Insurance Verification and Other Tips to Decrease Claim Denials

When asked, dentists regularly report managing dental insurance as one of the biggest challenges of their business. Given the role dental insurance plays in revenue generation– nearly 50% of dental practice revenue comes from insurance claims–it makes it clear that finding ways to improve the claims process could have significant impacts on the industry.

It’s one reason why the ADA is working to reform dental insurance laws. But, while larger professional organizations focus on systemic changes to improve how dental insurance is managed and how dental practices receive payment, there are things you can do within your own practice to improve the claims process and keep your revenue stream consistent.

Quick Links

• The Role of Insurance Verification in the Claims Process
• Top Reasons Your Insurance Claims are Denied
• The Cost of Claim Denials
• Automated Insurance Verification and Other Tips to Improve Claims Acceptance

The Role of Dental Insurance Verification in the Claims Process

Services rendered inevitably leads to payment, but inevitably isn’t a time period most businesses can function on. There are overhead costs to meet and so ensuring amounts owed to your practice are paid on time is an important aspect of the business. However, bills go out and payments come in is a pretty simplistic look at all the moving parts that oversimplify the dental billing process.

First and foremost, a solid and comprehensive treatment plan can help your patients prepare for care expenses and time then when they can handle out-of-pocket expenses. However, even for your patients, understanding what treatments and procedures are covered by dental insurance and what costs they must cover is crucial for ensuring on time payments. With a treatment plan in place, you help your team and your patient prepare while not exceeding coverage limits.

Of course, one of the key components to a treatment plan as well as patient understanding of out-of-pocket expenses is dental insurance verification. More specifically, gaining a complete understanding of what a patient’s insurance will and won’t cover as well as what copayments will be required can help ensure you can cover the costs of patient procedures.

This helps ensure that, when you submit your claims, you’ll get the payment you expect and, similarly, your patient won’t be surprised by unexpected charges. When it comes to managing your revenue cycle, dental insurance verification can help you stay on track and ensure full payment of those claims.

And, if you don’t verify the insurance, not only may you delay payment, but your claim may be denied leaving your patient holding a bill. The consequence for your practice? Not just a delayed payment but possibly time, effort, and resources spent on collection. In short, you end up spending more money than you’ll likely recover.

Top Reasons Your Insurance Claims are Denied

Of course, verifying insurance can prevent some claims from being denied, especially when it comes to procedures which aren’t covered. Still, many dental practices face an uphill battle when it comes to insurance claim denials. If you’re one of those practices, know you’re not alone, but company, much like inevitability, doesn’t pay the bills.

Even before we get into the weeds and look at the line items that can wreak havoc on the dental insurance claims process, there are systemic issues with dental insurance and coverage. Insurance companies make money when they don’t have to pay out for procedures and treatment. While not necessarily nefarious, it is the cost of business, it does make your job harder. You have to submit a clean claim to ensure you get payment, but the person reviewing your claim? Their job hinges on finding mistakes. So, even simple mistakes may result in a claim denial.

The other systemic issue you’re facing is the complexity of dental insurance policies. Often, your patients don’t know what’s covered and following all the requirements of the insurer can be difficult, especially when your team is managing many different insurers. From waiting periods and pre approvals to exclusions and documentation requirements, even filing a claim can be time consuming and delay payment. Once your team has met all of these requirements, it’s still not a guarantee you’ll be paid.

In fact, while some of those are among top reasons insurance claims are denied, there are still some other issues which might lead to the same end. Other reasons your claim may be denied include:

• Exceeding coverage limits
• Delay in filing/Too late for claim
• Lack of pre-authorization
• Lost claims
• Incorrect coding
• Incomplete or incorrect information

It’s estimated that nearly 85% of denied claims are potentially avoidable. While some of these issues are correctable, even if you resubmit and the claim is accepted, for many practices, that delay is costly. 

The Cost of Claim Denials

Much the rest of the payments process, the costs of a denial are not simple. Initially your dental practice must manage and incur revenue loss, but beyond that, someone must recoup the payment. When re-submitting a claim, it’s still unclear whether the insurance company will pay in full, partially, or not at all.

In addition to revenue loss, re-submitting the claim can add up. Often, the cost of resubmitting can run $25 per claim, nearly 3x the cost of submitting an initial claim. Then, given time constraints, the process often requires swift action meaning your team must focus on determining the error or issue and working with the insurer and insured.

The time your team spends managing insurance and insurers is already significant. Adding avoidable claim denials to their list of tasks prevents them from providing the service and care your patients need and deserve and, perhaps more importantly, prevents practice growth. 

Tips to Improve Insurance Claims Acceptance

With insurance claims and payments providing most of your revenue, managing the process is paramount to practice success. Knowing the potential problems is only half the battle. The other half is understanding the steps, tools, and resources you can use to decrease insurance claim denials.

Obviously, as we mentioned, verifying insurance is one of the key first steps. This way you can not only verify whether your services are in or out of network but also understand the cost to your patient. Further, this process helps ensure the procedures and treatments you plan are covered by your patient’s policy.

In addition to that step, makes sure you:

1. Gather all necessary patient data
In dentistry, 42% of denials come from missing or inaccurate information ranging from an individual’s prefix to incorrect plan information. 

A policy might offer coverage, but it may come with limitations or requirements such as pre-authorizations. Though scheduling and patient desire may have you contemplating pushing a procedure up, wait until you have authorization. A delay is less costly than a denial.

3. Check your coding
Whether dental codes or medical codes for dentistry, the wrong code can cause big problems. A missed letter or an incorrect number could make the difference between payment and denial. And, let’s face it, coding can be as complicated as these insurance policies.

4. Familiarize yourself with different insurers
One of the most challenging aspects of dental claims is how variable rules and preferences are, depending on the insurer. While it’s impossible to know every insurer and every preference by rote, familiarizing yourself with some of the bigger insurance companies and their payer requirements can save you a lot of trouble.

5. Pay attention to deadlines
One of the easiest ways to have your claim denied is to miss a deadline. Often, claims must be submitted within a specific time frame based on the time of treatment. This is why so many practices have dedicated team members for claims as it can be a time consuming process.

6. Monitor your denial rate
Among the practice analytics you monitor, one of them should be your denial rate. Every practice has denials, but if they creep above 5%, it may be time to review your process and train your team.

7. Keep meticulous files and audit them
For many insurers, documentation is key. While you may not always need to submit files, ensuring your documentation is thorough, informative, and up-to-date and auditing regularly for those characteristics can save you in the end.

8. Use available tech tools to support your goals
There are, notoriously, a few industries slow to adopt new tech and healthcare has been among them. Often, tried and tested processes and procedures, even if they rely on pen and paper, have been favored by administrative teams, including paper forms. However, paper forms require data entry and data entry is a well-documented source of human error.

Still it’s not just about looking for tech tools to decrease data entry errors. In fact, tools like automated insurance verification can decrease errors and denials and, the right tool, can help you identify errors even before you hit submit.

If you’re looking for ways to not only improve your revenue stream but also increase efficiency and give your team their time back, get in touch with the iCoreConnect team. We’re ready to help you improve your tech stack so you and your team can focus on your patient’s, not on whether or not you’ll be paid for procedures.