By Amber Darst
A few years ago, I was propelled into the world of dental insurance. I knew very little about dentistry before becoming the insurance coordinator for a local practice. The woman I was replacing decided to attend nursing school and had to leave the practice quickly to begin her new adventure.
I received four days of formal training. You heard right, four information overloaded and packed days. My exact duties were to verify patient insurance, calculate all copays, acquire preauthorizations, and provide financial counseling assistance to patients before their restorative procedures, along with managing payroll and billing.
I made numerous calls to insurance companies, even to ask the most fatuous questions about the explanation of benefits (EOB). I was completely perplexed about how to take information from the EOB and apply it to a patient’s account. I could not believe that dental insurance was so complicated. To me, it was like reading a foreign language. There was so much fine print and so many areas to cover. There were innumerable varieties of policies and coverages. Don’t even get me started on the carriers that were partnered with other carriers that now meant we had to honor an in-network fee for them as well. Whew! I was definitely in over my head!
But I’m not one to give up easily, so I dug my heels in deep and decided to educate myself about dental insurance. Fun? No. Rewarding? Absolutely. Within a few months, I had wrapped my head around enough to do my job efficiently. I could finally come to work with confidence and welcome patients into my office to discuss their policies without a shake in my voice.
I became thankful for my impromptu approach to my newfound career. Learning the hard way allowed me to develop a deep understanding of dental insurance by going the long way around and not simply mimicking what I was taught. Also, once I gained an in-depth understanding of the economics of dentistry, it really hit me just how much the accuracy of my work impacted the practice’s bottom line. The job and all it entailed was an integral part of the practice.
The practice I worked for had only one person at the front desk. My small office was tucked just behind hers. I was often pulled away from my insurance tasks to help with patient care activities such as check-in, check-out, bill payment, and answering the never-ending phone calls.
Of course, patient care always came first. Unfortunately, this often put my insurance duties on the back burner to be done haphazardly at some future time. I didn’t realize how common this issue was until I started working for my current company. I absolutely loved working in a private practice, but when an opportunity to work remotely fell right into my lap, I just couldn’t pass up the flexibility and what the position offered.
I now work for an outsourcing company with experts in various medical and dental back-office duties. My job involves helping dental practices ease their administrative responsibilities, which allows them to focus on what they do best: care for patients. I’ve spoken with several clients who are struggling to tackle everything just like I had struggled. I can relate to their pain all too well.
One thing is for sure; dental insurance verification is critical to maintaining a steady cash flow, and practices need to abandon half-hearted approaches. Having a fully dedicated, uninterrupted dental expert working on verifications and authorizations is hands down one of the most important aspects of running a successful and profitable practice.
How does outsourcing save time and improve your practice?
You can focus on improving the patient experience—Outsourcing allows you to focus more on your patients. As I said, patient care is the highest priority. You want them to feel welcome and not rushed. By outsourcing your dental verifications and other back office work, you and your staff can be more focused on direct patient care and customer service. When patients feel like they’re important to you, they’ll keep coming back.
It frees up staff’s valuable time—Calling an insurance company and verifying benefits for just one patient can take at least 20 to 30 minutes. Hold times are excruciating and there’s absolutely no way around it. Several insurance companies will not even allow you to set up a web management portal to verify benefits electronically unless you’re contracted with them, which forces you to make the harrowing calls to customer service representatives for each and every verification. Your staff’s time is valuable, and time is money!
It ensures hassle-free insurance verifications and preauthorizations—Insurance is tedious, which makes verifications complex. It takes so many small pieces to make up one insurance policy puzzle. You must verify maximums, deductibles, waiting periods, coverages, and miscellaneous clauses that are different from plan to plan. Trying to keep track of each and every detail can be a lot for someone to handle when there’s chaos distracting them in the office.
Missing just one detail can be very costly. This is not acceptable for the doctor or the patient who could potentially be left with an unexpected bill. Outsourcing this task ensures that it’s handled efficiently. An insurance verification specialist will check the patient’s eligibility for treatment when the person calls to schedule the appointment. Patients will be asked for their insurance information so that their plan and benefits can be verified before the appointment. Verifying benefits upfront prevents claim denials due to eligibility errors.
Getting help with preauthorizations and predeterminations can save even more time and headaches. I’m sure you’re well aware that some policies require a preauthorization for certain procedures. Again, it can take time to get an answer from the insurance company. It’s important to know that information should be submitted from the beginning of the process. Insurance companies are very particular with their requirements concerning attachments and letters of necessity. Providing the following details is a must:
- Patient demographic information (name, date of birth, insurance ID number, and more)
- Provider information (both referring and servicing provider)
- Requested service/procedure along with specific CDT codes
- Diagnosis (with corresponding ICD code and description)
- Location where the service will be performed
Insurance companies may also ask for medical notes, documents relating to previous treatments, and clarifications on the type of service provided. Obtaining prior authorization involves routinely calling the insurer to check on the status of the application. This is very time consuming.
Obtaining predeterminations is extremely beneficial as they give you and the patient an opportunity to review and understand the financial impact of the treatment and how much of the cost will be covered. The predetermination notes the contracted fee (if applicable), the write-off associated (if applicable), the insurance payment portion, and the patient payment portion. A predetermination is a good idea even for minor restorations. For example, composite fills on posterior teeth may not be a covered service and are often downgraded to an amalgam coverage payment only. This information will be revealed in the predetermination.
Verifications and authorizations are not the only thorn in your side. Have you ever pulled an insurance aging sheet to look at the outstanding insurance claims? I hope you answered yes! Knowing where your pending insurance claims stand is crucial to the proper management of your accounts receivable. Calling each of the insurance carriers about the status of the claims takes hours. Therefore, another very popular outsourced service is AR follow-up.
Those 30-day, 60-day, and the always-dreaded 90-day AR buckets are ugly little reminders that your money is still out there. Although it may take hours to fix, it’s always worth tackling. Remember, certain insurance companies give you only a small window of opportunity to complete claim adjudication and receive payment. After that, you can consider it a complete loss!
Getting outside support for dental back office duties saves money. Salaries for in-house dental assistants range from $20 to $32 per hour plus 30% for benefit costs. Recruiting, onboarding, and retention expenses are also high. Outsourcing is much more cost-efficient. You pay only an hourly rate based on the number of hours worked. Savings on overhead costs can be up to 30% to 40%.
Hiring an outside assistant is also economical for these reasons: payment only on an hourly basis; no payroll taxes; no benefits, vacation, or holiday pay; no need for additional computers, phones, and other equipment; fewer staffing problems; and no training costs. An outside assistant is more productive, with no interruptions by phone calls, patients, or other staff.
I felt compelled to share my story knowing how hard it is to juggle the day-to-day tasks of working in a dental insurance department. Had I known outsourcing was an option, without a doubt I would have asked the doctor to outsource at least a portion of my duties. It was a huge stress for me to watch my work periodically slip through the cracks.
Regardless of whether you outsource these services or keep them in-house, be sure to do an evaluation of how each of the tasks I discussed is being handled in your office. Ask yourself:
- Are all of the patient’s insurance verifications complete ahead of the point of service?
- Are they done efficiently, covering every detail of the policy?
- Are procedures that require authorization getting the necessary attention?
- What does the AR look like? Are there several claims pending beyond 30 days?
- Does my staff feel overwhelmed and spread too thin?
You may be surprised at what you learn!
Amber Darst studied business management at Hocking College. She was a dental coordinator for a private practice for several years before obtaining the dental coordinator position at Managed Outsource Solutions. MOS handles all back-office functions for medical and dental practices across the US. For more information on how MOS can help your practice, contact us at (800) 670-2809 or visit outsourcestrategies.com.