads to claim rejections.
Thus, to avoid any denials and file clean claims, the person should hold adequate knowledge of the complete revenue management cycle of the dental industry.
2) Failure in Insurance Verification:
Insurance verification of the patients prior their scheduled visit to the dental office. Appointment or treatment plays a major role in eliminating any scope of claim rejections. Patient’s insurance verification provides the knowledge of the patients’ background, such as their eligibility, insurance coverage, and active benefits, which eventually affects the planning of their treatment. The procedure re-surfaces various factors such as outdated, terminated or modified insurance policies, incorrect information of the patients, etc. that can further lead to dental claim denial. This procedure also provides a concise information of the complete procedure to the patients, cost bifurcation, and the surplus cost that has to be incurred by them. For dental practitioners, insurance verification ensures successful insurance billing, clean claim submission, and low turnaround time for claim reimbursement.
The procedure requires thorough verification of the patient’s background and insurance policy, as even a small information gap can drastically increase the chances of claim denial.
3) Precipitous Claims:
Insurance claims, when not submitted on deadlines, can lead to permanent revenue loss. However, claim submission done hastily in order to meet the deadline is amongst the major causes of claim denials. Errors such as missing X-rays, incorrect date of service, coding errors, and other supporting documents become unavoidable in claims when they are filed in a precipitous manner.
In order to avoid errors, one has to submit the claims right after the treatment is rendered to the patients. The process should be standardized to eliminate any scope of mistakes and information gap.
4) Ineligible Claims:
There are several cases of insurance claims that could be ineligible because of some technicalities in the insurance policy. Some of these technicalities are mentioned below:
5) Failure in Claim Monitoring and Denial Management:
Revenue management cycle is a long process that requires persistent efforts, continuous claim’s status monitoring, multiple follow-ups, and denial appeals to ensure the continuous revenue generation. It demands in-depth knowledge as well as dedicated time to manage the complete procedure. Failure in managing any of the steps can cause severe hindrances in claim reimbursement, even in revenue loss.
How to avoid any of these mistakes from happening first hand?
The eminent option to avoid such mistakes is to rely on experts to handle the complete revenue management cycle. Outsourcing a dental billing company which can handle the end to end procedure, including billing requirements, dental insurance verification, and patient statement, can make this process error-free bolstering the revenue generation for your practice.
When a dentist provides services to a patient, they expect to receive reimbursement for that service. However, whenever a denial is issued by the payer, it calls for the claim to be adjusted. These denials can be appealed, depending on the reasons.
At Capline, we have presented the most effective actions that should be taken to handle a claim adjustment.
Service Is Not Covered
If the claim gets denied because a service wasn't covered by the payer, you don't need to adjust the claim, however, they are to be billed to the patient at the time of service received. If you adjust the claim, that means you are providing the service free of charge. The responsible party for a service not getting covered would be the patient himself not the dental service provider.
Late Filing of Claims
Timely filing denials are quite common when submitting a claim that was previously denied. The only way to counteract this is when you resubmit a corrected claim, you provide the payer’s previous claim number that was issued on the denial. This will help see that the original claim was filed in a timely manner and providers won’t be denied.
No Prior Authorization
If a claim gets denied due to not receiving prior authorization, the first thing you should do is to check with the office to make sure they actually did not receive prior authorization. If they receive, all you should do is simply add the code and re-file the claim.
Duplicate Claim
Sometimes when a procedure is billed twice, the payer may mistakenly assume that it is duplicate. All Thanks to the new codes ICD-10, that cleared up some of this confusion.
If you are still worried about claim adjustment, talk to our experts today who will be happy to assist you. The above given are some scenario that you could receive as claim adjustment. So, take the guesswork out of dental billing, saving your practice’s time and money and turn to Capline’s team of billing experts for your practice.
Dental billing can pose complexities, if not done properly. Claim denials in the dental billing not only upset your patients but also affect your practice’s revenue, cash flow and efficiency. Errors in the dental billing or insurance verification process could be costing you more money than you think. Insurance eligibility verification is one of the most integral parts of a dental billing process. The researches done in the past have shown that most of the denials in claim processing occur due to the incorrect coverage information.
Failing to do insurance and eligibility verification properly can result in delayed payments, increased errors and non payment.
Capline increases your practice’s efficiency by reducing the average time you spend on the phone. Our insurance verification experts can get it all done for you by submitting error-free claims.
Here are some common errors you must avoid to ensure an error-free claim submission process.
Inappropriate Patient Information
Incorrect spelling names, typos in entering policy numbers and other mismatched data can cause a claim to get denied. There can be some other inaccurate information on a claim, like wrong SSN, date of birth or a misspelled name, that could result in claim denial.
To fix it, we verify claims for accuracy and missed information before submitting it with insurances. Our insurance verification team is experienced to automatically discover errors and other incorrect information that could result in revenue loss.
Patient’s Insurance Is Inactive
This is one of the most common reasons why a claim gets rejected. To make sure this does not happen, we check the patient’s eligibility at the time of appointment before the treatment process begins. Another good thing that you can do is to perform a batch check prior to a patient’s visit. Use the patient’s full name correctly to make sure that denials do not occur.
Sending Duplicate Claim Submission
A duplicate claim is the one that is resubmitted on the same day by the same provider and for the same service. In such a scenario, the provider will process the original claim by denying any other claim as a duplicate claim or service.
We can fix it by checking with your insurance provider. We will check whether the original claim is processed for payment or if it is denied and then take action accordingly. Claims rejected as duplicates may be valid for payment if the correct code is applied to prove that a claim is not actually duplicate.
Missing Documentation
In some situations, a claim may be denied if it lacks required documentation. In that case, the payer may require additional documentation to support the treatment.
Avoiding denials is not an easy task. However, our IV experts can simplify the entire process to avoid administrative errors that may lead to claim denials.
Insurance verification plays a crucial role in managing the revenue cycle of your practice. If verifications are not managed successfully, there are increased chances of losing revenue. In addition to the time and effort, there are other aspects that go in vain if a patient’s insurance is not verified properly.
Verifying insurance eligibility is important before providing dental service to your patients. The procedure is known to improve revenue and patient satisfaction if done properly. However, dental service providers find it challenging to carry out insurance verification process because they are already tied up attending patients. This is the reason they look forward to outsourcing insurance verification for their practice. If practices ignore to do IV, there are chances of delayed payments, non-payment of claims and ultimately patient dissatisfaction.
By outsourcing Insurance Verification services to us, you can get your claims billed and processed accurately. We take care of all the paperwork related to your practice, which, further helps in timely reimbursement.
We are well equipped with a team of insurance verification experts who are extraordinarily great at carrying out verification of patient details, deductible details, contact details, co-insurance details, coverage details, pre-certification details, patient benefits, and other required info to avoid the last minute cancellation and to ensure accurate billing and verification.
Advantages of Doing Insurance Verification Timely
Therefore, it is important to keep an eye on these common issues for insurance denials and see if you can improve your verification approach to decrease denials. Insurance reimbursements are the bread and butter of most of the dental practices, so it's important to keep a track of claims and assess the reasons for denials. If you don’t have that expert assistance for your practice, you are bound to repeat the errors that cause denials.
A claim review process designed properly will help you notify about problems that might be leading to claim denials. Consider the tips from our experts for keeping claim denials in control. By doing so, you will be able to spot issues early and take steps to maximize reimbursement.
Insurance Verification is one of the important steps in Revenue Cycle Management. Accurate and timely validation of patients’ dental coverage on their dental services, ensures whether they can file a claim or not.
Managing insurance verification for your patients takes a lot of time and effort from your office staff. Being one of the necessary aspects of your practice, dental insurance definitely turns out to be frustrating, if not handled well. Delays in insurance reimbursements and late payments can all leave your practice in the red. At Capline, we can help you with upfront and real-time eligibility verification that helps you know about the accurate deductibles and Co-pays of your patients. Our experts also ensure that the claim information submitted is correct and accurate.
To handle insurance without hassle in your practice, you must make sure that:
In association with Capline Dental Services, you will be able to save your dollars on collections. Our experts are very active at processing the entire information for patient eligibility. They will present you with the most accurate data that minimizes the chances of a patient having an outstanding balance. All the coding errors are skipped and you will be able to experience maximum reimbursement for your practice.
We can also help you reduce rejection rates by consistently tracking accounts receivables. This ensures timely receiving of payments. Our experts easily manage all your paperwork.
Our IV specialists will consistently monitor your patient’s information to prevent denials. This will eventually bring in more income for your practice. Sending claims at the right time means getting faster payments to your office. With reports that have a higher level of accuracy, you will be able to handle all the aspects of insurance billing and verification absent any sort of confusion.
So, if you are experiencing rejected claims and disrupted cash flow at your practice, you must take into account the above-mentioned tips that improve revenue and exceed expectations of your patients.
To know further about Dental Insurance Verification Process, you may get in touch with Capline Dental Services.
Insurance is one of the significant aspects both for the patients as well as for dental professionals. Insurance verification of the applicants takes a lot of time and efforts. In today’s competitive era, dentists and dental surgeons need to be smart enough to ensure that they deal with different tasks related to their practice in an improved and efficient manner. So, one of the wisest decision one could ever take is allocating the insurance related tasks to professional agencies. These firms hold experience in providing insurance verification services that are not only trustworthy but also earn applauds amongst clients. Here are some of the benefits of outsourcing insurance verification services that can help dentists to improve their patient’s experience.
1) Focus on the specialization: When you outsource insurance-related work to a billing company that deals with insurances, you get liberated from the unnecessary paperwork. This saves your time and allows you to stay focused in your work. This means dentists and other professionals can solely focus on their specialization without worrying about the charges and other clearances from patients.
2) Avoids risks in your business: Healthcare insurance comes with several aspects that need to be considered seriously when finalizing the medical bills of patients. If implemented in a wrong way, it could result in decreased revenues. Insurance verification performed by specialists helps you to know immediately whether the insurance provider can pay the respective amount for the patient’s dental treatment or not. Accordingly, you can inform your patients with the treatment plan and payment criteria beforehand.
3) Simplifies work process: Every dental professional prefers a smooth and aligned work process. These days dental billing companies make sure that the verification is performed and completed in a hassle-free manner. Dental professionals can then work with ease and stop worrying about the payments.
4) Reduced claim rejections: Dental billing and insurance companies understand the processing about the denial of claims. Claim rejections is a negative point for patients as well as dentists. Therefore, it is essential to deal smartly and effectively with it.
5) Decreased cases of claims rework: Claims rework takes a lot of time and energy of the staff at a dental office or hospital. Dental billing agencies make sure that almost every claim is rectified in the best ways.
6) Improved productivity of staff: Productivity and profitability are two sides of the same coin. In dental offices and hospitals, if the team is productive, it automatically fetches them increased profits. This is due to lesser time wastage in miscellaneous tasks. On outsourcing insurance verification, dental staff can drive their focus and goals towards serving the patients in a much better way.
7) Improved speed of billing cycles: This is one of the significant advantages of utilizing insurance verification services in the dental practice. Billing cycles get improved with decreased denial of claims. This leads to an overall development of the dental practice.
So, these are some major benefits of outsourcing insurance verification that should be utilized in the best possible manner for the growth of the dental practice.
Click here to know more about our Dental Insurance Verification Company
Insurance verification may seem like a task that can be efficiently handled in-house by your staff, but that’s seldom the case. If anything, it takes away the staff’s time and attention from delivering the best patient care. Insurance verification is a vital step in ensuring healthy collections of your practice and can have a serious impact on your revenue if ignored.
Outsourcing IV can assist you greatly in reducing claim denials, increasing collections and hence resulting in enhanced patient experience. Here are some pointers on how outsourcing your IV work to us would look like.
1. We work ahead of your schedule by doing all insurance verifications before the patient appointment. This lets your staff discuss the benefits with the patient as soon as they come in for their appointment.
2. We prioritize your schedule and work round-the-clock to ensure that all information is obtained through insurance companies by call or fax prior to the patient appointment.
3. We pay great attention to details to ensure that your claims don’t suffer from reimbursement issues due to incorrect assessment of insurance eligibility. This results in increased and healthy collections for your practice.
4. We are aware of the regular updates in the change of plans and find the most up-to-date benefits for your patients.
5. We estimate insurance payment and patient payment portions correctly. We allow no room for additional payment surprises for your patients, which, in turn, builds their trust on your practice.
6. Our highly trained, professional and friendly experts understand that filing a claim without proper insurance verification would simply result in more denials and patient balances, and hence prioritizes accuracy and timeliness while doing your IV work.
7. Our services and prices align with your goal of having increased collections and happy patients, and hence are cost-effective and affordable. We customize our services as per the exact requirements of your office to ensure that the needs of your dental practice are well taken care of.
If you would like a free consultation with our insurance verification expert to find personalized solutions for your practice’s requirements, please call us 888.666.0604 at or write to us at info@caplinedentalservices.com.
