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Dental Consultant Tip: Insurance Best Practices
Insurance is the patient’s responsibility. It is their insurance after all however, quickly and accurately verifying insurance is an opportunity to provide patients with excellent customer service.
Staying on top of insurance every day is crucial. It is vital that insurance does not backlog. Backlogs cost you time and money and reflect poorly on your practice.
When a patient receives a bill from the practice due to insurance denial it can cause an upset. Sometimes it is a front desk error, however the upset is often partially or fully due to the bill being unexpected because the patient had not been effectively educated on how dental benefits work.
By following this protocol your patients will be prepared. They may not be happy about a bill should they get one but, they will be more likely to blame their provider than you.
Before Patients Are Seen
- Benefits change. Keep PPO fee schedules up to date in your practice management software.
- Real Time Eligibility is widely available, saves time and increases accuracy.
- Accurate and complete patient insurance info is vital otherwise you cannot verify accurately.
- Always verify a new patient’s benefits before they arrive. The new patient should be called prior to their arrival with what to expect as far as their co-pay.
- Update benefits prior to existing patient appointments.
- The Treatment Coordinator re-enforces the clinical education the patient received in the back, creates an honest sense of urgency to make financial arrangements and scheduling smoother but, first the Treatment Coordinator needs to educate the patient on how dental insurancebenefits work including details of the patient’s specific plan. Key points to go over with all patients:
Dental insurancebenefits can be compared to a “gift card” from Target or Best Buy. You need a new cell phone that costs $1,000.00. You have a gift card worth $100.00. Guess who pays the difference?
Patients need to know insurance companies are not exactly their friends as insurance companies frequently deny claims. The patient should also know the patient’s benefits are not negotiated by your practice. They are typically negotiated by the patient’s employer.
The Treatment Coordinator should make known to the patient any restrictions, such as frequency limitations, etc.Going over the patient’s verified benefits helps avoid unexpected news for the patient later on.
You are the patient’s insurance advocate so to speak.It is you plus the patient against the insurance company. Let the patient know the way you advocate for them is to educate them on how their dental benefits work and to submit the claim completely and accurately. If the claim is denied you will send an appeal but, at the end of the day, if the patient’s insurance company refuses to pay, the patient is responsible for the balance.
Ensure all patients sign their treatment plan and your financial policy and that the patient receives copies of each.
- A “Co-Pay Estimate” is different than a “Pre- Determination” or “Pre-Treatment Estimate”.
A “Co-Pay Estimate” is generated by the practice.
A “Pre- Determination” or “Pre-Treatment Estimate” is generated by the insurance compant and is NOT a guarantee of payment as insurance companies often “change their minds”.
Do not offer a “Pre- Determination” or “Pre-Treatment Estimate”. If the patient requests one, that is fine but, then schedule the patient far enough out (not too far) to give enough time to receive the “Pre- Determination” or “Pre-Treatment Estimate” back from the provider.
- For existing patients, when they come in, ask for any change in their insurance. If changed, verify.
- The morning huddle should include a review of the day’s patients to ensure benefits have been verified.
- File claims the day of the procedure along with all required documentation. You do not want to backlog claims. Unfiled claims can quickly pile up increasing the probability of denial due to time limitations. It is also very poor customer service.
- Follow up on claims. With electronic filing many offices follow up after 20 days. Never go more than 30 days without following up. 80% of claims should be collected within 30 days. 95% within 90 days.
- Employee accountability is vital. Assign insurance to a specific employee otherwise you will have no accountability.
- If you have any large companies in your drawing area, group patients by the company.
- Track outstanding claims on a weekly basis. Daily is even better and highly recommended.
- Resubmit denied claims after proper research.
- Every month, send accurate statements but, only to patients with balances. Make sure pending claims are noted.
When Patient Are Seen
- Ensure needed documentation is included with claims (narratives, images, etc.) when required (restorative, perio, implants, endo, dentures, etc.). Send claims and documentation electronically. Doing so is a huge time saver.
- Double or triple check all codes so you don’t mistakenly use an old code. Use the latest edition of “Coding With Confidence” by Dr. Charles Blair.
- If code history is required (D4910 as an example), be sure to include.
- When submitting a claim double and triple check to ensure all information is correct. If you don’t, you substantially increase the probability of a denial wasting valuable time and energy.
After the Patient Leaves
- Track claims EVERY day. Your PMS will produce up-to-date reports if you have real-time access. If not, you can get the needed reports from each providers web site.
- Review daily:
- Clearinghouse Claim Submission Report: Can give you an early warning if attachments are required or if claims have been denied so you quickly get the claim fixed and resubmitted which is excellent customer service.
- Unsubmitted Claims Report. Complete and submit ASAP.
- Review weekly or daily: Insurance Aging Report. Providers have different deadlines. Always work on the oldest first. The clock is ticking.
- Get educated on how appeals work for each provider. Verify adjustments. Fight for your patient as you would want someone to fight for you if they were processing your insurance. See if you can determine if there is a fix to get claim approved such as:
- Deleted codes
- Codes requiring history
- Overuse of codes
- Omitted documentation/images
- Contract provision
- Missing tooth clause
- Wait periods
- Preventive deductibles
Kevin Tighe, Cambridge Dental Consultants, Senior Consultant, got bitten hard by the business and marketing bug during long summer days working at his dad's Madison Avenue ad agency. After joining Cambridge as a speaker in the mid-1990s, Kevin went on to become Cambridge’s senior consultant and eventually CEO. Cambridge Dental Consultants is a full-service dental practice management company offering customized dental office manuals. Frustrated? High overhead? Schedule a chat with Kevin at
What Does A Dental Consultant Do?
Many dentists will tell you dental consulting works. If dental practice management firms had no worth or benefit they could not stand up to harsh economic realities for long. What a veteran dental consultant brings to the table are systems and protocols successfully implemented in other practices that have been improved and tweaked over many years. Top dental consultants talk and network with each other. They pay attention to what works and what doesn't work across all dental practices.
Marketing & New Patients
Practice management consultants generally have little marketing training or background.
Note: Cambridge'a consultants are Certified SEO and Ad Words Specialists
Dental Office Systems
Key systems dental consultants implement:
- New Patient Phone Call
- Insurance Processing
- New Patient Experience and Patient Education
- Financial Arrangements
- Unscheduled Treatment Followup
- Stat Monitoring
- Daily and Weekly Checklists
- General Policy Manual
You will not get much ROI from your dental consulting if your staff do not have your back. You do not beed a team of cheer leaders jumping up and down with enthusiasm, but you do need staff who are smart and take some pride and ownership in what they do. If there is more than the usual drama in your practice that needs to be sorted out before you will get any real results.
What gets monitored gets done.
The "big" obvious numbers are important to monitor, but when you look at them they are typically already "in the books". You want your team to concentrate and be accountable daily on the "small" stats that bring about the "big" stats. How many practice owners know how many calls were made to unscheduled patients each day or overdue re-care or inactive patients? Many dentists vastly underestimate how much daily "outflow" is needed to keep a schedule full. How may dentists know what % of slots were open in their hygiene schedule each day? How many know how many NP calls there were yesterday, who scheduled and if they end up showing up? More importantly how many staff know considering it's their job to do?
The only way to monitor what gets done is with daily stats especially for your weak areas. For example, one employee should be specifically responsible for calls to patients who are unscheduled, overdue re-care or need reactivation. Other staff can and should help in coordination with the accountable employee, but that employee accountable reports daily on a spreadsheet like this: 1. # of calls or personal texts sent 2. # of contact
3. # of appointments with name and date 4. # of arrivals
It is the employee who is either making themselves valuable to you or not. If they are doing so, dismissing them will never enter your mind. On the other hand, if they are not making themselves valuable, you will be doing them and yourself a favor by giving them the opportunity to find a practice or other employment that is a better fit for them.
What most practice owners are missing is not how to book an appointment but how to be effective leaders. The best systems in the world are useless if the staff do not comply. Good leaders know how to get staff to willingly follow through and comply. Agreement among all team members is key. Your written office policies should contain those agreements and should answer most questions staff come up with. Doing so will save you much time and simplify the management of your practice. Staff non compliance is a sure sign of poor leadership. The primary reason practices underperform is staff non compliance. Key traits of leaders. All it takes is discipline:
- Always keep a cool head especially when "under fire"
- Realize that all mistakes are an opportunity for you and your staff to learn.
- Set a good example.
- Always be learning.
- Take care of yourself.
- Fight the impulse to address multiple issue at the same time. Frantic activity creates spotty results.
Questions You Should Ask
- Do you and/or your staff have to travel or does the consultant come to you?
- Is the program mostly one on one consulting versus seminars or courses with multiple clients in attendance? There are advantages to both.
- If the dental consulting is one on one who will actually deliver the consulting? I recommend knowing who your specific dental consultant will be prior to signing on the dotted line.
- Is program based on a specific dental practice management system? You want to avoid cookie-cutter programs. Ensure the program will be tailor-made to fit your practice's specific needs.
- The cost (including travel expenses and downtime) is certainly not the only factor, everything else being equal, it is still a major factor to consider. It's unwise to pay too much, but it's worse to pay too little.
If you do a little homework it should be fairly easy to pick a reputable consultant that is a good fit for you and your practice.