,Did you know that the ADA updates codes yearly? Here are a few reasons why it is important to know these code updates and changes., ,If your dental office is accepting assignment of benefits from your patient’s insurance companies, you will want to receive these payments as quickly as possible. Proper and updated coding will help you get your claims paid properly when filed. If you do not have access to the updated codes and descriptions and file a claim with an outdated or inaccurate code, the claim will be denied and/or the insurance company will pick an alternate benefit code for you., ,Undoubtedly, this code will be the code that has the least amount of reimbursement for your practice. You will be wasting time and money by having a team member appeal or correct the claims and your business will have to wait 30 to 120 days or more to collect revenue for your dentistry. If there is a balance due from the patient, the delay in billing will impact your ability to collect this balance., ,Not all insurance providers keep up with the ADA changes and there could be mistakes in payment for your services if this is the case. If you have access to the most updated version of the ADA CDT codes, you will have leverage when a claim is paid to your practice improperly. Being able to quote directly from the ADA CDT manual the definition of the code that is applicable to your procedure will give you a better chance of getting your denied claim overturned and paid in full. Knowledge is power., ,Each claim your practice submits for dental procedures is audited by the payer’s dental consultants. If these consultants see a number of discrepancies in the treatment provided and the coding used to bill these procedures, your practice could be put on “Focused Review” by the insurance company. If this happens, each of your claims will be delayed and require additional supporting documentation in order to process. If a practice is put on Focused Review by a dental insurance company that comprises a large percentage of their clientele, this can severely impact your revenue stream. Your dental team will be spending additional billable time on supplying the insurance company with supporting documentation. This will limit the amount of time they have to support your patients and other important responsibilities in the office. The delay in insurance payment will again affect the billing cycle for patient responsibility, making it difficult for your dental team to collect any patient balance due., ,For more detailed information check out our book, Dental Coding With Confidence, pre-orders for the 2023 edition are available in August., ,“If you don’t have time to do it right, when will you have the time to do it over?” ~ John Wooden, ,Many practices are busy. This is a great problem to have. Unfortunately, being too busy sometimes leads team members to just “send the batch” and wait to see which claim pays and which claim doesn’t. While this may save 30 minutes to an hour of time on the front end, the amount of time it will take to get the claims properly paid will increase by at least 30 or more days. Let’s not even mention the hassle of correcting claims that have been filed incorrectly., ,It is always best to make sure you have done it right the first time, especially when filing a legal document, such as a dental claim. Take the time to file a clean claim., ,Here are some questions to ask prior to sending out a dental claim:, ,There is a claim in the batch for a Crown (D2740), Build-Up (D2950) and a Recement (2952)-all for tooth #3. The clinical notes read, “#3 – Crown necessary due to large, old amalgam restoration with leaking margins and decay.” This tooth did not have an existing crown, therefore this claim is incorrect., ,It is human nature to make mistakes, so check the tooth numbers. Look at the – radiograph and make sure the tooth is the same., ,Know your dental payers and what documentation they require for each claim. For example, Cigna needs a seat date to pay for a crown build-up. I don’t know why, but they do. Send them the seat date with the initial claim, along with anything else they need. If you don’t know what they need, you can usually find this information on the payer’s website., ,Take the time to look over the claim prior to sending it out. Are there any blank spaces that need information? If it is an insurance company that always requires an alpha-numeric ID, are there letters and numbers in the id?, ,If your electronic filing software is updated regularly, it will flag most claims that need attachments, have coding errors (outdated coding) or eligibility issues (insurance has termed). This will save time and alert you to issues you may have missed when you initially checked your claims for errors. But remember, even if you have the latest version of your dental software or other electronic filing software, if the insurance company is not keeping up on their end, your software may not be flagging the errors., ,For more detailed information check out our book, Dental Administration With Confidence, pre-orders for the 2023 edition are available in August., ,Many of your patients have dual insurance and will want you to file them both for optimum coverage for your dental services. Here are some tips to make this process easier to manage., ,It is especially important to verify benefits and eligibility when your patient has dual insurance. There are specific details that you must know before you can give your patient an accurate estimate of their out of pocket expense. Pay close attention to the eligibility dates, age limitations, full time student status, and coordination of benefits rules. Ask questions when you call to verify benefits for your patient, such as, “Does your insurance company coordinate benefits?” Some insurance companies do not and it is important that you know this before you give your patient a treatment plan that reflects dual coverage. Verify eligibility for both insurance companies prior to each dental appointment. This will save time it will take to file corrected claims once you are alerted (30 days later) the insurance has terminated. Secondary,pre-estimates are notoriously inaccurate., ,This can be a tricky question in some cases. There are so many insurance plans with so many different rules. Here are a few:, , ,The Golden Rule of adjustments : Thou shalt not make adjustments until both claim payments have been received and checked for all errors. Remember this and you will have a much easier time with your accounting. Here is an example of how this can go awry if you are adjusting before receiving the secondary claim payment:, ,$1,500-375-512.50=$612.50,$612.50-425= $187.50, ,If you have already adjusted based on the primary, you will have to re-adjust based on the primary and secondary payments which could lead to confusion and errors., ,For more detailed information on how to manage COB in your practice, Practice Booster is offering a customized training program for your team: Calming the Confusion Around Coordination of Benefits. For more information on this amazing program email [email protected].
