Any dental practice can sustain itself when reimbursed fairly for services rendered to patients. The dental practice can get its cash flows moving when paid promptly by patients and insurance companies.
More than half of the revenue for a practice comes from payments by insurance companies. Here is where dental eligibility verification comes into play. The dental team needs to confirm the details of the patient’s insurance plan and any conditions or benefits before commencement of service.
The verification process must include the validation of the policy, plan coverage for services, annual limits, etc. When done effectively, the dental practice protects itself from delays in reimbursement. This helps in revenue cycle management for the practice.
In most cases, an insurance company denies a claim submitted by the dental practice due to incomplete or erroneous information in the claim form. Some of the most observed dental insurance verification mistakes committed by dental teams are as follows:
The team needs to verify the patient’s insurance details before the day of the visit. This applies to patients who are first time visitors and regular patients. This applies to regular patients as well. There are many reasons that a patient’s details may change since the last since the last visit. The policy could have lapsed, the patient’s address could have changed, or the patient might have switched the plan to another insurance company.
Many verifications arise due to a failure to thoroughly check the details and intricacies of the patient’s plan. Failure to conduct a deep probe of the clauses of the plan can lead to denial or partial reimbursement of the claim. Such lapses might also turn into disputes with the insurance company.
Oversights by the dental team in confirming details such as coverage for costly procedures or preventive services directly affect reimbursement from the insurance company. Eligibility verification thus helps the dental practice to garner full and timely reimbursement for services rendered by the practice.
Small errors, such as an incorrect name or an address wrongly spelled, can elicit a denial from the insurance company. This can affect cash flows and is a waste of time for resources at hand. If it is not an outright denial, there could be delays in reimbursement timelines. Most insurance firms have stringent data matching guidelines, and any deviation in names or numbers causes an automatic rejection of the claim.
Some services recommended by the dental practice might need prior authorisation from the insurance company. Missing out on a crucial step due to an oversight in dental eligibility
verification can be detrimental. The claim submitted will be denied by the insurance company, even if it is medically necessary.
Pre-authorisation is mandated by insurance firms to ensure that costly procedures or services recommended are an absolute necessity. Pre-authorisation helps to lower the risks linked with claim submissions.
There can be multiple instances of patients covered by more than one insurance plan. The patient could have two plans, or both spouses could be covered by an insurance plan. The team must verify the details of both plans. The coordination of benefits needs to be applied as applicable.
The practice stands to gain when dental eligibility verification is effectively done. Besides just smoother cash flows, it gains the goodwill of patients and a stronger reputation in the long run. Some benefits of dental eligibility verification include:
Eligibility verification helps to reduce billing errors since the dental team can collate policy information and patient records before the visit to the clinic happens. The dental team is thus able to post claims that are timely and accurate.
The team can lower claim rejections since they do not make unnecessary errors associated with no timely verification. Policy numbers, patient information, etc., when confirmed on time, ensure negligible claim rejections.
The verification of patient insurance information helps avoid any mistakes caused by any erratic demographic records in what an insurance company might have on its files.
When the dental team confirms policy validation dates, inactive policies, policy limits, or services not covered by the plan before the scheduled appointment date, invalid claims can be avoided. The process gets streamlined, and lower claim denial rates are achieved.
A timely dental insurance verification check also alerts the dental practice about any inactive insurance policies. Accurate data collated on time prevents lapses or surprises for the patient at the time of billing and thus helps to maintain continuous cash flows.
This helps the practice to be financially stable since claims get prompt approval, and reimbursement happens at expected intervals. This thorough verification process helps maintain accurate data while preventing claim denials.
The verification process ensures a revenue flow for the practice while minimising claim rejections. A timely reimbursement rate helps improve collections. The practice increases revenue while reducing interactions with the insurance firm.
This, in turn, reduces the time and administrative costs associated with resources at the dental practice to handle rejected claims as rework appeals are reduced. This makes the
dental practice more efficiently and allows the dental team to focus on core activities such as patient care and service.
Managing the RCM effectively while also optimising expenses enables the practice to invest more in patient care, technology, or other requirements.
Eligibility verification builds cost transparency as it gathers accurate data concerning the insurance plan of the patient, as well as the limits, coverage, services, etc. that are bound by the policy. It also confirms the financial obligations of the patient and any out-of-pocket expenses that also need to be borne by the patient. This enhances transparency and aids patients in managing possible expenses concerning the recommended treatment.
Eligibility verification helps practices identify procedures without coverage in advance. Any possible alternatives can be discussed with patients. Any possible billing misunderstandings are avoided. Clear communication about insurance coverage and financial commitments helps to enhance the patient’s relationship with the practice.
In a complex dental care landscape, dental eligibility verification plays a critical role as a defence against claim rejections. The team needs to manage the verification process so that claim denials are restricted to the minimum. The practice needs to streamline the dental insurance verification process and thus safeguard cash flows while lowering the burden on he dental team. In addition, this can instil trust and confidence in patients.
