Dental billing is a challenging task for a dental practice. The team needs to put in a lot of effort to keep the practice running successfully. The tasks that need to be done include credentialing of dental practitioners, verification of insurance coverage of patients, billing and coding, claim submissions, etc.
All these activities take up a lot of time and effort. So, when claims are rejected, it can be frustrating for the dental team. All the effort and care that went into billing, coding, and finally claim submission get wasted. There is a ray of hope, however. The team needs focus and adequate knowledge to reduce dental claim denials and have a good run of successful claim submissions.
Any dental practice can realize that rejected claims are not just a wasted effort. It can result in bottlenecks in cash flow, loss of revenue, and additional workloads. Some steps that the dental team can follow to reduce dental claim denials are as follows:
Merely submitting claims is not enough for a dental practice. The team needs to monitor and follow up on every claim that has been submitted to the insurance companies. It also needs to keep a track of all denials and focus on appeals for the same.
A careful tracking of all claims and denials is vital, as it helps the dental team to ensure that claims submitted on time and rejected claims are also appealed promptly. Such tracking also helps to identify trends in claim denials. Interactions with every patient should preferably be coded on the date of service. Claims that are rejected should be tracked by the insurance company and the type of claim. This needs to be done at defined intervals.
The practice needs to analyse all rejected claims regularly. It is generally observed that the cause for denial can vary according to the practice, specialty, and procedures. However, the analysis can reveal specific claims that get rejected without having to browse through several of them.
The dental team needs to maintain a register of all denied claims, the date of receiving them, the type of denial, and the date when the practice filed an appeal. By studying the register, the team can spot specific trends in claim denials and address them at the earliest. Once the team has done a careful analysis, it can then prioritize working on the leading three causes for claim denials, as this would cover a large majority of lost reimbursements.
The dental team must focus on identifying the denial rate of claims. This enables the team to focus on areas that are detrimental to the revenue cycle. The general mode of calculating denial rates is by adding the total dollar amount of claims denied by insurance companies in a defined period and dividing it by the total dollar amount of claims that were submitted by the practice in the same period. The team can also calculate denial rates by insurance company or the cause for denial.
Billing and coding are challenging tasks, and the dental team needs to be equipped to handle this vital activity for the dental practice. The team needs to have knowledge of all applicable codes as outlined by regulatory bodies. Dental codes are not always static, and changes in codes happen every year with the introduction of new codes or new numbers being assigned. The dental team needs to be trained at regular intervals, as this enables them to manage the regulatory landscape and help in reducing claim denials.
The dental team must consider insurance eligibility verification as a vital step before commencing treatment for any patient. By successfully verifying the insurance policy details and the benefits that can accrue to a patient, the team can ensure that the insurance company will reimburse all the claims due to the practice.
Verification at every patient visit can help the team to understand if the patient’s policy is still active, the extent of coverage for services and procedures included in the policy, if prior authorization is needed, etc. The verification process will also confirm the dues that need to be borne by the patient, which include copayments, deductibles, etc.
An eligibility check, even before the patient visit, will ensure that the dental team has the correct information to fill out. This ensures that claims submitted have a negligible chance of getting rejected.
There can be several instances for a dental practice when a dental procedure can meet medical necessity considerations and can be claimed through medical insurance. Dental and medical cross-coding means a submission of dental procedures to the medical plan of the patient and not to the dental insurance company.
These cases arise when a dental procedure is deemed medically necessary. The dental team must identify and apply the correct codes that can aptly describe the treatment offered to the patient. The dental team needs to be updated with CPT, CDT, and ICD-10 codes that are vital for medical and dental billing and cross-coding. The practice needs to ensure that the teams are regularly trained and aware of all codes and the changes that happen at frequent intervals.
A dental practice can thrive not just with quality treatment and service, but also with efficient billing and collections. The dental team must maximize the collection from insurance companies and patients for its survival and its ability to offer the best possible service.
By accurately verifying the insurance coverage details and clearly explaining the benefits of the plan, the patient can understand when the dental practice is safeguarding their interest. The practice can thus earn the loyalty of its patients and earn potential referrals.
No two insurance companies can be alike when it comes to handling the appeals process. This can be the reason why the dental team can find it challenging to manage the appeals process for multiple insurance companies.
Some insurance might consider an appeal to be a new claim with extra details added, while some companies might ask for the original Explanation of Benefits along with extra details. Some might accept appeals from the dental practice only through their web portal.
The dental team must make a list of submission requirements for all insurance companies that they deal with. The dental team can also process claims and appeals in batches based on the insurance company. The dental team needs to understand that rejected claims are a wasted effort that can cause a negative impact on the cash flow of the practice. The team needs to follow a few simple steps that help reduce claim denials while helping boost the operational viability of the practice.
