Planning NOW for Everything Insurance in Your Practice

April 24, 2020

Filed under: Uncategorized — tntadmin @ 3:18 pm

Managing your patient dental benefits on all levels is crucial to keeping your cash flow moving. Being proactive in managing your patient dental benefits is just as important! (think obtaining patient benefits and clean claim submissions!)

Now is a great time to take a hard look at your current insurance systems in these areas and determine what areas present challenges, how can you improve and come out of this even better!

Before beginning your review, be sure to run these reports:

  • Insurance Aging
    • 30 day
    • 60 day
    • 90 day
  • Claims not submitted and Rejected claims reports
  • Procedures not attached to claims
  • A/R Aging
    • 30 day
    • 60 day
    • 90 day
    • Credit
  • Insurance Verifications and breakdowns
    • What patients will you systematically obtain this information
      • New patients
      • Hygiene patients
      • Treatment patients
        • We recommend a full clean breakdown for each patient every year starting at their new patient appointment, and an eligibility check at each subsequent appointment after, or if the patient presents with a new insurance.
    • When will you obtain the information
      • we recommend starting 4 days prior to appointment
    • Who will obtain the information
      • Administrative team
      • Insurance Coordinator
      • Outsource/third party
    • How will the information be obtained
      • Online
      • Phone
      • Fax
    • Where will the information be documented to ensure all team QUICK and accurate access         
      • Consistent documentation is crucial in being able to utilize this information thoroughly
      • Patient insurance tab by new year/date/group number
      • Eligibility notes on appointments for quick review of immediate eligibility notes
      • Be sure to ask for a reference number EVERY time

Having the correct insurance breakdown information will protect/improve your reimbursement time, allow for more accurate patient share estimates and decrease the number of denials.

  • Daily Claim Submissions
    • Who will be responsible for submitting claims daily
      • Administrative team upon walkout
      • Insurance coordinator
      • Outsource/third party
    • Running daily reports to ensure that all claims have been submitted and received
    • Reviewing rejection reports
    • Ensure that each claim is submitted with the attachments and documentation required for clean claim submission and first time round reimbursement!
      • Know what codes need what attachments
      • Understand documentation required
  • Run the insurance aging report at least weeklyWork the aging claims consistently Calling insurance companiesChecking onlineResubmissionsDocument all recovery efforts with complete detailAsk for reference number every time
  • Posting payments
    • Who will be responsible for posting insurance checks –  paper, VCC and online EFT payments
      • Administrative team
      • Insurance Coordinator
      • Outsource/third party
      • Ensure training for accurate postings especially adjustments and primary/secondary insurance
        • If you have a lot of account credits, this is definitely be a flag for you to review
    • Check EFT payment portals daily and consistently
      • Create a system to ensure these are NOT MISSED
      • If you don’t have a system for this, they will get missed and then get messy
    • Send statement immediately if account balance remains after posting
    • Thorough document of insurance communications on insurance payments (why something wasn’t paid, deductibles, etc)
      • This will save you time over and over again, especially with appeals and patient questions
    • All claims that pay less than expected and with denial documentation must be reviewed for potential appeals and resubmissions
  • Appealing claims
    • Who will be responsible for researching and appealing denials
      • Administrative team
      • Insurance Coordinator
      • Outsource/third party
    • Thorough documentation must be saved in duplicate in patient chart including
      • When appeal was sent
      • What was sent with the appeal
      • Why the appeal was presented
      • Who you worked with at insurance company to appeal
  • Updating Fee schedules
    • Who will be responsible for updating fee schedules
      • Administrative team
      • Insurance coordinator
      • Outsource/third party
    • When will the fee schedules be updated
      • Annually

Keeping your fee schedules current will make your life much easier!

  • A/R
    • Statements
      • When will you send them
        • Monthly
        • Bimonthly
        • After posting payment that produces an account balances
      • Who will be responsible for sending statements consistently?
        • Administrative Team
        • Insurance/Financial Coordinator
        • Outsource/Third party
          • Statements must be reviewed before sending to ensure accurate account balance and thorough documentation
          • Documentation at time of payment posting will save you time in research efforts if a patient calls with question on account balance. Work smarter not harder.
      • How will you send statements?
        • Electronically
        • Snail Mail

As you can see there are many areas to review in your practice to really make your behind the scenes cash flow systems hum with consistency. You’ve got the time right now – we have the resource to help!

Dental Support Specialties are experts with these systems, implementing them and working them consistently!

If you would like to learn more about how Dental Support Specialties can help you please call 330-639-1333 or click here to schedule a call at your convenience

As our way of giving back and being part of our dental worlds solutions in this crazy time, we implemented COVID relief pricing for our clients on March 17 and it will continue through the at least the second week of May.

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