A couple of years is the transformative ground for the dental sector following a digital revolution. Dental billing challenges still persist, and these issues result in denied claims. New technology adoption is rapid post-pandemic. The steady flow of cash keeps the practice afloat, and yet it remains complex. Otherwise, the dental industry is less responsive to suggestions.
With recent tools, such as cloud-based PMS to monitor claims and analytics that offer a real-time dashboard. The changes in the billing landscape over the last four to five years utilize the experience of specialty billing firms.
Claim rejection is among the common issues, one out of many. Today’s policy system is strict as regards CDT coding, documentation, and insurance verification. Claim submission requires attention to detail, and the small errors doom a claim faster than any major issues. The study reveals that more than 80% of dental claim denials are due to incorrect patient information, eligibility issues, missing CDT codes, missing vital attachments, COB issues, and lack of prior authorization.
Developing an understanding of dental insurance policies comes with escalations. New policies are constantly becoming law, and if the practice does not submit claims according to new rules, then getting payment becomes complex.
An illustrative example for an annual maximum of $1500. Cavity filling is due in January, which costs $100. 80%, i.e., $80, is what the plan pays, and the remaining balance is $ 1,420. In March, the dentist suggested a root canal, which would be another $700; the plan pays $560 (80% coverage). The total amount paid by the plan $640, with $860 remaining for the benefit period.
Finally, in October, the patient needed a crown that costs $900, and the plan pays $450 (50% of the plan because of restorative services). Out of $1500 annual maximum, the patient has utilised $1090, with a remaining balance of $410 for the benefit period. The services, after consuming $1,500, are 100% the patient’s responsibility. The maximum resets at the end of the benefit period.
HIPAA, Medicaid, and state regulations have strict protocols to secure information. The constant change and keeping up with legal complexities, with patient care. Documentation compliance, audits, and security measures are not just checkboxes to check. They are more than that. If the practice does not have a dedicated professional to deal with that, it can quickly become frightening. Outsourcing to Capline Services ensures that each claim undergoes strict measures to follow compliance and maximize approvals with lower errors.
Front-office staff deal with patient interactions, appointments, and scheduling. Additionally, when they are delegated the billing responsibility, results are unprocessed claims, errors, and missed deadlines. Keeping up with coding and insurance updates requires vigilance to avoid disputes. A hand with expertise is always helpful.
The front-office team often lacks expertise, which is why outsourcing to Capline Services for dental insurance billing can free up the in-house staff for patient care.
Denied claims are a crisis, and what used to work before is becoming irrelevant now, due to technological advancements. Let’s discuss a few solutions to keep up with the latest and become insurer-compliant.
