Whether it’s a dentist, an orthodontist, a periodontist, an endodontist, or a prosthodontist, dental insurance verification is crucial to their dental practice. Dental claim denials can lead to substantial revenue impacts on dental practitioners. Moreover, at times, claim denials may even lead to a loss of reputation as the patient may think that a dentist has performed a needless procedure. By outsourcing dental insurance verification from a professional service provider, dentists can increase their revenues and improve their cash flow management.
Factors to Consider When Choosing a Dental Insurance Verification Partner
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Coverage of Specialties:
Dental insurance verification services vary by specialty. The procedure for verifying a claim on endodontics will differ from that of a claim on periodontics. Dental insurance verification companies deal with insurance claims in a range of specialties and are well-versed with the unique verification requirements for different cases. For example, according to the American Dental Association, specific procedures like periodontal scaling and root planing (SRP) have a higher frequency of claim denials or additional information requests. When verifying claims for such procedures, providers of dental insurance verification services need to take extra care.
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Up to Date With Requirements of Private Dental Insurance, Medicaid, and Medicare:
Often, patients don’t know that their coverage depends upon the amount spent on coverage by their employer and not their own specific clinical needs. A typical example of this misconception is the “missing tooth clause.” According to this clause, insurance companies do not cover the replacement of missing teeth before purchasing an insurance policy. Insurance companies also place restrictions on the number of trips needed to control gum disease. Similarly, dental benefits covered under Medicaid vary by state. Some states provide extensive coverage and some only cover emergency dental care.
Professional dental insurance verification service providers are well-versed with private and government-supported medical insurances’ unique requirements. This awareness helps in improving the quality of dental verification and reducing claim rejections.
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HIPAA Compliance:
The Health Insurance Portability and Accountability Act (HIPAA) has implications on all healthcare practices, including dentistry. HIPAA rules for privacy and data security apply to all “covered entities” or any practice that submits an electronic claim to a dental plan. When choosing a dental insurance verification service partner, make sure they are compliant with HIPAA. Non-compliance with HIPAA can lead to fines of up to $1.5 million per violation.
The best dental insurance verification companies ensure all safeguards are in place so that no sensitive patient information is at risk. They perform regular information security audits and employ anti-theft technology to safeguard their computers from theft. They provide constant training to their employees on aspects such as how to avoid suspicious email links, how to spot phishing scams, etc. All the patient data that resides on computers is encrypted to limit their access only to individuals with proper administrative access.
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Focus on Quality Assurance:
In the 1970’s dental insurance covered 100% of preventative services. Today, there are a lot more restrictions on preventive care. Many insurance companies set waiting periods before covering specific dental procedures. That means a patient cannot take a root canal during the waiting period, even if they need it badly. Professional dental insurance verification companies have stringent quality checks in place to ensure all claims are verified thoroughly.
Dental insurance verification specialists look at various factors in each claim and ensure no detail is overlooked. Things checked by them include effective dates of policies, individual and family deductibles, waiting periods, type of plan/ fee schedules, and much more.
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Timely Reporting:
When outsourcing dental insurance verification, choose a partner that has a system for sharing detailed performance reports. These reports should have all the details, including claims denied due to incorrect verification. Such reports help dental practitioners staying up to date on the number of dental insurance verifications performed by the outsourcing partner, the percentage breakup of in-network and out-of-network benefits, etc. Such detailed insights can help practitioners identify performance improvement areas in their revenue cycle management compared to the overall dental industry.
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Competitive Pricing:
The best dental insurance verification companies do not come cheap. When looking for a partner to outsource dental insurance verification, dental practitioners need to look at various factors. These factors include price, quality control systems, HIPAA compliance status, insurance verifiers’ skills and experience, etc. of their prospective dental insurance verification partner.
For example, a less-expensive dental insurance verification partner with no HIPAA compliance can result in much more expenses in the form of fines. Or a partner with inadequate reporting mechanisms will not be able to give practitioners insights on areas of improvement in revenue cycle management.
Some dental insurance verification companies charge a setup fee, which is not needed at all. Professional companies operating in this space have a set up ready, which can start delivering from day one. Moreover, the setup can also be scaled at short notice to meet high volumes of dental claims.
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Services Offered:
When exploring for dental insurance verification, check with them about their service offering. For example, a good dental insurance verification provider will offer a customized verification form based on dental practices. Secondly, they should offer multiple verification options such as emergency verification, follow-ups on eligibility checks, etc. Also, they should provide dental providers full flexibility to opt for service on a need basis. That way, dental providers do not have to incur fixed costs on dental insurance verification when facing low demand.
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Processes Followed:
Dental insurance verification starts with, collecting key documents such as the patient’s dental insurance card. Check with your dental insurance verification about what steps of the dental insurance verification are covered by them. For example, what are the critical documents needed by them to start verification? And once they receive these documents, what processes do they follow as part of verification.
For example, upon receiving key documents, a reliable dental insurance verification company will manually verify insurance coverage with the insurer by either calling them up or checking online. Next, they will confirm all important details such as pre-authorizations, plan exclusions, etc. Once all the information is available, they will cross-check the collected details with the billing system’s data. If any information needs to be updated, they will update it then and there to avoid trouble later.
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Checklists and Procedures:
Professional dental insurance verification companies have detailed procedures on things to be covered during the insurance verification process. Ask for the checklists followed by them while verifying dental insurance claims. A reliable partner will have comprehensive checks in place to look for all key aspects. This should include basic information such as policy dates, spellings of names, addresses, etc. to policy-specific details such as deductible met, downgrades/ limitations, and specific clauses like the missing tooth clause.
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Special Care During COVID-19:
The economic damage caused by COVID-19 has led to massive unemployment. This can have expensive implications for dental offices. For example, a patient may have taken a certain coverage, but they may have lost benefit coverage because now they are unemployed. When talking to dental insurance verification companies, check with them if they can create customized verification forms to include additional questions. According to the American Dental Association, here are some questions dental offices need to ask patients considering the COVID-19 pandemic:
- Since we last saw you, has there been any change in your dental coverage?
- Since we last saw you, have there been any employment changes for yourself and/ or the policyholder?
- If there are any employment changes, has the employer-provided you or the policyholder any paperwork on how long the dental coverage will remain effective.
Ideally, it is recommended to collect a copy of such paperwork and keep it in official records to avoid disputes later.
The special care during COVID-19 is even more critical for dental care providers because their expenses have gone up. Things like PPE kits and other COVID-19 related expenses may not be covered under their insurance contract. In these times, every penny counts, and the last thing they need is a claim rejection due to incorrect employment verification.
How to Avoid Denials in Medical Billing?
Claim denials are a common phenomenon in dental insurance. As a dental practitioner, you want fewer and fewer denials for better revenue management. Here are some ways to avoid claim denials in medical billing:
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Check for Pre-Certification/ Authorization:
For certain special dental procedures, insurers require both the patient and the provider to get a pre-authorization before initiating the treatment. If no pre-authorization is obtained for such procedures, it can lead to denial of claims. One way to minimize such rejections is to encourage patients to contact the insurer directly to confirm if their plan is eligible for certain procedures.
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Ensure Documentation is Error-Free:
A common reason for denial of dental insurance claims or delays in settlements is errors in insurance claim forms. Even basic mistakes like spelling mistakes in patients’ names or addresses can prove costly for dental practitioners. Dental insurance verification companies have stringent quality checks to ensure all documentation for claim submissions is error-free.
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Adherence to Claim Filing Deadlines:
Every insurer has deadlines for filing claims. For example, Texas Medicaid has a deadline for submitting claims within 95 days of providing the dental service. Once the deadline is closed, dental care providers cannot do anything to recover their dues. Another common reason for denial is duplicate claims submission. The best dental insurance verification companies have clear processes and systems in place to ensure all claims are filed within the deadlines.
Benefits of Outsourcing Medical Billing Services
Medical billing and coding services can help dental care providers immensely in revenue cycle management. By outsourcing medical billing services, dental practitioners do not have to worry about administrative tasks like submitting dental claims on time or ensuring all the forms are error-free.
Here are some key benefits of outsourcing medical billing services.
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Reducing Accounts Receivable Days:
For dental care providers, it does not matter how much revenues have been earned until they are converted to cash. Accounts receivable days in dentistry vary by practice. For those into orthodontics, the amount due for more than 30 days is typically low. But for those involved in more complex procedures, such as oral surgeons or endodontists, this number is high. Outsourcing medical billing services can help reduce A/R days, thereby increasing the cash available to meet operational expenses and invest in expansion.
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Improved Billing Compliance:
Professional medical billing agencies are well versed in the regulatory requirements of bill claims. For example, regulatory authorities are very particular about HIPAA compliance, and any breaches in HIPAA requirements can lead to fines.
Dental practitioners also have to worry about compliance audits carried out by insurers. A failed audit can lead to reimbursement of payments to insurers. Outsourcing medical billing ensures all the processes are followed as per the law.
To conclude, choosing the right dental insurance verification partner can have substantial business benefits for dental providers. By engaging a professional dental insurance verification partner, dental practitioners can prevent delays in payments, minimize claim resubmissions, and eliminate partial or full claim denials.
Why Choose OutsourceRCM for Dental Insurance Verification Process?
OutsourceRCM has more than 10 years of experience in providing high-quality dental verification services to dental practitioners all over the world. Our comprehensive dental verification services offer multiple verification options, including less-than-48-hour emergency requests. OutsourceRCM is an ISO 9001:2015 certified company that strictly adheres to HIPAA standards. We have the best dental insurance verification tools, which ensure high accuracy and fast turnaround times. Our processes are highly scalable and can quickly adapt to a surge in claims. Furthermore, we have the best technical support in terms of software, data security, and adequate back-up support. By outsourcing dental insurance verification services to OutsourceRCM, dental care providers can experience a vast improvement in their revenue cycle management.
