As an office manager, do you feel like you’re being pulled in a million directions every day? You are scheduling to goal, coaching staff, presenting treatment plans, focusing on patient acquisition and retention, responding to the doctor’s needs, and so much more, while simultaneously trying to handle the many billing processes that keep the practice on track financially. To make your life easier—and take your collections to the next level—follow these five proven best practices to ensure your dental billing process is unbreakable, no matter how many plates you have spinning!
1. Credential providers as soon as they are ready to join the practice
Whether the previous practice owner is retiring, a new associate is coming on board, or the owner has decided to sell, as soon as you know another doctor will be joining the practice, you should begin the credentialing process. If you work for a multi-location practice and providers see patients at more than one office, credential them at all appropriate locations to decrease complicated claim follow-up and payments being sent to the wrong office.
As you are working on the credentialing process, have an internal protocol in place for scheduling patients while waiting for the approval letter. Ask the insurance carrier if the credentialing will be effective on the application date (backdated), or on the approved date. This will help you determine the best internal method and verbiage for scheduling patients.
2. Submit claims using the most current ADA format
As of March 2021, the most current ADA format for claims is still the one from 2019. Using the most up-to-date format cuts down on insurance denials due to missing information on the claim form. The differences may be minute, but they are critical when it comes to getting a claim paid the first time. All it takes is one box that has incorrect or missing information and—BAM!—that claim is kicked back to you without payment. Check with your practice management software for any updates if you are currently using an older claim form, or you don’t see the most current claim form as an option to choose.
3. Bill office fees to insurance companies
Do you have insurance-negotiated fees on your ledger? Are they listed on the patient’s treatment plan? Do you find yourself making debit adjustments in the patient’s claim to match the explanation of benefits (EOB)? Patients are understandably upset when they are hit with unexpected additional copays, which can lead to negative online reviews and lower patient retention.
Did you know that you can keep the negotiated (PPO) fee on the ledger and also change your claim format to bill full office fees to the insurance? A best practice is to also show the full office fee on the patient’s treatment plan. Let’s talk about why:
- Most states (currently 38) allow the patient to be held 100% responsible for the full office fee on a noncovered procedure. So, when you verify the patient’s insurance, ask if the noncovered services are subject to the plan’s negotiated fees. If not, the patient is responsible for the full office fee without any PPO adjustments. Believe it or not, this small step can increase your collections by 25-40%!
- List the full office fee on the treatment plan. The patient will appreciate your billing transparency and won’t face surprises later. They’ll be able to prepare to pay 100% of the full fee if their insurance denies the procedure as a noncovered benefit. Conversely, if the insurance pays more than expected, refund checks are an amazing internal marketing tool and can boost patient loyalty!
4. Submit claims under the correct rendering provider
You are working hard to fill the schedule every day, but are you remembering to schedule patients with the correct provider—the one that will be on the claim form? Are you verifying the rendering provider on the claim form before sending? Here’s why both of those steps are so important:
- Sending a claim with the incorrect provider can lead to numerous undesirable consequences: improper payment or denial, payment sent to the wrong location or to the patient, insurance audit, and more. These are all avoidable with a quick review of the claim form and a double-check that the rendering provider is listed correctly (boxes 53-58).
- If you have associate providers in the practice who are paid a commission based on total insurance collection, eliminate the guesswork by having them sign off on the day sheet to confirm that the procedures charged under their name are correct. When sending the claim with an associate as the rendering provider, confirm that the billing provider is correct on the claim (boxes 48-52a).
Remember that hygienists are not rendering providers that need to be listed on the claim—the doctor that performs the exam is the rendering provider.
5. Review claims for accuracy prior to submitting
This final best practice is the most important, so that you catch any of the above before submitting the claim for payment. In addition, review the following information to ensure the claim is 100% accurate:
- Patient information
- Insurance information
- Procedures and fees
- Provider information
Insurance denials due to incorrect insurance or patient information are the mother of all lost profits. By reviewing all insurance and patient information and verifying that it matches what the insurance company has on file with an insurance representative, you’ll ensure your claims are squeaky-clean and ready to go.
Best practices are so-named for a reason. They are time-tested and proven to be the most effective and efficient ways of getting desired results. In this case, you want to prepare and submit claims in the very best way so you are collecting the most from insurance companies in the least amount of time. Also with the least amount of effort, because you’ll avoid spending more time later resubmitting and/or preparing appeals.
Author's note: For further reading on this topic, I recommend the free e-book, Becoming the Ultimate Office Manager: Rocking Pre-Appointment Readiness.
SANDY ODLE is the chief experience officer and cofounder of eAssist Dental Solutions, a company specializing in remote dental and patient billing. Sandy partnered with Dr. James Anderson 11 years ago, and now they work with dentists and dental office managers all over the country.