Strategies & Planning to Reduce Insurance Claim Denials for Dentist

Dental insurance claim denials can severely impact a practice’s finances. To maintain healthy revenue, consider these strategies to minimize denials and streamline reimbursements:

 

Accurate Patient Information

Ensure patient demographics and insurance details are entered correctly. Even small errors like missing the patient’s zip code or the subscriber’s date of birth in the dental software can lead to claims being rejected. Identifying these minor mistakes can take months, causing frustrating delays in claim processing.

 

Pre-authorization and Verification

Verify insurance coverage and obtain pre-authorization before procedures. This helps prevent denials for uncovered services. Preauthorization may not be ideal for urgent treatments. Training your staff in the commonly used codes ensures they can quickly gather all necessary information before starting procedures, streamlining the process for urgent patient needs.

 

Using the Right Codes

Using the correct codes for procedures is crucial. Regularly update your coding knowledge and ensure your team is trained on the latest coding standards. Incorrect or outdated codes are a common reason for denials. The ADA updates dental codes annually, so it’s crucial to keep your team informed of these changes. Staying current with the latest codes helps prevent delays in processing patient claims.

 

Timely Submission

Submit claims as soon as possible after the service is provided. Delayed submissions can lead to missed deadlines and, consequently, denials. Implement a system to track submission dates and follow up promptly. Many dental insurance plans like PPO, especially state Medicaid plans, have a 90-day filing period for claim submission. It’s always a good idea to check the specific terms of each insurance plan, as filing deadlines can vary.

 

Documentation Accuracy

Missing attachments, such as X-rays, treatment notes, or other required documentation, are common reasons for dental claim denials. Additionally, incorrect or insufficient narratives that fail to justify the necessity of the procedure can also lead to denials. Ensuring that all required documents are included and properly detailed is crucial for the successful processing of claims.

 

Regular Audits by Dental Owners

Dental owners should definitely audit their dental claims department for errors. Regular audits help identify and correct mistakes in coding, documentation, and submission processes, reducing the likelihood of denials and delays. By auditing claims, practice owners can ensure accuracy, improve efficiency, and maintain a healthy revenue cycle. It’s a proactive approach to safeguarding the financial health of the practice.

 

Staff Training

Dentists invest in their skills by attending continuing education courses to master complex procedures. It’s equally important to invest in your administrative team. As the industry evolves annually, their work directly impacts office revenue. Prioritizing their training ensures your practice remains efficient and profitable. Training empowers staff with the knowledge they need to handle claims efficiently, leading to increased job satisfaction.

 

Conclusion

By focusing on accurate patient information, proper coding, timely submissions, and staff training, dental practices can significantly reduce insurance claim denials. Remember, proactive measures today can save you significant trouble in the future.

By: Denise Siu