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| Linda Drevenstedt |
Power Thought: Drevenstedt Consulting
12 Ways to Simplify Your Insurance System
1. Send all insurance electronically DAILY. Batch the claims and be sure all clinical staff members check their day sheets for procedure correctness before sending claims. No paper in envelopes!
2. Get DIGITAL with radiographs, perio charts and intraoral camera photos to attach. Attach these through National Electronic Attachment, (NEA). DO NOT print these or send regular x-rays in envelopes (time waster.) Here's the link: www.nea-fast.com
3. Send everything you can with the claim. For crowns, send a pre op x-ray AND an intraoral camera picture of that tooth. For perio, send an FMX with vertical BWX - the insurance carrier has to see bone loss, a full perio chart with recession and bleeding points charted - yea, just like hygiene school! For implants, partials and dentures send a panorex. Send a narrative if it is not obvious to "a fifth grader" that the service is needed.
4. Ask patients to update their insurance information annually. Things are changing at a rapid rate. Do not rely on the patient to tell you that their insurance has changed. E-mail me for an update form: linda@drevenstedt.com
5. Get insurance data BEFORE the new patient comes in. Verify coverage, benefits available, what they have already had done and intervals for basics like, Panos, BWX, FL, etc. Look this up online.
6. Load all PPO fee schedules into your software and attach the patient's group to the fee schedule. This way you have an accurate treatment plan print out and fee co-pay estimation.
7. Check your electronic claims report each morning to clean up any rejected claims immediately.Re-file with a note, "Second Submission," all claims with no payment at 30 days.
8. Check the status online of any claim that is 45-60 days old. If you can't work online, then call to check on the status.
9. Print and then close all claims at 80 days that have not been paid. Send a copy of the claim, a cover letter and a statement to the patient that the balance is now theirs after you have attempted three times to receive payment from their insurance company. This allows you to keep your Insurance Over 90 Days report at "0." Run this report EVERY month and check it.
10. Avoid pre-estimates at all costs. They cost you in unscheduled treatment. Use an online service to look up benefits. Use good common sense. If the tooth has a large amalgam with a broken cusp, take a photo to send with the claim for the crown or onlay. If both teeth on either side of a bridge site need crowns and the tooth fits the parameters of the policy, don't pre-estimate. If, on the other hand, the tooth was lost before the policy, not within, then you need a pre-estimate to see if the bridge is covered. Most plans don't like to pay for bridges if the teeth on either side are good and the tooth was removed outside of the policy dates.
11. Take a deep breath and realize this is a game with the cards stacked in favor of the insurance company. They get to make the rules, change the rules and work as hard as they can to NOT pay you. Do not get emotional. It is a game. Learn as many of the rules as you can. Go to an insurance update course annually.
12. Spiff up your insurance protocols this month. It has become a necessary process for many practices. Patients are relying on their insurance more than ever in this economy. Know how to efficiently work with insurance to help your patients and your practice get paid.
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