A denial of claims leads to a disruption in cash flows. Claims that are delayed and submitted beyond the deadline can cause a disturbance in workflows and can demotivate the dental team.
Do Not Wait For The Patient Visit To Begin Dental Insurance Verification
The team at the practice must confirm patient details concerning the insurance policy plan of a patient at least three working days before the patient arrives at the practice for a scheduled appointment. When dental insurance verification is done in advance, it enables the team to allow for timely planning with patients about payment. It also facilitates a smoother patient experience.
The dental team needs to confirm details such as effective coverage dates, waiting period for coverage to begin, if benefit maximums have been reached, or if any deductibles are yet to commence.
If the dental team does not address these problems earlier than the scheduled appointment date, the team is not prepared, and the patient can get a higher bill than expected. This hampers the patient experience, and, more importantly, the patient might also not make payment on the day of the appointment due to a lack of adequate time to prepare for funding arrangements.
The team can make the patient experience smooth and can clear dues on the day of the appointment itself if the dental team has confirmed insurance coverage details in advance.
Depending On Predeterminations For Out-of-Pocket Estimates For Patients
The team can ask for a predetermination request from the insurance organization if needed. The predetermination is a tentative estimate that outlines a suggestive amount of insurance coverage as well as the patient’s financial payout. This is done even before the start of dental treatment.
When briefed by the dental team, the insurance reviews the request and accordingly prepares the predetermination and shares the same with the practice. The details that can be included in the predetermination include the patient’s eligibility status, services covered by the plan, amounts payable, plan maximums, and details of co-payments or deductibles.
While the above is exhaustive, the team must make an error by solely depending on predetermination and not carrying out any insurance verification. While there may be an overlap between predetermination and insurance verification, there are some stark differences.
A predetermination does not reflect payment by the insurance company and might not always be dependable. The predetermination might hold good only for the date that it was processed. Insurance verification, on the other hand, enables the team to interpret the data, plan the appointment date, and share details with the patient accordingly.
The dental team may have to wait for the predetermination request, as an insurance company might not share it immediately. This can lead to a delay in treatment for a patient. When the team performs a due verification check, it has better control over information and can act appropriately. Once insurance verification is done, the team can plan the treatment schedule with patients.
Lack Of Time To Control The Insurance Verification Process By The Team
In case the dental team is pressed for time, the insurance verification process can be outsourced to specialists. They ensure that all necessary details, including copays, OPE, etc., are shared with the practice well before the scheduled appointment.
They can then explain the coverage benefits and empower the patient to plan the treatment with confidence.
The dental team can also make it clear to patients that they are ultimately accountable for the cost of treatment rendered to them.
Avoiding The Use Of Outdated Information
The dental team must take care to avoid verifying the insurance benefits of regular patients. The team need not assume that coverage of a regular patient should be taken for granted. The team must update the records in the practice management system and ensure verification is done for every appointment scheduled at the practice.
There are times when the insurance coverage of a patient can change sooner than the team can anticipate or realize. This could be due to a change in employers or marital status. It could also be due to retirement. Some patients also change their insurance company periodically.
In some cases, there could be a new policy offered by the same insurance company with some additional benefits added. In such cases, the team needs to ensure that newly added benefits are in effect at the time of the appointment, as there could also be a possibility of a waiting period. Moreover, changes in the policy plan for patients that has recently changed might not reflect in the portal. Hence, it is advisable to verify the coverage benefits of a new patient as well as a regular patient.
Avoid Hurrying The Verification And Committing Errors
Performing the insurance verification process for a few patients seems simple and not very time-consuming. But for the verification of multiple patients booking an appointment daily, the process can be cumbersome and time-consuming.
The team should avoid hurrying through the process of verification. It should not skip a patient or even rush through a patient’s verification step without complete due diligence. This can unintentionally lead to an increase in the number of claim denials.
Understand COB Rules And Conduct Regular Training
There are many instances in which a practice has patients who are covered by multiple insurance plans. In such cases, the dental team needs to understand how the insurance verification process will identify which insurance policy will cover the patient for the treatment offered.
In these cases, the rule of coordination of benefits (COB) will apply. The primary, secondary, or tertiary insurance policy will have to be identified by the team, and claims submitted as per the COB rules.
The sequence by which a patient’s insurance policy coverage gets selected is known as coordination of benefits, and is tricky for the dental team to identify the primary insurance company covering the patient. It can also depend on a specific situation of a patient. An incorrect order of the patient’s insurance coverage will result in a claim denial.
Hence, the team needs to be adequately trained about insurance coverage rules and thus help the practice collect more from the insurance organizations.
Always File Claims On Time
Most insurance organizations have tight rules and deadlines with respect to the filing of claims. There are also dates to be adhered to by the dental team for filing of revised claims.
Some claims might have to be submitted between six months to a year, while some insurance companies ask for submissions within a fortnight or a month from the date of the scheduled appointment.
The team needs to submit accurately filled claims within a couple of days of the treatment offered to the patient. A failure on the part of the dental team to submit claims within the set deadline can lead to a potential loss of revenue. This can cause an interruption in cash flows.
While the reasons for missing a deadline could be many, the practice must ensure that all such reasons are identified, and all efforts must be made to ensure timely claim submission.
File Claims Accurately Without Missing Any Vital Data
The dental team must ensure that all claims submitted to the insurance organization are precise and accurately filled out. Failure to do so, either omission or incorrect data, can lead to denials. Missing data or inaccurate details can be a lack of codes, wrong codes, or incorrect personal particulars.
Services Not Covered By The Insurance
There are multiple options that a patient can select while confirming an insurance policy. Some patients may not desire treatment coverage for all services. Some services might get covered by the plan, while may have to be paid by the patient. Claim denials can happen when the dental team has not verified the insurance coverage accurately and on time.
The team must also ensure proper documentation accompanies all claim submissions. A failure to support claims as proof for the need for particular procedures or services can also lead to a denial.
The key reason for claim denials is not conducting timely and accurate verification processes. This can lead to an interruption in cash flows for a practice. Adopting a few recommended measures, as mentioned above, can considerably reduce such issues.
