4.24.15 Issue #685 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Belle DuCharme, CDPMA
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Do You Need an Insurance Coordinator?
By Belle DuCharme, CDPMA

Staffing expenses are usually the highest expense incurred when operating a dental practice. Being able to afford to hire more staff when the need arises must be approached realistically and never out of panic or desperation. A common scenario is for a practice to grow beyond the one person at the front desk being able to handle it all, and a new team member is needed to accomplish all of the tasks at hand.

If there are more than 20 patients being processed per day at the desk, it is time to look at hiring another full time employee with a definitive job description. The job description now becomes two, with the Business Coordinator as the Financial/Insurance Coordinator and the new hire as the Scheduling Coordinator (the first in line to answer phones and collect and enter patient data). If the practice sees 40-60 patients a day and is involved in more than 10 Preferred Provider Networks, the feedback I receive from practices is that an Insurance Coordinator is also needed because of the time it takes to verify benefits, appeal dental claims, sit on the phone waiting to talk to a representative, entering insurance checks in the system and doing the write-offs by contract and entering and updating insurance fee schedules.

More practices lose patients over miscommunication involving dental insurances and billing than they do in actual clinical dental care. There must be diligence to collect co-payments and applicable deductibles (as contracts stipulate) from patients to ensure adequate cash flow to keep operations in the black. The Insurance Coordinator is often the one to give this information to the Financial Coordinator if not involved with the check-out. Achieving treatment acceptance involves being able to explain the coverage and financially prepare the patient for out-of-pocket costs. This takes time at the desk and is often cut short by phone interruptions and patients needing to be checked in and out. This is the reason the Insurance Coordinator is needed, to complete the patient check out process.

Being involved as a PPO provider is a personal decision. It is important to be aware of patient perceptions in your demographic and whether this decision is best for your situation. The following is recent information from the Delta Dental Plan Association:

Although almost 85 percent of the total population has medical coverage, only 57 percent of the total population has dental coverage, among those without dental benefits, “lack of insurance” was the most commonly cited reason (44 percent) for not visiting the dentist. The most commonly reported individual health-related service not received because of cost is dental care.

Eighty-one percent of individuals with dental benefits reported seeing a dentist twice a year or more, while only 34 percent of uninsured individuals reported the same frequency of seeking preventive care. Furthermore, people without dental benefits are less likely to have tooth-saving and restorative procedures (fillings, crowns, root canals) than those with benefits but more likely to have extractions and dentures. Those who currently receive dental benefits place a high perceived value on their coverage – as indicated by their reported willingness to pay up to three-and one-half times more to acquire such a benefit. 

Since the 1960s when dental insurance was first offered by employers, the maximum per calendar year has not changed with the average still being $1,000 per calendar year or fiscal year. Statistics show that more people visit the dentist who have insurance than those who don’t. A dentist who is not a Preferred Provider in a network of insurance companies can lower the revenue into the practice considerably. A patient might say, “Why doesn’t my dentist accept my dental plan?” The opportunity to attract more patients is there, but because of the constraints on optimum care and the reduction by 30% or more of the dentist fee, the PPO network dentist must rely on volume and efficiency to survive.

Quality care comes at a quantified price, and the dentist’s efforts to control some costs are not sufficiently successful to achieving the goal. Good dentistry cannot be sacrificed to be profitable in the PPO network. Volume of patients would dictate that the dentist must work out of two to three rooms at a time and perhaps double up on hygiene days or hire another dentist. Operational costs become larger issues and stress levels shoot up.  

According to PayScale.com, the median salary for an Insurance Coordinator is $16 an hour (December 2014). This is considered a full time position in practices with heavy PPO network numbers. This person is mostly concerned with checking and filing insurance claims, attaching narratives and other documentation, following up on unpaid claims, verifying insurance eligibility and other duties as described above. Follow-up on unpaid claims often requires up to 20 minutes on the phone per issue. If no one is working this system, your over 90 day accounts receivables is going to be very high.

Is there another way? You can explore your options with us by signing up for a course in Office Management Training and learn how to manage your practice to ensure success.

If you would like more information on McKenzie Management’sTraining Programs  to improve the performance of your team, email training@mckenziemgmt.com

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