The Impact of Insurance Denials on Dental Practices

Denials are the bane of every dentist looking to get paid quickly and in full by insurance companies. If they continue to happen over time, your insurance AR begins to balloon, and you end up leaving good money on the table. Not every office has the time and resources to dedicate to denial and claim management, but there are a few processes you can implement to help bolster your defenses and streamline revenue cycle management. Let’s look at the top 3 ways you can overcome insurance denials and get 100% of what you’re rightfully owed with each dental billing claim.

1. Review and understand reasons for denials

   To overcome the impact of dental insurance denials, the first step should be to understand why they’re happening in the first place. These could be due to:

• Coding errors
• Inaccurate patient information
• Patient is out-of-network for a particular procedure

It is essential to have a system in place to review and analyze each individual denial. Plus, training your team to identify the most common denial reasons and how to avoid them in the future can dramatically reduce the number of denied claims. While each of these reasons might seem small and insignificant, they are crucial to maintaining cash flow over the long term, and without diligent care, can quickly spiral out of control.

Coding errors and insurance denials

Coding is another potential hiccup in the claims process that can cause denials. Each treatment has its corresponding code and misusing them, or using outdated codes is a sign that your claims may be falling behind. Not everyone has the ability to memorize the literal hundreds of CDT codes for each procedure, and what if the ones you do know end up changing in the annual revision and deletion process? Here are some quick facts about dental coding:

Do I have to use CDT codes?

Yes, they are required for reporting by third party services, and HIPAA-designated as the standard format for dental claims. Essentially, CDT codes are the “language” that your claims use to report procedures to the insurance company, making their accuracy all the more important.

How are CDT code changes, revisions, and deletions determined?

Codes are changed every year after the voting board determines that any requested revisions can be appropriately met and are for the benefit of general dentistry. This means that even with sufficient and general dental coding knowledge, some procedures will be changed or added to each year. Without this knowledge, you could be seeing more insurance denials in your future.

How do CDT codes help with insurance denials and getting my claims paid on time?

Outside of being the standard of communication for dental insurance, CDT codes help get your claims paid by removing insurance denials off of the table. Coding inaccuracies happen all the time due to the nature of code changes, and it quite literally pays to pay attention to the goings-on of dental coding.

What can I do to make sure all my dental codes are accurate to prevent insurance denials?

Today, it’s easier than ever to give your staff the tools they need to remove the unknowns of dental billing and coding.  Be sure to check out the coding resources at Practice Booster for up-to-the-minute requirements for narratives, CDT codes, and more.

2. Improve insurance verification processes

   A significant number of denials are due to patient eligibility issues, such as:

• Specific treatment(s) not being covered under the current plan
• Patient isn’t insured during the time of the appointment
• Incorrect birth dates, SSNs, or other individual information

When you implement a thorough insurance verification system, these smaller errors can be mitigated. This could be done during the initial appointment scheduling process and again on the day(s) before the appointment. Patient demographic information and insurance coverage should be accurately recorded in your PMS and fully verified to prevent such denials. If a particular patient or family group has frequent changes in insurance coverage, you can also make a personal note to the rest of your staff reminding them to be vigilant about these potential changes prior to an appointment.

3. Outsource your dental billing

   The dental billing process is a direct pipeline to your revenue cycle management. Without an efficient flow, you could be missing money on the way to getting paid.

Outsourcing to a trusted partner and overcome insurance denials

Outsourcing your dental billing has many tangible benefits:

• An expert team diligently working you AR each day
• A focus on insurance over 90
• Results-based cost that scales with how much you collect

Your staff no longer need to worry about the intricacies of each claim on top of other daily tasks that keep your practice running. Why focus on the minutiae of insurance claims when your staff can be meeting and greeting patients, establishing life-long relationships, and offering the best customer care possible? Plus, what if this outsourced team would be a shared benefit to your staff, instead of replacing them? eAssist Dental Solutions can help with this and more.

Insurance denials can become a thing of the past

The eAssist Dental Solutions platform revolutionized end-to-end dental billing outsourcing, with bespoke revenue cycle management solutions tailored to your needs. If you have a specific focus, such as patient retention, accounting, or dental billing, our platform has a solution that can work for your practice. Plus, we were created by dentists for dentists, with the knowledge that every outstanding claim is money we are rightfully owed. Schedule a consultation below and experience what has made eAssist the #1 dental billing solutions platform in the country.