Are You Getting Reimbursed? Dental Insurance for 2011
“If we aren’t reimbursed, we just write it off. We are busy enough that we don’t need the hassle of getting our patients mad and frankly it takes too much of my staff’s time chasing after unpaid claims.” Dr. J. Hadenough
Not every practice can boast that it is busy enough to write off insurance money that is due them. The insurance industry will pay eligible claims, but only if we follow the rules in the insurance billing process. Often training is lacking at the front desk, which allows thousands of dollars to go unpaid annually. Claims that are initially rejected by the insurance company, more times than not, are collectable if follow-up is performed immediately. If the follow-up still does not result in payment, then get the patient involved either with a three-way call to the insurance company or by including a letter from the patient addressed to a specific insurance adjuster (ask for the person’s name who will be reviewing the claim).
The reimbursement process is a sequence of interdependent steps that start with the dentist’s service to the patient. The following is the outline of this important process.
Lack of information that often holds up claim processing is:
The dental record is a legal document, and services rendered should be accurately described and legible on paper or precise in the clinical notes area of the software system you are using. The rules for documentation are clear when it comes to billing to an insurance company. If the service is not documented with the elements necessary to justify the CDT codes, then the work should not be billed to the insurance company. The services rendered need to include the diagnosis and any special circumstances that may have occurred, along with the correct date of the service. For instance, if the patient was seen as an emergency on Saturday and you are posting the service the following Monday, make sure that the date of service is Saturday.
Often, it takes an experienced or trained billing coder to catch and correct claims so that they are paid. One claim was rejected because a crown was performed on a 3rd molar. The insurance company did not pay for restorations on 3rd molars, because they are usually extracted or out of alignment. However, when the insurance coordinator resent the claim, she included x-rays showing that the 3rd molar in question was in occlusion and a narrative explaining that the tooth had excellent bone and was a necessary tooth for the patient to chew food. The claim was paid at the contractual rate of 50% of the UCR fee.
Dental insurance benefits are an excellent source of cash flow, with very few problems associated with reimbursement if you provide the information necessary to expedite the claim. Need training to improve your reimbursement rates and increase cash flow in your practice? Sign up for a training course through McKenzie Management and we will give you the tools to succeed.
McKenzie Newsletter Information:
To unsubscribe: To discontinue receiving the Sally McKenzie eManagment newsletter,
click on the link at the very bottom of this page for instant removal,
To report technical problems with this newsletter or to request technical help,
please send a descriptive email to: firstname.lastname@example.org
To request services, products or general inquires about The McKenzie Company activities
please send a descriptive email to: email@example.com
If you would like to have any of your dental practice concerns answered personally by Sally McKenzie,
please send a descriptive email to her at: firstname.lastname@example.org
Copyrights 1980-Present The McKenzie Company - All Rights Reserved.