Insurance is a game with the
cards stacked in favor of the
insurance company. They get to
make the rules, change the rules,
and they like to keep their money.
7. Enter all PPO fee schedules into Dentrix. Attach the fee
schedule to the patient’s insurance group in the Dental
Insurance Plan Information dialog box. This way you have an
accurate treatment plan print out and fee co-pay estimation.
8. Call or check online about the status of claims not paid
in 30 days. Ask the carrier for payment within 10 days.
Make a note in the Insurance Claim Status dialog box within
the claim that indicates your intervention to check the
claim status. Be sure the patient is sent a statement when
statements go out, and add a billing statement note that
explains that you have followed up on the claim.
9. Call or check online about the status of claims not paid in
60 days. Ask the carrier for payment within 10 days. Make
a note in the Insurance Claim Status dialog box within the
claim that indicates your SECOND intervention to follow up
on the claim. Be sure the patient is sent a statement when
statements go out, and add a billing statement note that
explains that you have followed up on the claim.
11. Run your Insurance Aging Report and print status
notes on the report. For all claims where you have taken
intervention action three times and that are over 90 days
old, follow this protocol:
• Print and then close all claims at 90 days that have not
been paid.
• Send a copy of the claim to the patient along with a
cover letter stating that you have attempted three times
to obtain payment from their carrier.
• Send a statement to the patient that indicates that the
balance is due within 10 days.
12. Avoid unnecessary pre-treatment estimates at all costs.
Pre-treatment estimates often become unscheduled
treatment. Instead, use an online service to look up benefits,
and use good common sense. If the tooth has a large
amalgam with a broken cusp, have your team take an
intra-oral picture to attach to the claim with the x-ray and
narrative. 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
whether 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.
A couple more: Go to an insurance update course annually. Use
Dr. Charles Blair’s Coding with Confidence as your rule book of
the game. Take his newsletter: www.drcharlesblair.com.
Make your insurance system and protocols
consistent. Take time each day to do these
steps. Patients are rely ing on their insurance
more than ever. Know how to efficiently work
with insurance to help your practice get paid.
Linda Drevenstedt, MS, President of Drevenstedt Consulting, LLC is a consultant, a life coach,
speaker, author, and webinar developer with
an insightful and broad perspective. Her “Steel
Magnolia” approach is honest and straightforward with a spoonful of sugar. She has real “in
the trenches” experience from dental hygiene,
dental assisting and managing a multi-specialty
dental group practice.
Figure 1 Procedural forms can help improve your efficiency and consistency.
10. Call or check online about the status of claims not paid in
90 days. Ask the carrier for payment within 10 days. Make a
note in the Insurance Claim Status dialog box within the claim
that indicates your THIRD AND LAST intervention to follow
up on their claim. Be sure the patient is sent a statement
when statements go out, and add a billing statement note
that explains that you have followed up on the claim.
She holds undergraduate degrees in Dental
Hygiene and Business Management and a
Master’s degree in Health Care Administration. Dentistry Today has voted her a “Leader
in Consulting and Speaking” for the past 15
years. Linda’s new book, Life Path by Design,
is currently available on Amazon. Email her at
[email protected].
LINDA DREVENSTEDT
President of Drevenstedt Consulting
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