Optimizing your insurance systems

June 23, 2010

By Denise Ciardello and Janice Janssen

We all hate the “I” word — Insurance. The mere mention of the word leads to eye rolls and heavy sighs. But just like taxes, to survive in the dental industry your office will have to deal with the insurance world. It doesn’t matter if you are married to big insurance by accepting all the plans, latched on by having primarily Medicaid patients, dipped your toe in the pool with only one or two plans, or are totally out of network but still file and accept assignment of benefits from your patients’ plans — it’s a necessary evil that has crept into your practice.

How is the insurance aging system in your office? Is it non-existent except when you inquire about outstanding claims? Is it a chore that tears the flow of the office apart when it’s “that time of the month”? Or is it a smooth, effortless occurrence that you never know even takes place, other than when you see the checks flowing in? The latter is what you need to achieve, and it is possible as long as the systems are in place to make it happen.

Question 1: Do you verify insurance before seeing a patient? It is amazing to think of all the offices that do not verify insurance at all. How do you know that patients have an insurance plan that will allow them to use their benefits in your office? How do you know they still have that particular plan? Do you think that an airline employee would let you on a flight and ask for your ticket at your destination? Or better yet, call you a month later and tell you that you were on the wrong flight? You arrived at your destination and received all the services you needed from the airline, so you would not be in a hurry to make amends on the outstanding bill, right? Then why would you let a patient come in for a cleaning, extraction, or crown and not know in advance how you will be paid? Yes, this means that someone will have to call the insurance company (say it ain’t so!) or go online to look up the benefits package. There are even companies that will do this for you at very reasonable rates. If you need assistance with finding these companies, please contact us. At the very least, make sure that the insurance plan your patient thinks he or she has is indeed the correct plan.

Question 2: How do you submit claims to the insurance company? Are you still printing and sending your claims by snail mail? If you have even one working computer in your office, you have the technology, so why aren’t you using it? Electronic claims are not just the way of the future, they are the way of today. It is a proven fact that you will receive payment on your claims twice as fast with electronic submission. That should be reason enough to find an electronic process and use it.

The best part about eClaims is that each time you send a batch of claims, you receive a status report on previously sent claims. You get a sneak preview of what that EOB will look like before that paper comes in the mail. If an X-ray or any additional documentation is needed, you will know sooner and get to it quicker, which allows you to get paid in a more expeditious manner. This leads to the issue of submitting X-rays with the claims. Yes, there are still some insurance companies that do not accept electronic attachments, but those numbers are dwindling every day … OK, every year.

The electronic clearinghouse that you use will give you details on how to begin this process and the percentage of companies that accept them. Without a doubt it is worth a phone call. If your radiography process has not come into the digital age, then you still must send a copy of the X-ray, print the claim, and send it through the good ol’ U.S. mail system. Remember to send a copy, and DO NOT send the originals. Most insurance companies no longer return X-rays. Your prophy, perio maintenance, fillings, etc., may still go electronically. Now that we have streamlined the submission process, let’s move on to the aging of claims.

Question 3: How often do you work on insurance aging? These are your claims that are overdue. Possibly the first question is: When do you consider a claim overdue? Industry and insurance standards dictate 30 days; however, if you use the electronic claims process, this number should be decreased to 20 days. Is your insurance aging report run daily, weekly, or monthly? How much is too much or not enough? By running your report monthly, you are probably increasing the delay in payment from the insurance company. Think of it this way — you submit a claim for Mr. Smith on May 10, and you typically work your outstanding claims on the 20th of each month, so by June 20 when Mr. Smith’s claim isn’t paid you contact the insurance company (you are now at 40 days past the DOS), only to find out that the claim was never received and you must resubmit it. Using your current method, it will be 70 days before you “revisit” this claim. In our opinion, monthly is not an efficient timeframe.

Some insurance coordinators run their insurance reports daily. This may be overkill, but we applaud their aggressiveness and tenacity. These are the offices that typically have only one or two claims over 30 days. Hurray for those go-getters!

Our experience has proven that this should be on your weekly task list. You catch the “non-received” and the “additional information needed” more quickly and get paid in a more timely manner. We previously mentioned the status reports with electronic claims, and if those are being monitored you will catch the claims that require additional information in short order. In this case the weekly report will assist you with the claims that were never received. Side note: Doesn’t it seem like every fifth claim is never received?

Question 4: How are you documenting your conversations with the insurance companies? We will go back to the first point of this article, that if you have computers and are filing electronically, then documentation should be maintained on your computer as well. Most practice management software has an “insurance status” box, window, or notes section. Use your software to benefit you and those that might be coming in behind you.

It’s incredibly frustrating to see members of the same team put notes in different places — some on the computer, some on the paper report, and some on sticky notes. Set up a system for your office and train all team members on the system. What should you document? The person’s name, which gives you credibility if you have to call back, the date and time, and of course, what was discussed and the course of action. If the claim had to be resubmitted, document that. If the representative told you the claim would be processed within 10 days, write it down in a place that will remind you to call and check on it in 11 days. You must follow up because the odds are that they will forget about you with the click of the receiver.

Question 5: How do you input your payments? Say for example someone paid for only three of the four procedures submitted. How do you resend part of the claim? Some versions of practice management software allow you to split the primary claim so you can satisfy part of it with the payment and resubmit the unpaid procedures. Or, you get the check and life is good. But wait, the estimate you gave the patient for their portion was WAY off and the person now has a large balance. You may need to do some research to determine if additional appeals need to be made; whatever the outcome, don’t forget to document your findings. If the balance is truly the patient’s to pay, drop a statement in the mail instead of waiting until you run statements at the end of the month. This way when the patient calls you in two days to inquire about the balance, it’s still fresh in your mind and you can explain the reason. Another method of payment to consider is the direct deposit. Talk about the speed of lightening. You will receive payments two to three times faster than with conventional methods.

What are your insurance systems? Are they being followed? Are you happy with the results? Industry standards state that .5% to 1% of your monthly production is acceptable as outstanding insurance A/R. Any more than that and you are letting someone else hang on to your money — interest free. Not a very profitable savings plan. This is money that is rightfully yours and should be in your pocket.

All dental offices have to deal with insurance companies in one way or another. Spending time setting up the proper systems for verifying, submitting, and working the insurance aging report can change insurance companies from the beasts that you dread tangling with into manageable tasks that keep the cash flowing. In addition, your patients will appreciate the fact that you stay on top of their benefits and payments.

Denise Ciardello and Janice Janssen are the founders of Global Team Solutions, a practice management consulting firm specializing in team training, team building, and employment law compliance. Janice can be reached at www.janssenconsultingllc.com (314) 644-8424; and Denise at www.InnovativeDentalSolutions.net (210) 862-9445.