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What are Dental Claim Denials and how to avoid them?

Dental claim denials can drastically slow down a practice’s revenue stream.  Therefore, dental professionals seek out dental billing companies to handle insurance billing.  The task of billing for a busy practice is often too complex or time-consuming for in-house staff to tackle.  It’s one thing to avoid denials, and it’s another thing to appeal and follow up on denials.  For today though, we’ll focus on avoiding denials altogether.

Claims can get denied for a slew of reasons.  The key is knowing how to avoid dental claim denials.  First, make sure authorization or pre-certification is obtained.  Professionals must know when pre-determination is needed and receive it as near the date of service as possible.  Pre-authorization can take up to 7 days, so timing of attainment is crucial. 

Second, verify the benefits of your patients before procedures.  Most patients do not know the extent of their insurance plans, including coverage and even if their plan is active.  Insurance companies may have certain maximums, exclusion clauses, waiting periods, contractual limitations and frequency issues.  Also make sure that medical necessity is ascertained.  Moreover, if there is a missing tooth clause in the patient’s coverage, this can lead to denials.  You must stay on top of this or have a billing company ready to check benefits at the drop of a dime. 

Also Read: 10 Reasons Why Your Dental Insurance Claims Will Get Denied

Third, make sure to scrub the claim before submitting.  Even the smallest of errors on a claim can lead to a denial.  This means checking the narratives, clinical information, and coding for any discrepancies, inaccuracies, or lack of data.  Almost half of dental claims are denied due to not enough information.  What can help mitigate the chance of incorrect data entry is to make sure the individual performing the duty has no other duties in front of them at the same time.  It is important that the biller is not multitasking, as this will increase the odds of distraction, lack of focus, and inevitable human error.

Fourth, don’t use outdated claims forms.  Insurance companies update their claims forms often, and it’s important to call and make sure you’re not sending in the wrong forms.  You want a biller who is up-to-date with all billing procedures and codes.

Fifth, make sure your x-rays and charts are legible before submission.  Have an intraoral camera available, so that the insurance company has no reason to say that it can’t see the condition of the patient’s mouth, and thus deny the claim.  Insurance companies are consistently looking for reasons not to accept the claim.

The sixth way to avoid denials is to make sure you have experienced and skilled billers.  Some providers think they can train staff on-the-fly for dental billing, and that strategy usually fails.  Dental billers need an astute knowledge not only of how to bill for dental claims, but also dental claim coding.  Also, the biller must have a certain amount of patience to stay on the phone sometimes for hours while either following up or appealing a denial.  Moreover, the person in the office doing the billing is often taking office calls and checking in patients simultaneously.  This can all lead to burnout, job dissatisfaction, and turnover.

A practice that tries to wear many hats tends to be a jack-of-all-trades.  But when thousands and sometimes millions of dollars are on the line, you don’t want someone who’s just “decent” or “learning on the job” in charge of that money.  Instead, seek out professionals who only do billing, and have been doing it for years—five years minimum is recommended.  With the task of billing removed from the immediate environment, you’ll find that you’re able to focus on patient care and overall well-being of the practice.  Everyone is simply more present—and when the organization is present, the people within it are healthier mentally.