capline dental services

Mistakes You Can Avoid by Checking Patient Eligibility

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A study conducted by Capario reveals a shocking number of practices that do not check insurance coverage before the treatment. According to the study, there were some practices that didn’t check eligibility until the treatment whereas there were some who did not check eligibility at all. The results were quite disappointing and concerning too as failing to check eligibility can lead to a variety of issues related to the RCM. Listed below are some of the mistakes that you can avoid by checking patient eligibility before the treatment:

Inappropriate Billing
To ensure accurate billing, it is important to check patient insurance eligibility before the treatment. Not checking eligibility leads to issues in billing for both your practice and patients. For patients, not verifying eligibility could lead to a patient being overcharged for their treatment. Similarly, if your staff provides treatment without checking the coverage and eventually gets to know that the patient is not covered under the treatment, it results in your practice paying more than what the patient expected.

Similarly, without verifying the insurance info, your patient might end up paying higher or lower copay.

Reducing Denials
Providers who do not check coverage before providing treatment are likely to have their claims denied. Claim denials can be very difficult to resubmit, so checking coverage before the treatment can prevent claim denials and delayed payments.

If your dental practice offers treatment and submits a claim without checking the patient’s coverage  and later discovers that the patient is not covered, the claim is likely to be denied. To prevent this, you must tell your staff to verify eligibility before submitting a claim. To prevent this from happening in the future, it is also important to investigate the cause of claim denial whenever it occurs.

Avoiding Duplicate Billing
When a claim is submitted more than once, there is an increased possibility of duplicate billing to occur. Sometimes a procedure is canceled but it is not removed from the patient account. This might even occur due to a simple human error.

There are many practices that are fined each year for processing duplicate bills. If a practice files inaccurate claims willingly, it’s naturally considered a fraud. The best way to prevent such an error from happening again is by conducting an audit. Audit will help you analyze that all claims are billed accurately for the given procedure.

Many practices lack staff expertise and the right technology to manage denials effectively. Outsourcing revenue cycle management to an expert dental billing company like Capline could be a profitable alternative. We can help you extract the root cause of denial and multiply the revenue cycle. Contact us today to discuss how we can shape your practice’s bottomline.