Chapter 7: Financial Coordinator
Study Guide and Resources
Ask Yourself
- Does anyone on the staff feel awkward talking about money?
- Is your office insurance savvy or insurance driven?
- What can you do each day to ensure claims are processed?
- Do you know how insurance claims are managed in your office?
- Do you have an office insurance policy in place?
Ask Your Staff
- Are insurance claims sumbitted within 24 hours of treatment?
- Are we still submitting anything on paper? Why?
- Is there a follow up procedure with insurance companies?
- Do we have claims outstanding over 30, 60, 90 days?
- Do you know the office insurance policy?
Take Action
- If you don’t have an insurance policy, write one that addresses claims, follow-up steps, patient accounts and office expectations.
- Always underestimate insurance payments, not overestimate them.
- Put a process in place to manage patient accounts and collections to ensure timely follow-up and payment.
Insurance Outsourcing: Is it Right for Your Dental Office?
We get a lot of questions about insurance outsourcing. Insurance is one of the biggest headaches in the office and can be the cause of much stress and anxiety for the front office team.
There are several companies that offer insurance outsourcing, and my office started working with eAssist over a year ago. It has been one of the best decisions we’ve ever made to reduce stress and help the front office run more efficiently.
What you need to know about insurance outsourcing and what happens when you get started.
When we decided to outsource, we weighed the costs compared to keeping it in house.
Here is how we justified it. We looked at it like the cost of an additional employee, but without the additional cost associated with an employee. We did not have to cover sick time, insurance, vacation, time off, or employment taxes.
The result completely freed up our existing staff to handle patients’ issues, the schedule, treatment presentations, and other key components to build a thriving office, while letting the new company handle the insurance.
What’s changed?
Our outstanding insurance claims have gone down, and our collections have gone up. Because outsourced insurance is paid as a percent of collections, the company is not only motivated to get claims paid fast, but they know when to fight a claim that should have paid or should have paid more.
They understand the ins and outs of insurance entirely, and can ensure we’re getting paid on time and what we’re owed. They oversee the claims we submit and verify that the codes are correct. When items are returned that need more, they email us to get more information or narratives from the dentists to send to the insurance company.
When we started, I explained in detail what I wanted. We have two eAssist representatives supporting our office, and I went over with them how I want write-offs handled and how I want coverage books updated when we receive payment.
They are now my go-to for any insurance questions, so our team no longer has to guess. We can get real answers from the reps because they conduct research and find out what we need to know. We recently had some turnover in the office and I’m currently training new staff, but I don’t have to worry about insurance anymore because we never miss a beat since we outsourced it.
4 reasons I suggest outsourcing your dental insurance
- Control—As you know, embezzlement in our industry is an issue. In my opinion, outsourcing this part of the dental practice is one step toward protecting us and our interests. I know this does not guarantee we won’t experience embezzlement, but having someone outside the office handling the insurance money without physically touching the check seems to diminish temptation. It keeps our office staff honest because they’re aware there is a third party watching the insurance claims going out and checks coming in, so there’s an increased chance someone will catch anything suspicious.
- More focus from the staff—Dental employees get sucked into the insurance game and often can’t get out. They get on the phone and spend hours with insurance companies, which is not fun and can frustrate the team, and that attitude projects to patients. I prefer to keep my staff off the phone with insurance companies as much as possible, so I can keep them focused on what’s important and not bring down the office morale.
- The company is paid based on what the insurance pays—How quickly insurance pays is motivation for the company to get the claims paid at the highest amount possible and as quickly as possible. An office employee is paid regardless of whether the office is paid by insurance or not. This is what keeps our outstanding insurance claims down since we switched to an outsourcing company.
- They are our insurance experts for my team—This was not one of the reasons I initially decided to outsource, but it has become a benefit. My team knows that eAssist knows insurance and our plans better than anyone. So, with a quick email to our representatives, our team can get reliable answers to most of our insurance questions, without ever having to call the insurance company. On a side note, have you called an insurance company lately? I called one recently and the recording told me that I would be on hold for 47 minutes. Talk about a waste of productivity and money!
I realize that outsourcing can be costly, but so can hiring and retaining a full-time employee, or dedicating hours of each day to handling insurance claims and issues with insurance companies.
It may not be a fit for every office, but it has worked for ours and continues to benefit our office and staff in new ways every day.
Is Your Office Insurance Driven or Insurance Savvy? There is a Big Difference.
Love it or hate it, insurance is something that everyone in the dental industry must deal with on a regular basis.
To serve our patients well, it’s vital for us to understand the ins and outs of insurance, including the details of what’s covered and not covered by specific plans. After all, when patients come to us for treatment, one of the first questions they inevitably ask is, “Will this be covered by my insurance?”
If you work in a dental office, learning the basics of insurance is a necessity.
The problem is, many offices go too far by focusing the entire framework of their patient relationships around insurance details. There is a huge difference between an office that is insurance driven versus one that is insurance savvy.
What’s the difference?
First let’s look at what it means to be insurance savvy.
“Savvy” means being knowledgeable and smart about something. For staff in any position in a dental office, this means knowing how to solve problems related to insurance and being able to maximize treatment coverage according to patients’ benefits.
Being insurance savvy means being familiar with common policies, helping patients understand how their plan works, accurately estimating what insurance will cover, and a willingness to help patients appeal if coverage is denied.
Regardless of whether your office is classified as fee-for-service or in-network for a plan, you need to be insurance savvy to complete patients’ treatment plans.
This seems like common sense, right? Every office wants to think of its team as insurance savvy. But here’s what I see happening in many offices. Over time, in their attempts to be insurance savvy, the staff gets mired down in insurance details so that it becomes their focus, instead of patients being their focus.
An insurance driven office is making treatment decisions based on insurance, not on what’s best for patients.
You might believe that your office is insurance savvy, not insurance driven. To find out, check whether you’re guilty of any of these scenarios:
Scenario 1:
A new patient calls in and you welcome her to the practice. You ask her name and how she heard about you. The very next question out of your mouth is, “What dental insurance do you have?”
What is this telling the patient about how you value her as a person when you ask that question in the first 30 seconds of the phone call? You haven’t gotten to know the person at all or even asked why she’s calling to schedule an appointment. In the first moment of your relationship with the new patient, you’re letting her know that you prioritize her insurance coverage over her needs.
Scenario 2:
In the morning huddle, there’s a new patient’s name on the schedule. When discussing the new patient, the first question a team member asks is, “What insurance does he have?” Another team member responds with the name of the less-than-optimal insurance carrier, and the energy in the room plummets.
Now your team has negative thoughts about working with this patient, when the only fact that has been presented about the patient is his insurance. What about other important details, like his reason for scheduling treatment, or how he heard about the practice? Is it fair to the patient to have the entire team view him negatively or positively based on his insurance?
Scenario 3:
A patient comes in for an exam and is waiting to hear the doctor’s thoughts about the treatment plan. The doctor’s first question is what amount of insurance benefits remain on the patient’s plan for the year. Wouldn’t this patient be justified at being upset that the doctor’s focus is on insurance instead of on her health needs?
Yes, of course we want to help patients maximize their benefits. But the treatment plan should be developed based on what’s best for the patient, not on insurance benefits.
So, when I say your office should be insurance savvy but not insurance driven, my point is that it’s important to remember what we’re here to do. We’re here to take care of patients and give them the best dental care possible, not to let insurance dictate their treatment.
Honestly, is the insurance company looking out for the best interests of patients? No. That’s our job. We must focus on the patient relationships first and the insurance second. That’s what being insurance savvy is all about.
Out of Network Letter to Patients
Date ____________
Dear Family,
After much deliberation, we have decided to end our preferred provider status with X dental insurance company, effective xxxx xx,20xx. We will continue to accept your insurance; however, we will do so as an out-of-network provider.
Unfortunately, being a participating provider for X Insurance is becoming harder for us as they are reducing our fees sometimes by 55% or more. We have always maintained a high standard of care for our patients, and have been unwilling to compromise or cut corners just because of insurance company’s shortcomings.
What does this mean for you? You can continue to receive your dental care at our office. With some insurance plans, there really is very little difference between in and out of network benefits. However, you will need to read your specific insurance contract to determine if your benefits will change by going to an out-of-network provider feel free to call our office so that we can review your specific plan with you.
As we have begun letting patients know recently about the change in our status, we have found that most of our patients have chosen to pay a little more co-pay, to keep the high level of care we provide. We would love the opportunity to review your plan with you and make sure that you fully understand how this might or might not impact you. We are also available to discuss your specific treatment plan, if you are still in the middle of completing your outstanding treatment.
We appreciate your loyalty, and hope that this has only a positive impact on your dental care. Please call________or ______ at our office if you have any more questions about your benefits.
Sincerely,
Dr. ___________________________
How to Explain Insurance and Unexpected Balances to Patients (Webinar)
Love it or hate it, insurance is something that everyone in the dental industry must deal with on a regular basis.
To serve our patients well, it’s vital for us to understand the ins and outs of insurance, including the details of what’s covered and not covered by specific plans. After all, when patients come to us for treatment, one of the first questions they inevitably ask is, “Will this be covered by my insurance?”
Click below to watch the Webinar replay!