04 Sep Ask the Front Office Professional | An Advice Column
by K M McBain
Hi eAssist Nation subscribers! I am Kristen and I’ve had the privilege to team lead with eAssist for over a year. I launched 70 offices with eAssist in 2017 alone and maybe even some of you reading this are familiar with me from team leading. Using my diverse practice background and experience (19 years of dental administration) as well as knowledge(CE) and network of amazingly resourceful and knowledgeable colleagues, I have been able to answer many office manager’s questions about billing procedures, general advice, and best practices. I started this column in hopes to help more than a single office manager and to give all of you access to my opinion and advice. Unless a direct sited fact from a trusted source, anything you read here is conjecture and should not be taken as a definitive or solitary answer. I hope you find the column helpful and at the very least, entertaining.
Q&A’s Relevant to every Office that accepts and bills Insurance:
- Q: Why do you bill a secondary preventative claim out when primary paid 100% of allowed amount? Isn’t that a waste of time and resources? – (Kimmy D. OM in Port Orchard, WA)A: Hi Kimmy! We appreciate you submitting your question to the column. ALWAYS BILL SECONDARY COVERAGE (and even tertiary) The answer seems simple but is often overlooked by many experienced billing professionals. Primary may have paid the preventative claim at 100% however often in most situations the provider takes a write off adjustment of some sort. I have found in billing out secondary in these types of situations more than half of the time the COB (coordination of benefits) allows payment of the write off amount or greater up to the UCR charge to the practice. Which in turn allows the provider to reduce their primary W/O and have more payment per service. Either way if the secondary pays or doesn’t- it will not negatively affect your practice or patient to bill secondary and tertiary insurance to get the most money possible per your provider’s time.
- Q: What are the pros and cons of billing out a UCR fee instead of the Contracted Fees on a claim? – (Sarah F. OM in Chester Co., PA)A: Greetings, Sarah, thanks for asking and I am glad you asked! This sort of goes hand in hand with the first question I answered above. To be most profitable in your practice ALWAYS BILL YOUR UCR FEE ON CLAIMS– I also recommend at the same time keeping your fee schedules updated and posted within the patients’ ledgers. This means patients’ will not be billed UCR fees, only the insurance company and you will have less write offs in the patient account. Billing the UCR fee on claims will enable you to see when an insurance company allows and pays higher than the fee schedule you have in the system and in coordination of benefits situations where the insurance company may allow more than estimated which can result in a debit adjustment (charge) rather than a write off. In fewer words, billing the UCR fee out on claims minimizes your write offs and in some cases patient portions and maximizes payments per service from the insurance companies. Any advantage against insurance is a Win for your provider-am I right?
- Q: The Dentist I work for is old fashioned and does not trust EFTs (Electronic funds transfer Systems) how do I convince him to get with the times and sign up? (Tanisha M. in NY,NY)A: Thanks Tanisha great question! We hear this a lot! My advice of course- SIGN UP FOR EFTs ALREADY! This one simple step ensures faster payment, in most cases 1-2 weeks faster turnaround time, and the payment gets deposited directly to your provider’s bank account! Much more secure than snail mail. If your provider had a regular job would they want their paycheck mailed to them or direct deposited into their account? I am guessing most people choose direct deposit. Benefits of signing up for EFTs for a practice are: a. it drastically eliminates the risk of embezzlement, b. helps avoid any future credentialing snafus regarding payments(example if you move locations or if an associate DDS is credentialed or billed as a pay to provider), c. prevents payments from going to a wrong location for a group practice setting, and d. it is easier to track payments that have been paid and not posted yet and payments will not be lost in the mail. Hopefully these pros outweigh any cons your DDS can come up with and he converts!
If you need any info or help to improve your practice relations or profitability email me at Kristen.email@example.com. I will answer all questions and if I don’t know the answer I will tap into our network of 400+ experienced office managers nationwide! I look forward to hearing from you!
Dental Billing Tips and News for Pros; Edition #127