For fewer claims denials, try better verification processes upfront

An ounce of prevention is better than a pound of cure… old adage, yes, but it holds true in the case of successful dental claims submission. The act of sending claims is simple, whether you're sending electronically or on paper. However, if your goal is correct payment the first time around, you may want to do your homework up front. With proactive systems in place, you can avoid claims problems by gaining the necessary knowledge of payer rules, eligibility, pre-determination status and other critical claims details.

The leading claims submission mistakes, according to payer and MDE partner Delta Dental of Colorado, include several issues easily addressed with a few practical workflow strategies that help mitigate elements like human error.

"Mistakes like using the wrong patient name, wrong date of birth, or wrong date of service are among the most common encountered by my processing department," says Danette Moran, professional relations manager with Delta Dental of Colorado. "Other issues include using the prep date instead of seat date for crowns, or inadvertently billing for services never performed."

Timely verification, as well as communication between front-desk staff and clinicians, can help reduce many claims denials due to these factors. Front-end prep work before a patient even arrives in the dental office is key. Ideally, you should verify patient and payer information several times: 1) when a patient schedules an appointment, 2) the day prior to the appointment, and 3) when the patient arrives in the office.

Using MDE's integrated eligibility solution, you can verify eligibility and benefits for all the patients on your schedule with a click of a mouse, saving staff time to perform verifications by phone or web search and avoiding costly claim denials.

This kind of layered approach helps ensure that all payer and patient information remains current and accurate. "Pulling and verifying patient and payer information for appointments as a routine can really help," advises Lynne Leggett, EDI specialist for MDE, a former office manager who now works closely with dental practices to maximize their profitability. It's important for dental offices to find the process—ideally electronic—that most efficiently accomplishes this task. Reimbursement is on the line.

In fact, even if you submit claims electronically, you must be careful not to assume that electronic submission guarantees claim acceptance. Knowledge of payer submission rules and attachment requirements is vital, and eligibility verification remains essential for preventing back-end denials. It's all about front-end, proactive knowledge and communication in regard to your claims.

Likewise, effective communication between clinicians and payers can eliminate those "wrong date" slip-ups when billing for crowns and other services, according to Leggett. (Although most payers won't pay until a crown is seated, some prefer that you bill using the prep date.) Both Moran and Leggett agree that whether a practice uses manual processes or takes advantage of real-time technology, solid communication between clinical and office staff is necessary to prevent the final common error: billing for treatment never performed.

"Solutions like electronic eligibility verification and electronic adjudication technology offer the kinds of proactive communication that really take the guesswork out of the revenue cycle," Leggett adds. "Denial prevention is a matter of having the right processes in place to ensure that a claim is clean before it ever reaches the payer."

What's New at MDE

What dental conferences are you attending this year? Share comments and pictures on our Facebook page! We want to know all about your favorite seminars, the trendiest topics, the most helpful best practice tips, and the executives, dentists and office managers you met.

Information Center

Telehealth is projected to spread to dental healthcare, especially in underserved populations. Removing the barriers in the healthcare system will allow telehealth to bridge the gap between societal classes. Those who may never have set foot in a dental office would be able to have access to oral healthcare. The following article, authored by George Lauer, breaks down how California will embrace the telehealth changes. What about the rest of the nation? How do you think telehealth will affect the dental industry? Share your thoughts here.

Answers to your billing and insurance questions

Question: Does listing PPO fees on dental claims affect dental fee data used to establish fees?

Answer: Yes, listing PPO fees negatively affect the evaluation of dental free data. This also makes it difficult to track write-offs, which is necessary to show the profitability of PPO contracts.

Message us with all of your billing and insurance questions. We'll be pulling together industry experts and resources to help you uncover the daily challenges you face and how to streamline your claims and payment processes, and more.

Dental office managers touch every clinical, financial, and patient-related aspect of a dental practice. They strive for optimal patient satisfaction, but oftentimes lack the tools to better day-to-day front- and back-office interactions. Keep an eye out for the April 2011 issue of The Observer, official magazine of AADOM, in which Brian Cutler outlines the benefits of technology—from scheduling to billing.

Thought Leader: With increasing technology and demand for better care in the dental industry, how do you stay ahead of the curve? Reach out to us on Facebook and Twitter, and tell us what you think!

Have something to say? Start a conversation on Twitter with the hash tag #dentalconversations. We'll join you as well as continue to talk here.