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.
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 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––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.
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!
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!
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.
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.
Proper infection control is a top priority of any dental practice to ensure the health of a patient is not compromised and to prevent the spread of disease and germs. Each dental practice must meet compliance and standards outlined by their state dental board. Achieving infection control is just the tip of the iceberg – it’s imperative to keep accurate and timely documentation of your dental office’s infection control policy and manual, staff training log, equipment and tool sterilization reports, etc.
Aside from maintaining the health of your patients and staff, having proper infection control protocol can safeguard your practice against retaliation. What kind of retaliation you may be asking? Disgruntled former employees. Time and time again, I’ve worked with clients who have experienced huge headaches because terminated employees alerted their respective state dental boards and made a claim on their former employer (insurance fraud, improper infection control procedures, etc.). State dental boards must investigate each claim they receive. Following a thorough weekly checklist of infection control activities can help keep your dental office up to date and ready for inspection at all times .
Infection Control Policies and Procedures Check List
- Have a detailed infection control policy and manual for your dental practice printed and available for all staff members.
- Keep a detailed training log that outlines each training, certification (i.e. CPR) staff member name and title, and their signatures confirming completion.
- Keep a weekly log to record and stay consistent with sterilization testing of your dental equipment each week.
- Some state dental boards provide an infection control manual. Obtain a copy online and use this manual as a guide to ensure compliance.
- Plastic materials (i.e. x-ray holders) used to be the standard, but now tools must be autoclavable.
- Never re-use disposable products. In attempt to save money, offices think they can wipe or spray these kinds of products for a second use.
- Keep dental instruments in their sterilized bag up until they will be used on the patient. Reducing outside exposure will ensure proper infection control.
- Always cover instruments, tools, and materials that may not be in use (i.e. containers for cotton balls). Aerosols can travel and stick to surfaces farther than expected.
- Spend extra time wiping down every surface every time a patient is seen.
- Keep your office’s ‘permissible practices document’ up to date. This document outlines all of responsibilities and tasks administered by each dental staff member.
- Be sure to properly dispose of needles and biohazards, and keep documentation of removal.
- Film x-rays are lined with lead – be sure to properly dispose of the lead foil. Additionally, save amalgam fillings for scrap metal.
Proper infection control management requires thorough documentation of your office’s day-to-day processes. Though infection control is expensive (I estimated it to cost $25/patient twenty years ago), it’s necessary for the health of patients, staff, and a well-run dental practice. Also remember, you don’t have to let the inspector in your office if they arrive unannounced. You can ask them to come back when the time is convenient for you.
One of the most common themes I encounter when evaluating a dental practice’s existing billing, scheduling, and management operations is the misconception that hiring additional staff or purchasing new technology is the go-to solution for solving areas that need improvement. When really the answer almost always lies in leveraging the resources you already have at your disposal to increase productivity, optimize schedules, and even grow monthly profit.
- Utilize the internet and insurance carrier web portals for eligibility checking.
Many insurance carriers have comprehensive online portals and websites available to check patients’ eligibility and obtain digital (PDF) reports that can be saved directly into a patient’s file. It’s common for front office staff to check eligibility over the phone, which is extremely time consuming and often very frustrating. Consistent negative feedback I hear from the front desk staff is the heavy workload due to the volume of insurance calls added to their other tasks. Using online portals and websites won’t fully replace calling insurance companies, but it will drastically reduce the time required and make this important task manageable. With less time being spent on eligibility checking, there will be less burnout and happier long-term employees.
- Maximize the existing employees your dental practice has on staff.
Dental offices often hire advanced qualified personnel (AQP) to help dentists provide care that a dental assistant or hygienist cannot. This hiring strategy when employed properly can allow the dentist to care for more patients.
I recently worked with a dental practice that had an AQP on staff, but was only being utilized at the skill level of a dental assistant. Instead of the dentist seeing 1.5 patients each hour (if the AQP was being utilized properly), the dentist was only seeing one patient an hour. The dentist was open four days a week and fully booked far in advance. Instead of needing to have an extra office day or extend hours, properly using the AQP to complete appointments would increase patient flow. Sometimes dentists are new to working with an AQP and have a tough time giving control over to someone else to finish his/her work. Since AQPs have a higher paygrade than dental assistants, it’s important to effectively schedule their time in harmony with the doctor.
- Learn every feature of your practice management software.
Staff Scheduling – Almost all software has a coding feature to easily visualize the staffing calendar to optimize appointment slots. For example, assigning colors to each personnel (doctor, AQP, dental assistant, etc.) can help the staff or office manager see the time requirement for each staff member against each appointment.
Appointment Setting – Utilizing the cancellation or broken appointment list feature can help in easier patient follow up and communication, and fill more open dental chairs when a cancellation occurs. For example, if a patient cancelled an appointment two weeks ago and it was recoded properly, and a last-minute opening occurs in the dentist’s schedule today, you can easily contact the patient to see if they can accommodate the opening. The patient will feel valued and top-of-mind, and the doctor can maximize his clinical time. Additionally, dental practices often invest in appointment confirmation services, like an email or SMS service. Instead of recording the responses from the service and then following up with patients to confirm via phone, I’ve seen front desk staff complete these tasks simultaneously, doubling up on their communication. If your practice pays for this type of service, fully utilize it – don’t pay for it twice (monthly subscription + staff hours)!
Treatment Plan Management – Many software systems can link treatment plans to an appointment for easier management and better results in the practice’s overhead. For example, a patient’s treatment plan could recommend work across three different appointments. One is scheduled the day-of the treatment plan review, but two are still open. As weeks or months pass by, you can run a report to show incomplete treatment plans, and allow for easier follow-up with patients. It’s important to always link a treatment plan to an appointment and add details (dollar amount, type of work, etc.) This will allow your practice to understand the projected monthly and annual income.
Prioritizing continuing education beyond your clinical staff is extremely important so your practice operations can run efficiently, saving time and money. Each client I work with always begins with reviewing overhead and finding areas that can be improved. Outsourcing time-consuming activities, like billing and eligibility, to experts can redirect practice staff time to focus on what matters most – excellent patient care. Dental Support Essentials offers ongoing support services including staff training, practice management services, credentialing, billing, and eligibility.
Insurance helps the public access health and dental services at a more affordable cost. It’s a necessary component to the healthcare industry and economy. The work required for effective dental insurance management and processing requires strong tact in thorough investigation and research practices. Without these strong practices in place, it’s easy for a dental office to fall victim to common insurance pitfalls that can negatively impact operations, collections, and patient retention.
Working with different dental practices over the years has uncovered common insurance errors experienced among the front office and clinical teams. Common dental insurance pitfalls to avoid include:
- Not investigating beyond the initial information the insurance company volunteers in the insurance coverage report;
- Not giving the front desk staff enough time to complete a thorough treatment plan; and
- Not differentiating multiple plans under a single insurance carrier.
Smart Investigation with Insurance Companies
During the initial dental treatment planning process, it’s common for insurance companies to return a report with preliminary information, but not necessarily include full in-depth details like waiting period and replacement period limitations, treatments received, and benefits used (in the current coverage calendar year). Investigating beyond the preliminary information received is integral to fully understand the treatment coverage and payment implications.
I recently saw the mistake of staff not investigating deeper beyond the information volunteered by an insurance company. A patient’s benefits were checked against their insurance and the practice was informed they had benefits for restorative work (50 percent covered). The doctor’s office then performed the prescribed restorative work (a crown) and submitted the claim, which was denied due to the patient not being covered for a crown. During the appeal process with the insurance company, I was informed the insurance company doesn’t consider crowns restorative, even though the ADA code book states crowns are restorative. This particular company considered crowns in their “major services” category and the patient did not have coverage for “major services”. Ultimately, the patient ended up having to pay 100 percent of the procedure because someone misread the breakdown of benefits. According to this patient’s plan, a crown was a major procedure, and nowhere on the benefits breakdown did it say no coverage for “major services”, it just showed what they did have coverage for. The dental office staff can’t assume insurance companies are going to disclose all necessary information upfront in the initial check. Yes, this may seem backward, but it’s the process at play and must be played correctly for the benefit of the patient and financial health of the dental practice.
Develop a Well-Researched Treatment Plan & Timely Patient Communication
We’ve all heard the saying ‘time is money’. This is particularly important when informing patients in a timely manner of their dental treatment plan. When the patient is in the chair, clinical reasoning is fresh in their mind, but once the pain has subsided, they leave the office, go back to their life and forget about making a timely treatment decision. The urgency of the treatment has subsided and patients often think an intermediate fix is sufficient enough if they are not fully informed on further care and treatment options.
The back and front office need to work in harmony during the patient’s visit to produce an accurate, well-informed treatment plan. This starts with the clinical team giving the treatment coordinator enough time to put the treatment plan together before the patient is sitting across from her. The coordinator should be explaining the financial options and scheduling the appointment, not still researching the details of the plan. Among the financial implications, the treatment plan should explain to the patient the cause, effect, treatment option(s), and what could happen if the problem isn’t fixed beyond the doctor’s assessment. This gives the patient a choice and responsibility of making an informed decision in a timely manner.
Providing accurate insurance and payment information to patients before a procedure (beyond preventative care) is the lynchpin to satisfied and trusted patient relationships. Slowing down, taking an investigative approach, and asking detailed questions with the dental insurance companies will help your dental practice avoid these common insurance pitfalls and rise above towards dental insurance management excellence.