12.9.11 Issue #509 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Nancy Caudill
Senior Consultant
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Get Your Insurance Claims Paid
By Nancy Caudill

“Outstanding Insurance Claims” - “Insurance Claims Aging Report” - these are names of a very important report that you should be generating in your practice at least monthly and preferably weekly.

What is it?
This report creates a list of insurance claims that have been processed by your business coordinators after a patient has been seen, an insurable charge was posted and a claim was created.  Some claims are electronically generated and some are manually created - it depends on your practice and the situation.

Why is this report important? 
It is not unusual for me to visit an office that has $50,000 worth of outstanding claims that are over 60 days old.  This is not acceptable, as this is money that is due for services provided in your practice, and there is no one on your business team that is responsible for staying on top of these outstanding claims. This is money that is NOT in your practice but should be.

Who should be responsible?
Your practice should have one business coordinator that is responsible for managing the outstanding claims in your office. Typically, this person is also responsible for the Accounts Receivables, including daily statement generation that was discussed in my last article. However, if you have a smaller office with few patients, then you may only have one person in your business office that is responsible for everything, including this.  A larger practice may have an Insurance Coordinator that is only responsible for insurance eligibility, generating claims, maintaining the outstanding claims and responding to inquiries from the various insurance carriers. It can be a full-time position in a larger office that accepts the assignment of benefits.

Electronic or Manual?
All dental insurance claims should be generated electronically to save time. In addition, the clearinghouse will initially reject any claims that have incorrect social security or ID numbers, missing information and other important pieces of information that is necessary for the insurance carrier to process the claim. By rejecting the claim initially, it allows your Insurance Coordinator to correct the data and resubmit immediately, opposed to waiting until a call is placed to the carrier to determine why the claim is not paid.

In order to submit electronically, the practice must purchase this service from one of several companies that can be found through the internet or through your practice software company.  Prices can vary - some companies charge per claim and others charge a flat fee per month.  Determine which works best for your practice.

In addition to subscribing to a service for processing your claims, you must also subscribe to a service that will process your attachments, such as x-rays, photos, periodontal charting, etc. If you choose not to use this service, any claims that must have attachments to them will have to be handled manually by printing the claim, attaching the x-ray or other documentation and mailing the claim. This is not only time consuming but it delays the payment process of your claim, as electronic claims are processed more expeditiously than manual claims.

What should be attached?
If you want to expedite your claims quickly and avoid an inquiry, the attachments are vital to your success of managing the outstanding claims. It is noted that insurance carriers are rejecting claims for various reasons and are rejecting more now than in the past, in an attempt to delay the process or hoping that the dental office will not respond to their inquiry, therefore avoiding the insurance company from having to pay on the claim. It is all a big game, unfortunately, but one that must be played for many offices.

In order to get your claims paid quickly, send along with the claim a narrative as well as a photo or x-ray that will support the reason for the treatment. Why wait until the insurance company requests the information - send it with the claim initially!

Narratives are vital to the payment of a claim for specific procedures such as onlays, inlays and crowns. The insurance company is looking for a reason to either downgrade the procedure to a filling or deny it altogether. The narrative supports the treatment, since often the photo or x-ray will not illustrate the condition of the tooth.

Narratives can easily be generically created in the form of a checklist for reasons such as:  cracks, lost tooth structure, previous endodontic therapy, etc.  This checklist can be attached to the routing slip of the patient that is receiving treatment for a procedure that needs a narrative. The dentist indicates which narrative is applicable for the treatment and when the routing slip is brought to the front desk, along with the patient, the narrative is then included with the attachment on the insurance claim.  It is a simple matter of “copying and pasting” the appropriate narrative into the “notes” section of the claim before it is submitted.

What is my objective?
No outstanding claims over 60 days for sure, and to improve cash flow, no claims over 30 days. This requires attachments, narratives and a protocol for “dialing for dollars” to the insurance carriers or visiting their websites to determine why the claims are not paid.  Remember - this is money that is owed to the practice. Go get it!

If you would like more information on how McKenzie's Consulting Coaching Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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