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Welcome to dental, I hope you end up loving it as much as I do!

As far as verifying benefits, I suggest that you first check with your doctor or office manager to make sure they agree with my suggestion. I think that benefits should be checked for all new patients or whenever a patient of record has a change in insurance.

Here is how I would suggest doing your verification:

New Patients: As soon as you receive a new patient’s insurance information, verify their benefits. This can be done by phone, or online. Each office has their own specifications as to what they are looking to verify. Minimally, you want to make sure you know the basic coverage and that their insurance will pay if they come to your office. I would suggest that you have a benefit breakdown form to follow along with and fill in all the information you need as you go. There is a template available in the Resources section of our site that you can use or adapt to work for your office.

I would not wait until the day of the appointment to do this if you can avoid it. Try to get the benefits verified at least 48 hours in advance so that when you make the confirmation calls you are confident that their insurance will work in your office. If there were any issues that arose during verification, you will then be able to discuss them with the patient during your call and prior to their treatment.

Current Patients: I suggest that anytime a patient tells you that their insurance has changed, collect all their new information and call to get their benefits verified so you are ready for their next visit.

I also suggest that you work with either an electronic eligibility system (many times it is a resource right in your practice management software) or work with a company such as Trojan, that electronically checks that your patients still have active benefits. It is a simple one button push to check that all your patients are still eligible. If your check comes back with a red flag or an error, then it is time to investigate. Just like with new patients, I suggest doing this at least 48 hours in advance so that when you are making your confirmation calls, you can confidently address anything insurance related with the patient prior to them coming to the appointment.

I hope that this helps and thank you for reaching out with your question.

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Question: We do a lot of financing in our office since most of our patients are uninsured. This includes Care Credit and in-house financing (tracked through Comprehensive Dental Finance). We also offer an in-house Dental Savers Plan for our uninsured patients. As a result, we have found this complicates each patient’s, account and it is not always straightforward figuring out balances owed. We are trying to streamline the post-treatment-plan acceptance phase where we enter and track the data about each individual’s balance and where it comes from so figuring out the amount owed before the patient arrives isn’t a project in forensic accounting. Do you have any recommendations for how to track these financial arrangements and monitor them on an ongoing basis? Our goal is that everyone at the front desk should be able to determine the amount owed for any given patient on the schedule after a minute or two of research max.

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That is a very hard question to answer because there are so many moving parts involved in the case acceptance process and the collecting of the balance… I have a few videos on this subject on the site which you definitely want to make sure your team watches, but also you might want to watch.

I am going to list out a few things that come to mind that I think are important to help you achieve what you are looking for:

1) Have a financial agreement with the patient that spells out what you offer and how they intend to pay. Make sure it gets filled out by your team, the patient signs it and then have it scanned into their chart. Always make sure to name it the same thing so everyone on the team knows what to look for when they need it.

2) Make sure your team is putting in excellent notes… Notes are so vital to making sure everyone on the team knows what is going on with the patient. We have our treatment coordinators print out the schedule each day and circle the appointments that they handled the treatment plan presentation as the day goes on. Before they leave at night, they have to make sure they have put in their consultation notes, to include the financial agreement information for the patient and the schedules are then turned into our Junior office manager, who reviews them the next day to make sure the arrangements are ok and that there are no red flags that need to be handled.

3) We have our insurance notes and our treatment plan notes in different colors so that when you are scanning notes, they are easy to see.

4) We try to keep our adult family members separated into different accounts so it does not get too confusing. Many times the kid’s accounts are not hard to figure out but the adult ones are the accounts that are confusing. They get more work done at larger amounts of money and if they are both getting the treatment done at the same time, it becomes hard to figure out the balance when their payments and the insurance payments are all coming in at different times for different procedures. It makes it much easier to have them separate because at least you know that you are narrowing down the balance for one of them specifically and not both.

5) We recently started outsourcing out insurance part of the practice which has helped a ton. We work now with a company called eAssist and they handle all of the insurance from submitting the insurance claim, to making sure that we get paid correctly and in a timely manner all the way through to entering the insurance checks and balancing the account. I was getting so frustrated with this area of the practice and decided to out-source it to them because this is their core competency and it allowed my employees to spend more time in the office with the patients and off the phone with insurance companies. They enter all the checks and call on all of our open claims and then put in notes that are in the exact same order each time with all the information my team needs to accurately discuss the balance with the patients. We are thrilled that we moved to this – let me know if you want information about them.

6) We do what I call “next day reviewer” and I teach on Front Office Rocks. Part of the problem about figuring out the balance is that the team waits until the day the patient has an appointment or sometimes even as the patient is walking up at the end of their appointment. That makes it very stressful for the employee and many times they just take a guess at where the balance is coming from. The patient ends up usually not thrilled with the answer and then leaves many times without paying because they tell the employee to let them know when they figure it out and they will pay then. As you know, it is better to get the patient to pay while they are in the office, versus letting them leave because the chance of that patient paying the bill goes way down and then patients come in sometimes for multiple visits without paying, which is never good. I would prefer that the team review all of the accounts the day prior to them coming in for two reasons: 1) it gives them time in a not stressful environment to review the account and figure out the balance and 2) it gives the employee time to call the insurance company if needed to find out status of an outstanding claim before the patient comes in. This allows the educated employee to be able to clearly talk with the patient about the balance which gives your office a much higher chance of collecting on that balance. Also, this employee that figures out the balance, needs to put in clear notes and the entire team needs to be trained at where those notes are so in case someone else checks the patient out, they can also inform the patient on what those notes say and collect.

7) The huddle is also huge in the process of getting your team on the same page. Every patient should be checked out by the front desk before they leave no matter what but there should be specific discussions with everyone on the team when a patient has a balance and that it is very important that the team brings them to the front desk so they have to collect on that balance.

I hope that this helped… if your office is anything like mine, there are different people in the accounts and so many moving parts… there definitely is not one right answer but with training and follow through to make sure the right systems are in place, this issue can definitely get under control.

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Question: We are looking for a good narrative for SRP. We have found that many of our claims to Delta Dental, although they tell us when we call for benefits, that they allow for all 4 quads in the same visit with documentation, then, deny it stating that they don’t find it necessary by consultant review. We only submit for SRP with probing depths over 4mm and we send the periodontal chart, the chart notes and x-rays. We often even submit with intraoral photos showing calculus build up and inflammation but they still seem to deny many of our claims for SRP to Delta Dental. We aren’t seeing that for all other insurance companies but want to make sure we are safeguarding ourselves. Please let us know if you have a great narrative that you can share with us.

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We certainly understand the frustrations with insurance companies and their propensity to deny claims. We must always remember the insurance belongs to the patient so we need to start by always letting the patient know we are doing the best for their dental health by providing the recommended treatment. We will be happy to file their insurance claim for them but the insurance companies can and are in the business to deny claims whenever they can so if they have an issue with what the insurance company denies, etc. they should take it to their HR department for review. If the corporation/company providing the insurance to their employees complains enough to the insurance companies or threatens to leave that is the only time the insurance companies seem to sit up and take notice.

The 3 D’s with insurance companies are Delay, Decline & Deny. The most common mistake made when filing an insurance claim is the absence of information and attachments. Providing the wrong information can cause headaches, but also not providing the right amount of information can cause the same delay or denial. Also, providing the same, unvaried, or routine narrative for claims that are similar can also raise red flags to the insurance examiner so vary them each time they are sent especially when sending to the insurance carrier you are having issues with.

The narrative should always contain the periodontal condition that the patient presented with at their exam as well as the amount of time it has been since they were last seen in a dental office. Most carriers want also require the American Academy of Periodontology Case Type explained on the claim form as well. Example: “Patient stated they have not been seen in a dental office or had any type of periodontal care since (Date/or approximate amount of time.) Patient presented with Case Type III-Moderate Periodontitis including generalized 4-6 mm periodontal probing depths, Bleeding on Probing, Mobility (state specific teeth if not generalized) exudate, (if present).” Also mention the amount of deposits present and refer to intraoral photos for evidence of this, furcation involvement, missing teeth and recession. Always include a current FMX w/BWX or preferably VBX if available and periodontal charting showing comparisons if available. Any other detail from the hygienist’s or doctor’s clinical notes and intraoral photos if available.

Also, be sure you are up to date with the new code that has been introduced and available for use as of January 2017. Here is a link to the ADA site with more information: http://www.ada.org/~/media/ADA/Publications/Files/D4346EducationGuidelines_Final2016May17.pdf?la=en

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