The answer looks like Yes! Dental billing is often complex process for most of the healthcare
professionals and
revenue cycle management companies.
Even a slightest error can cause huge loss of revenue. Revenue cycle management companies manage
dental billing process in a way to reduce the stress of healthcare professionals.
It’s also very essential and crucial for healthcare professionals to know the top reasons for dental
denials and dental delays. However insurance companies concentrate only on reaping money. They
target on monthly premiums and profit gain and avoid claims with reference to documentation in
patient’s contract.
Ways to reduce Dental Denials:
Do not submit incorrect information and documentation
Submit claims within the time scheduled
Don’t forget to attach X-rays and claims
Attach the description provided by healthcare professionals for X-rays.
Keep an eye on frequencies, exclusions as well as limitations.
Do not miss on forming an office policy for feasible process.
Common reasons for Dental Denials by Insurance companies:
Incomplete information and documentation
Late claim submission
Missing X-rays and Claims
Missing X-rays description
Frequencies, Exclusions and Limitations
Incomplete Information and Documentation:
Improper documentation and incomplete and inaccurate information has led to 50% of dental denials
which has to return to revenue cycle management companies or healthcare professionals with a pending
status and no revenue payments.
Insufficient information is another most common reason for dental denials. Insurance companies
expect for complete patient information without any errors. Incomplete information will not provide
the details of the claims they are looking for. Eventually, claims can’t be processed.
Detailed information regarding patient information and dental procedures including their ID number,
service date should be definitely submitted in the claim form. This information will help to process
the claim further.
Healthcare professionals’ details are also important while claim submission. Revenue cycle
management companies usually collect the details of patient as well as healthcare providers and
procedure details that insurance companies are waiting for.
Healthcare provider’s name, license number, address and tax identification number TIN, EIN or SSN of
dentist is very essential for claim submission process. Revenue cycle management companies should
make sure of not missing any of this information during claim submission.
Insurance companies will require specific documentation for particular claims to process further.
For instance, in the cases of scaling and root planning, insurance companies would require X-rays
and prior charting that shows bone loss.
A recent study has also revealed either periodontal charting or last six months full mouth series
for periodontal, endodontic and also orthodontic procedures are very primary and compulsory for few
plans.
Information on treatment and procedures and various steps taken for treatment can also prevent
dental denials as mentioned in many cases.
A well-equipped revenue cycle management company usually has a conversation with insurance companies
regarding plans and required documentation for the procedure which indeed keeps dental denials away.
Late Submission:
Deadlines are very critical. In fact very important in claim filing process. Missing a deadline can
leave healthcare providers under revenue loss. So, it’s essential to train the team to meet
deadlines accordingly.
Reminders and alerts at front office will aid in following the deadlines and avoiding the mistake.
Reminders for individual insurance companies should be documented and posted throughout the dental
practice.
When it comes to revenue cycle management companies, they have a team to serve healthcare providers
as partners and stay in charge of meeting deadlines and submitting claims on time.
Claims must be submitted as soon as dental services are availed by the patient. Otherwise there’s a
place for dental denials showing the reason late submission.
No matter what, the claims should be submitted or filed within one year from the date of service
rendered. For other plans, there’s shorter time filing period of 90 days.
Missing X-rays and Claims:
Missing X-rays and claims are one of the major concerns as per American Dental Association.
Dental providers often submit X-rays and claims before the acknowledge receipt from the insurance
companies. As these X-rays and claims are sent several times, there’s a chance for thinking that
claims are submitted along with X-rays and dentist will receive EOB for the same.
According to Dental Association, each healthcare professional must contact insurance companies
personally and individually in order to particularly meet claim processing requirements.
Very low standardization of attached documents and inability to reference attached documentation for
several insurance payers in a unified location creates major confusion and stands as a reason for
dental claim denials.
Missing X-rays description:
Revenue cycle management companies or healthcare professionals in the first place are supposed to
explain the attached X-rays documentation. A description that explains the reason for treatment and
what the X-rays exhibit is very necessary.
A brief explanation that justifies the treatment must be submitted in printed format and digital
X-rays.
Appropriate and accurate labeling and particulars like date on X-rays is much required.
Frequencies, Exclusions and Limitations:
Usually frequencies, exclusions as well as limitations vary according to insurance plans.
The dental policy’s amount available actually depends on limitations like annual or lifetime
maximums.
Patients will have to cover for only fewer years or few times a year for specific procedures along
with frequencies.
Individual insurance plans usually covers replacement of crowns only five to seven years.
Many contracts have age group limitations for certain procedures based on patient’s age.
Hence, it’s important to get a copy of patient’s information along with certification of insurance
that mentions exclusions, limitations of age and also benefits of plans prior to procedure
performance.
In order to reduce frequencies of insurance difficulties or problems, new policies might occur
especially to handle dental denials.
How outsourcing benefits Dental Billing procedures ?
First and foremost challenge in every dental office is always the staff or the absence of skilled
manpower.
Outsourcing is mostly preferred by many companies to finish their billing services without any
interruption.
Saving money and keeping time would be one of the reasons to think of outsourcing but it also
benefits in dental billing process
Outsourcing is never a new topic, it’s always satisfying when it comes to dental billing costs. If
the billing method or process goes wrong, the entire billing procedure becomes a big failure.
When outsourced with better company and opportunities, dental billing becomes very effective and
provides maximum time for patientcare.
A separate dental billing team isn’t required. Instead outsourcing will have experts who work for
healthcare professional’s reimbursements.
Hope you have got the information on dental denials. For more suggestions, please comment below. We
will definitely consider them if relevant to the topic. For more queries on healthcare and updates,
please subscribe to our blog.