Verification of insurance eligibility and patient information is a crucial step in the billing process related to medical practices such as dental healthcare. It directly affects the revenue collected by healthcare facilities, making it an indispensable part of the business. The practices followed by the staff of dental care providers thus determine how much reimbursement flows into the business. Poor handling of insurance verification results in delays and non-payments, which hits practices in many ways. This is why it’s a prudent move to enlist the services of dental insurance verification companies that meet the precise requirements of the practitioner’s operations.
The process of dental insurance verification is a long, tedious, and time-consuming affair that encompasses checking extensive data relating to patients. This can be daunting for dental care professionals as it keeps them involved in these repetitive cross-verification tasks.
Some of the common challenges that practices encounter while claiming insurance benefits include:
- The amount of time spent in follow-ups with insurance companies regarding the benefits and coverage of new or existing cases.
- Changes in insurance plans of the patient, and the subsequent increase in the time spent in communicating and verifying these changes to clarify the revised coverage details.
- Regular and repetitive data entry into the system to record patient insurance details and schedule claims accordingly.
- Cross-verification of the data provided by insurance representatives to ensure that no misinformation or erroneous data is included in filing claims.
To better appreciate the complexities of the process, here’s a look at some of the essential steps that dental practices ought to follow for the insurance eligibility verification process to work out smoothly:
Creating a Checklist for Insurance Verification
When it comes to recording extensive details about a person, it’s necessary to create a checklist with the necessary questions and pointers. It’s essential that the front office staff ask the right questions and record the details correctly to avoid any future mishaps. Details should be recorded from source documents and copies and the same should be attached to verify the information when necessary. An electronic medical record of the incoming patients should include the following information:
- Name of the insurer, contact details, and claims address
- Insurance ID
- Name of the insured
- Relationship of the insured person with the patient, in cases where the two are not the same
- Effective and end date of the policy
- Current status of coverage
- Clarification regarding which processes or procedures provided by the dental practitioner are covered by the insurer
- List of the documents necessary to claim the insurance
- The amount that the patient might have to pay (copayment) and the amount deductible
Collecting Patient Insurance Card Details and Setting Up a File for Each Patient
Once a checklist is created, it is essential to record the patient’s details with integrity. Setting up a file, electronic or otherwise, that contains all of the patient’s details makes it much easier for dental practices to keep track of claims. Keeping copies of the details makes the file that much more complete and it becomes a handy informative aid during the claims filing process. A complete and concise file also helps to verify dental eligibility prior to the treatment and thus allows practitioners to present an estimated cost to the patients.
Contacting the Insurance Provider and Documenting all Coverage Details
Verifying the details submitted by the patients is the next step in the process. This involves communicating with the insurance company and checking if the coverage the patient expects is in keeping with the actual coverage the insurer is currently providing. Owing to changes in regulations and guidelines, coverages may increase or decrease and that may affect the insurance policies in unexpected ways that patients might not be aware of. Having a clear idea of whether or not the insurance company is going to cover the expenses puts both the dental practitioners and patients at ease to move ahead with the treatment. Importing data from the insurer’s records electronically is the safest and fastest way to access critical information without encountering any data-entry problems.
Recording Information Accurately
Recording of accurate information determines whether a claim will go through cleanly or end up being denied. This is why it’s important to have trained personnel handling the data verification process. The process, being repetitive in nature, is prone to pick up several errors that cause the claims to be delayed by several days or weeks. For a large enough practice, having several claims held up in this manner can mean a large part of the revenue not flowing in at the desired time and holding up the rest of the revenue cycle.
Regular Follow-ups with Patients
In medical billing, it’s an expected practice to inform patients early on about how much of the expense would fall on them, so that they can be prepared at the time of payment. This requires having a transparent communication system between the dental practitioner’s office, the insurance company, and the patient. Information between the three should flow readily so that the billing process does not meet with any unexpected issues at the eleventh hour.
Benefits of Outsourcing Dental Insurance Verification Services
The tasks enumerated above can become highly taxing on the time of a dental practitioner and their staff. This has led dental practices to associate themselves with external insurance verification services in the pursuit of productivity.
The benefits of outsourcing dental insurance verification to experienced insurance verification companies are discussed here in detail:
Assurance of Compliance
It is known that dental insurance verification services adhere to standard industrial guidelines and regulations. This makes their practices follow protocols that ensure quality in their work. An insurance verification company can discern between what is necessary and what is not to have an efficient claims process. Along with compliance in their documentation practices, it is also expected that they provide consistency in their overall services. This makes an association with a dental insurance verification services provider beneficial to dental practitioners all over.
A Repertoire of Technologically Advanced Tools
There are several technological challenges that small to medium-sized dental practices encounter while handling bulky electronic information. These challenges can be easily sorted by having an armament of technological solutions on board. External insurance service possess several highly efficient digital tools that make the insurance-related data recording and processing swifter. Having technology on one’s side also makes the work more accurate and less time-consuming. This is one of the most important factors why outsourcing dental insurance verification proves beneficial to dental practitioners.
A Platform to Scale Operations
During times when the inflow of patient increases or insurance claims-related filings pile up, it becomes difficult for dental care providers to manage operations smoothly. Instead of trying to haphazardly shuttle between patient care and revenue cycle management, it’s wiser to take the aid provided by the best dental insurance verification companies in the industry. These dental insurance verification solution providers are well-prepared to handle sudden upswings in cases as well as increased workloads owing to denial management. This makes them all the more indispensable when considering the pros of outsourcing dental insurance verification.
Increasing Productivity and Overall Efficiency
The ability to complete the dental insurance verification process in a short time is very much desirable as it means more cases can be dealt with in the same amount of time. This efficiency in workflow comes from having the right people doing the right jobs. While dental practitioners with their years of dental care education feel lost in the insurance jargon, external service providers are much better suited to complete the job that they have been trained to do for years. Acknowledging the abilities of people makes the workflow much simpler and streamlined, thereby increasing the overall throughput of the business.
Expert Handling and Support
Sometimes, insurance claims can run into unexpected issues, and having an expert on one’s side can save a lot of time and money. What might seem like an insurmountable problem to a rookie, is a run-of-the-mill issue for an experienced person and they can have several different solutions drawn up in a short time. This is why it is advisable to have a dental insurance verification expert handling the troublesome cases and providing practitioners support where it’s due.
Choosing the Right Collaborator
Taking into consideration the benefits that outsourcing dental insurance verification brings to the client, it becomes the de facto option of collaborating with one. But with a plethora of options available in the market, it’s difficult to assess which service provider would suit the practice best.
While choosing an outsourcing insurance verification services partner, the client should take into account the following key considerations:
The fundamental requirement for a dental insurance verification services provider to meet the industry standards is to have HIPAA compliance instilled in their practices. This is because it outlines the basic practices which can ensure the protection of sensitive information. Complying with current good documentation practices and current regulatory guidelines is thus the very foundation of establishing credibility for a dental verification company. But there are ways of going above and beyond simple adherence to compliance. For best outcomes, there must be quality assurance checkpoints and KPIs in the insurance verification process. Setting QA standards into the companies’ expectations assures dental practitioners of receiving high-quality services from the vendor.
Randomly initiated audits can help keep a check on the overall integrity of the quality control system. Reporting quality findings can help refine the process and prevent wrongful practices from becoming commonplace.
Informed, connected, and specialized skills
An insurance verification services provider that is experienced in different fields such as physical therapy, chiropractic, radiology services, etc., can be counted on to be more well-versed with the overall medical insurance practices. Having such experience makes an insurance verification services provider a dependable name in identifying and assessing insurance eligibility. Furthermore, a well-informed dental insurance verification solutions provider knows the insurance plans of different private insurance companies inside out. This valuable information makes claims much easier to access.
Trained Staff and Inherent Cost Benefits
An insurance verification services provider that has a well-trained staff is very much desirable. This means a dental practice does not have to invest additionally in training its employees to understand the implications of insurance policies. It’s advisable to consider the charges made by the service provider to ensure that the cost of training employees is not something that is billed to the client. Having the expected charges mapped out well in advance leaves no scope of being surprised at the time of billing. It’s essential to set the boundaries during the initial phase to clarify what charges can be considered appropriate for the services being availed.
At the end of the day, dental practices seek to outsource their dental insurance verification process to have some cost-benefits in their operations. The services offered by insurance verification service providers must, therefore, be affordable for dental practices. In the same breath, it must also be said that the best services are not always the most affordable ones. A fine balance between both is crucial in determining how much a dental practice wants to invest in outsourcing to save up on other expenses.
Who We Are and Why We Are Considered an Industry Authority?
MedBillingExperts, has over a decade of industry exposure to insurance verification. This has enabled us to know the process of dental insurance verification through and through. In the above writeup, we have elucidated how we stand out from the crowd and provide the very best of insurance verification services to our clients. We keep ourselves up-to-date with the best technological tools and changing regulations to be of assistance to our clients in their hour of need. We also provide round-the-clock support to deal with queries and issues that may arise in the challenging sphere of insurance verification.