Every dental practice aims to offer quality care and service to patients. A practice can then be rewarded with a steady stream of patients and referrals. This, in turn, yields better cash flows for the practice. However, cash flows can be affected when the dental team fails to file claims on time.
When it comes to dental insurance claims, timely filing is of vital importance. Missing a deadline can affect the cash flow for a dental practice and revenue cycle management. The dental team must not wait to file insurance claims. Delays often lead to denied claims, which affect cash flows and lead to possible bad debts.
The team must also note that the norms for the timely filing of policies can affect the dental insurance claims submission process. The dental team needs to understand the need for timely filing and the cost of missing a deadline.
Different insurance companies have their own norms for filing and their respective deadlines. These periods can extend from 3 months or more from the date of service rendered to the patient.
Some private insurance companies might offer a 3 to 6-month filing window, and some HMOs and PPOs may provide a window of 6 months or more. The window for government and Medicaid plans is usually smaller.
Many insurance companies maintain filing timelines for submitting claims to control their spending and avoid unanticipated payouts. A sudden arrival of old claims can impact their financial projections and cash flows. Insurance companies can use late filing as a reason to reject claims and make payments to a dental practice.
A dental practice has limited control over submission guidelines. The team can, however, handle the filing process to ensure timely submissions.
A practice should ideally submit claims within 2 or 3 days of rendering the service or procedure. Very often, a delay in filing could mean a risk of the team omitting or forgetting to incorporate some crucial information required for a clean claim submission.
All the information needed for a claim submission must be included, such as patient details, insurance policy information, attachments, narratives, clinical notes, etc. A focus on all such details and a timely filing of the claim can avoid unnecessary claim rejections and write-offs.
There is a challenge in submitting clean claims in such a short period, as the dental team is also busy managing other administrative tasks of the practice. Patients who are at the practice today will have higher priority than yesterday’s document and paperwork.
The team needs to identify insurance organizations that have tighter deadlines. The team must target these organizations as a high priority. Based on the date of service rendered, the team needs to prioritize the filing of the oldest first and then advance to later ones.
The team can use the practice management software to identify the sequence of claims. The PMS will showcase the status of claims as well as pending submissions. The dental team can make a note of upcoming deadlines on the PMS too.
By prioritizing the claim sequence and submitting claims to the insurance organization that has a stricter deadline, the team can ensure timely filing, and collections are a lot easier. This process will also safeguard the practice from potential financial losses.
A few steps that a dental team needs to follow are as follows:
By maintaining an updated list, the team can stay aware of filing deadlines for insurance companies and plan the timely submissions for the same. The dental team needs to be regularly updated, as insurance policies and deadlines are dynamic and are subject to change. Such information can be obtained during the insurance verification process.
Streamlined processes need to be followed by the dental team for prompt documentation and submission. The team must ensure all necessary documentation is collated and assessed as soon as possible. The practice can assign a specific team member to track claim submissions and take remedial steps if needed.
The practice must ensure that the dental team is regularly trained and motivated to file all submissions on time and has all processes in place to ensure that timely filing can happen. Ongoing training will keep the team updated on all changes that happen in
dental insurance and billing insurance regulations. Moreover, it will also help in swiftly verifying and updating patient insurance data. This will result in all claim submissions being filed accurately and promptly to the respective insurance company.
The practice needs to conduct regular audits of all billing and insurance filing processes. These internal audits would help to detect any potential issues or delays in processes that could lead to missing the deadlines for timely filing. The practice must ensure that the dental team has all the support needed for accessing prompt and precise information for the timely submission of claims.
The practice must also track and monitor the outcomes of the billing team with performance metrics that include turnaround times from completed appointments to claim submissions. The denial rates with respective reasons for rejection can also be collated. These results can be used as inputs for overall improvement.
The dental team needs to evaluate the denial through a detailed examination. Specific causes for the claim denial need to be analyzed. It can also happen that an insurance company might have committed a simple error on their end. It could also be a case of miscommunication. There are many instances when insurance organizations have committed errors that have resulted in a claim denial.
The team has to collect all applicable documentation that supports the case for the practice. This means proof of timely submission or if the patient has provided wrong information for filing.
The dental team must file an appeal within the stipulated time frame. This timeframe varies within insurance companies. The practice needs to offer a clear appeal letter that is accompanied by all the relevant documentation. The appeal needs to contain an explanation for reconsideration of the claim, with all the supporting evidence.
The practice, over time, must develop strong relationships with teams from the various insurance organizations that they interact with. These relationships can help to accelerate the resolution process. The team can also connect representatives of
professional dental associations for support and assistance in dealing with rejected claims.
Maintaining revenue cycle management as per expectations is vital for a dental practice. Missing a deadline for claims submission can hurt the practice. The dental team must ensure the timely filing of claims with the respective insurance company. Clean claims must be submitted that contain accurate patient information and all the relevant documents needed by the insurance company.
