Navigating Dental Insurance
Discount Plan vs. Insurance
Credit Balances?
Why so many unhappy hygienists?
Social media can be a useful tool to your dental practice. Many dentists are finding it a great way to connect with their patients and bring in new patients. Many people now use it to get their daily news. Today, if you are a dentist, I want you to use it for something else. Go online and read what hygienists are doing and saying. There are Facebook groups dedicated to getting out of hygiene and these groups are BIG. Hygienists on many forums and in many conversations have the same complaints. More is demanded of them for less reward. They spend the same money and time it would have taken to get a nursing degree but many of them don’t get full time work. They certainly don’t get the same benefits that are offered to nurses.
How did we get so many unhappy hygienists? Because we wanted to make our patients happy and we joined all the insurance networks. Suddenly our whole office needs to work harder to get paid. This resulted in shorter appointments and more admin work. That takes a physical toll on the body. It stresses hygienists out and they start to lose morale. So what can you do?
First you can make sure the administrative duties stay with the administrative staff. So many hygienists are reviewing insurance coverage and treatment to make sure they can take x-rays or do fluoride. That should be done before they open the chart. Your admin staff or verification company should have reviewed coverage and frequency and let the hygienist know the answers to the common questions the patient will ask.
Second your assistants should be helping with sterilization, room turn over, treatment planning and x-rays. These are tasks that don’t require a hygiene degree. It gives your hygienist back 5 minutes per appointment. And 5 minutes is huge.
Third, treat them like providers. Pay them like providers. Expect them to work like providers. They need to be educating your patients, they need to let that emergency patient fit into the opening in hygiene and triage the patient. Support expanded duties and further education. It will only improve your practice.
How do you protect your accounts receivables from staff turnover?
The problem of finding and keeping good help is a common conversation among dentists these days. Stories circulate of one person leaving and all of the sudden collections is down, candidates scheduling interviews and not showing up, and the staff telling the dentist they just can’t get it all done in a day. In many cases payroll goes up and up and the performance goes down.
Is it you? Is it your hours? Is it the job?
The fact is the dental front desk job has changed. It requires a lot more time focused on insurance. More time for someone to track down the payment for the care you provided. This time will increase practice overhead but does not always increase reimbursement. Front office employees need to do more for the same pay or less. Many offices are too small to offer benefits like retirement and health insurance. I believe these factors have contributed to the high turnover we are now seeing nationwide at the dental front desk.
How do you keep the system going consistently? My answer; eliminate the frustrating and time-consuming tasks from the job completely. You can now hire an outsourcing service to check eligibility, call on old claims and sent statement to your patients. This puts the workload on your existing staff back into balance. It reduces their stress level, it gives them more time to strengthen the relationship with your patients and, improves the quality of information they have to communicate with patients.
The best part is; no matter who is on vacation, gets the flu, or quits, your claims go out, your payments get posted and your A/R is always healthy.
www.dentalsupportessentials.com
Pre-Authorization vs. Predetermination
Ever wish a tech company would develop an app like Mapquest or Waze to help navigate your dental staff and your patients through the maze of insurance claim complexity?
Even the terminology is challenging!
Predetermination. Pre-Estimate of Benefits. Preauthorization.
These terms are very confusing to patients—even to staff! So, what do these terms mean? What’s the difference between them?
Occasionally, dental offices find that a plan granted preauthorization for treatment is denied payment when the claim is submitted. The denial is often rooted in a hazy understanding of the what constitutes “preauthorization” and what is simply a “predetermination” or “pre-estimate of benefits”.
Preauthorization
Preauthorization provides advance written approval for the planned service, which is generally valid for 60 days. Typically, preauthorization is not part of routine dental insurance plans, except Medicare, Medicaid, or managed care plans where certain types of services may require advance approval—or preauthorization.
This preauthorization for specified managed care plan services can be very important as failure to obtain it may—depending on the patient’s insurance plan—result in denial of the claim. In essence, preauthorization is a presubmitted claim for treatment, with diagnostic notes, radiographs, and specific procedure codes reflecting prescribed care.
In some states, once a health plan provider formally preauthorizes a course of treatment for one of its enrollees, the plan is required to pay for that authorized treatment. Because of this, many insurance providers are beginning to shy away from preauthorization.
Predetermination
Predetermination––sometimes called a pre-estimate of benefits or pretreatment estimate––provides confirmation that the patient is indeed a covered enrollee of the dental plan.
It also verifies that the proposed treatment is a covered benefit for this patient. In other words, a predetermination is a formal inquiry of patient’s eligibility for coverage but NOT a guarantee of payment. Many times, the insurance company’s initial response is inaccurate.
A predetermination typically requires all the same diagnostics as a preauthorization. It’s a process entailing a lot of work that results in no firm answer regarding payment. Again, a predetermination not a guarantee of payment, it is simply an of the patient’s benefits. However, it can only be accurate if the deductibles, maximums, and waiting periods are calculated in. Many times they are not!
One is example is a patient who had a $5000 treatment plan. Her insurance policy limited maximum coverage to $1000 annually. The dental office sent a predetermination to the insurance company; the insurance carrier replied by stating that the patient had 50% coverage of her $5000 plan—which was NOT true.
The treatment coordinator then had to explain to the patient that the insurance company would actually only pay 50% up to $1000 and not 50% of the entire plan––despite what the staff received in writing from the insurance carrier. It’s very difficult to explain to a patient why they will owe more than an additional $1000 than what the insurance carrier indicated. Most times, this confusion results in the patient declining treatment.
A Predetermination Is Not A Real Authorization
There are some benefits to obtaining a predetermination, such receiving notice of patient eligibility in writing, and it may prove to be useful financial tool when obtaining a patient’s consent for treatment and providing an estimated cost of what out-of-pocket costs may be involved.
But there is also a significant down side. The process of obtaining a predetermination often takes 4 to 6 weeks. This time-delay leaves time for patients to reconsider, lose interest, or forget the importance of the treatment plan.
And most importantly, the wording used to in explaining coverage to a patient is essential.The patient must be led to understand that a predetermination is only an estimate and not a guarantee of payment by their insurance provider.
Deductibles, copays, non-covered services, and the percentage of the dentist’s standard service procedure fee that the insurer has pre-negotiated with the dental provider may not be noted in the predetermination.
After much experience, we recommend that dental staff circumvent patient confusion by all together avoiding words like “authorization” and “determination”. For in-network providers, the best course is simply to rely on the fee schedule and break-down of benefits already provided by the insurance carrier. A predetermination is redundant and takes up staff time. However, should the patient request an advance understanding of costs, we believe the best terminology to use is “pre-treatment estimate”—which clearly communicates that the sum is only one’s best calculation of the total costs for services and potential out-of-pocket costs to the patient.
Is Dental Insurance Eligibility Taking Too Much Time?
Did you know checking your patient’s dental insurance eligibility (ahead of their appointment) takes an average of two hours a day? That’s at least 10 hours a week or 40 hours a month, at a minimum. Spending ¼ of an 8-hour day making phone calls, checking websites, and digging for information can really add up!
Dental insurance eligibility verification is like flossing. It’s a preventative measure that keeps from costing you more down the road! If patients don’t floss, they are prone to gum disease and more expensive treatments. If you don’t check eligibly ahead of time, more time and money will be spent on tracking down payments.
Ring…Ring…Ring…More Phone Calls?
Many insurance companies’ websites have eligibility information, but can really vary and either be comprehensive or extremely limited and inaccurate. This means hopping on the phone and starting the insurance phone call tunnel. Insurance companies greet you with a slew of automated prompts, having you repeat the reason of your call several times without the promise of a helpful (human) representative.
Two Tasks at the Same Time
Front desk staff often must manage two tasks – calling insurance companies and welcoming patients – which requires two different approaches. Phone calls require a firm tone and approach to get through prompts and reach live help (who often read scripts) and uncover the answers you need. While greeting patients requires a warm, pleasant, and welcoming tone. After spending 20 + minutes on a likely frustrating phone call, it’s hard to flip a switch to a warm smile and genuine tone when a patient walks through the door.
Secondly, it’s easy for front desk staff to prioritize easier tasks ahead of checking insurance eligibility because of the inevitable frustration and time suck. Eligibility is almost always going to be last, but it is also one of the most important because it heavily impacts your collections. It also happens that patients with “easy” insurance companies get checked, but the companies that are difficult to deal with fall low on the priority list.
Negativity from insurance phone calls can bleed into a patient’s treatment planning discussion if you aren’t careful. If a patient has an insurance that is very difficult to deal with on the back end, those feelings can unknowingly influence your conversations with patients. You must work around the negativity that can be generated when dealing with insurance companies.
Dental Support Essentials helps save time and boost internal morale with insurance eligibility verification, which is based on a flat monthly fee per volume of patients. We check eligibility three days in advance of an appointment, allowing for enough time for difficult cases, making patients, doctors, and staff happy!
Top 5 Reasons Your Dental Claims Aren’t Getting Paid
Are you looking to increase your dental practice cash flow? One area of business that heavily impacts monthly production is the dental insurance claim process. A very time-consuming, tedious process, dental claims may not be getting paid due to several reasons, but almost always begins with lack of follow up with the insurance companies after submission.
- The dental claim didn’t make it to the insurance company.
Many times, dental claims are submitted electronically and staff don’t check to see their rejections report or if an area of the claim is incorrect. The issue lies with the quality of the information.
- The dental claim is missing complete clinical documentation.
Insurance companies require a detailed clinical report and narrative depending on the procedure. The dental claim may be missing narratives or x-rays, and there isn’t enough documentation on clinical notes for reimbursement.
- The dental claim was submitted with bad information.
Sometimes it’s as simple as poor information from the patient or a mistake inputting information on the staff’s behalf (i.e. birth date, address, social security number, etc.) Always verify eligibility information before the patient sits in the chair.
- The dentist’s credentialing is out of date.
If the dentist’s credentialing is out of date, insurance companies hold onto the claim. Manage your renewal closely and start the credentialing update process at least three months ahead of time to ensure ample time for completion.
- The insurance payment has been completed, but hasn’t been posted.
Often, the claim has been submitted and payment from the insurance company has been sent, but a bottleneck is created at the posting phase. This happens when staff are too busy and the payment hasn’t been recorded in your software.
As we all know, dental billing management is a full-time job. Dental Support Essentials offers a turnkey Accounts Receivable solution for your practice from insurance eligibility checks, billing, follow up, appeals, and more! Trusting experts to manage your AR will save your staff valuable time and increase your reimbursement rate. So, what are you waiting for? I’d love to connect and discuss opportunities to streamline your dental practice!
Top 5 Reasons to Outsource Dental Billing
Is your dental practice experiencing a low collections rate or low morale due to overworked staff? As the practice owner, you may recognize things need to change but feel stuck and don’t know where to begin. Don’t fret! An effective, non-invasive solution of outsourcing billing and insurance eligibility to experts can help your dental practice thrive with satisfied patients, content staff, and increased monthly production.
There are common signs to look out for that indicate your dental practice could benefit from outsourcing, including:
- When phone calls with insurance companies (to get a breakdown of a patient’s benefits) are taking up too much time from your dental staff. Lengthily phone calls can take away valuable time with patients and can negatively impact your business. If patient interactions are suffering, it’s time to outsource your eligibility so your front office staff can focus on what matters most.
- When the dental office manager says, she can’t get all her work done or refuses to take a lunch break and works overtime. This is a sign you need a second pair of eyes on your dental office’s books. The office manager is overworked and likely experiencing burnout, which increases the likelihood of her finding a new place of employment and leaving your dental practice in a bad spot. Outsourcing billing will allow your business operations freedom and not dependent on one person.
- When there is a big stack of EOBs that haven’t been posted or monthly production is taking longer than 30 days. There should always be less than a month’s production on the books for the said month. If it has been over 90 days old, you need to outsource.
- When your over-the-counter payments are not being collected by the front office staff because of competing demands (eligibility checking and billing). If these over-the-counter collections aren’t happening, it’s time to outsource.
- When you know you need a staffing change, but are afraid to act because your business hinges on your existing employees.
If your dental practice is experiencing any of these pain points, compare the financial impact of hiring an additional employee verse outsourcing. Hiring a billing manager requires a salary, benefits, employee management, etc. Outsourcing to experts such as Dental Support Solutions is paid on a percentage (3.5%) of monthly collections. If you have a slow month and collect less, you pay them less. It’s a smart, scalable solution to increase collections and decrease Accounts Receivable.
Outsourcing dental billing operations ensures that the practice can survive apart from any one employee and business can continue if an employee leaves. Outsourcing can remove fear and present you with another option. Don’t feel stuck! Dental Support Essentials works with dental practices to manage their eligibility and billing operations. Your Accounts Receivable will improve, productivity of your staff will increase and they’ll have more time to fill your schedule, since they won’t be bogged down by billing management.
4 Keys to Help Protect Your Dental Practice
It used to be that dental offices existed as their own little island. The same five employees would stay for 20 years and personal and professional lines could become blurred. From dentists giving their employees loans to babysitting each other’s children, dental office staff interacted as an extended family unit. Dental office environments continually evolve and as technology advances, the landscape of employee and HR management needs to change. Time and time again, dentists don’t protect themselves or their practice until it’s too late and a former employee is wreaking havoc on operations.
Invest time upfront on simple procedures and documentation to ensure your dental practice has a trustworthy, accountable staff.
- Sign a non-disclosure and non-compete agreement
Create a non-disclosure for all employees, and non-compete agreement for dental associates and hygienists to review and sign. This agreement outlines that if the employee leaves the practice for any reason they (1) will not recruit patients, (2) will not tell patients why they are leaving the practice and (3) will not inform patients of their new employer. The sale of a dental practice is a common event for staff attrition to take place. With change in practice ownership, staff don’t always stay under the new dentist.
Hygienists and dental assistants take immense pride in building authentic, caring relationships with patients and often feel like they may have ownership over the relationship. Hygiene accounts for about 30 percent of a dental office’s business. Don’t allow your hygienists to reduce the selling value of your practice or impact your revenue if they leave on unhappy terms.
- Perform criminal background checks
Criminal background checks are a common hiring procedure across industries to give a comprehensive report of a candidate’s history and background. This ensures you’re hiring dependable, ethical staff members. Some dentists may feel criminal background checks are big deal or “over-the-top”, but you are ultimately protecting your practice and business.
I’ve worked with several dental practices that did not complete criminal background checks prior to hiring front office staff resulting in bad hiring decisions of former convicted felons. One red flag to be aware of is extreme gaps in employment history. This can sometimes indicate potential past criminal history. And remember, this isn’t a matter of a lack in trust, but having a low-cost solution to making smarter hiring decisions and protecting your patients, staff, and practice.
- Document all employees have received (and agree) to the dental office employee manual
A dental office employee manual outlines procedures and expectations for each employee of a dental office including, standard conduct, dress code, HIPAA and OSHA compliance, etc. To ensure compliance, each employee should receive a copy of the employee manual and provide a signature that they have received it. Documenting the rules and employee’s signatures of agreement will help with employee and HR relations if situations arise.