How does your office deal with rejected medical claims for dental procedures? Too many offices deal with denials on a case by case basis instead of looking for larger patterns and creating new systems. In 80% of cases, a corrected and resubmitted claim will eventually be paid. But wouldn’t your office function more smoothly if fewer claims were rejected in the first place? If you want to transform your medical building and cut the number of returned claims, the 5 Ps of dealing with denied claims can help you develop better documentation and billing habits throughout your practice.
Probing Questions . When a claim is denied, call and find out why. Get the details. Don’t be afraid to ask questions. Once you have a clear, concise, exact answer, prepare to solve the problem, but also tag the rejected claim with the reason for the rejection. Different insurers use different vocabularies for the same thing, so try to standardize the wording within your office. It will help you with the next ‘P.’
Piles of Papers. Make piles for each sort of rejected claim. For instance, your piles may include claims rejected for demographic reasons, claims rejected for insufficient documentation of medical necessity, claims rejected because a procedure wasn’t covered, or claims rejected for coding errors. Once a month, make a date with your piles. See how many claims were rejected for each reason, and record the numbers for the month.
Prioritize. Now that you can see why your claims are being rejected, you can aim for fewer rejected claims. You can’t address every problem at once, so pick the largest pile for now. Maybe you have a huge number of claims rejected because of improper demographic information. This points to a problem in your patient intake and registration procedures. Schedule a training to address this particular problem. Next month, target the next biggest pile, and so on, until you’re avoiding repeat mistakes in the medical billing process.
Positive Training and Reinforcement. Keep your training positive, so your staff all feel like they’re part of a team. Explain how the mistakes cause the practice to lose money, and set a positive goal. “We’d like to reduce this sort of error by 50% in the next 4 weeks.” When your staff make the change and reduce rejected claims, celebrate. Throw a little party, give them a certificate, do something to show that you appreciate the efforts they’re making to smooth the billing process. Focusing on one change at a time and keeping it positive will get claims under control without causing stress or in-fighting among departments.
Personal Touch. Finally, some of your greatest allies in reducing returned claims are your contacts in the insurance companies. Try to work with the same agents on a regular basis. Be polite and friendly. Develop a relationship with them. This way, you’ll have an ally on the inside who can help you perfect your claims, solve problems, and even influence contracts and policies in the long run. It’s true that we can do many things entirely by computer these days, but an occasional phone call and a personal touch will work wonders for your billing and claims acceptance rates.
Treat denial reports as a valuable learning experience and use them to implement the 5 Ps in your practice. Soon, you’ll see a dramatic increase in claims accepted on the first submission, and your practice will thrive as a result.
If You’re Serious about the Oral-Systemic Health Link, Be Prepared to Treat Pregnant Patients
In 2011, an OB/GYN posted an open letter to dentists on his blog. He reamed out members of our field for providing inadequate treatment for his pregnant patients, endangering both their health and the health of their unborn children. However, even as we’ve uncovered more evidence for a link between oral health and healthy pregnancies, some dentists shy away from treating pregnant patients. Frankly, this is absurd. You treat patients with other systemic health conditions like diabetes or heart disease. So why shy away from treating someone whose systemic health condition is a sign of health, rather than illness?
The American Congress of Obstetricians and Gynecologists issued guidelines for the dental treatment of pregnant women in 2013. They urge doctors to evaluate dental health at the first prenatal visit and to urge patients to seek dental care. They also point out that dental treatments during pregnancy pose no risk to the mother or fetus, and may, in fact, prevent both preterm labor and the transmission of unhealthy oral bacteria from mother to child.
ACOG has repeatedly emphasized that x-rays, fillings, crowns, root canals, local anesthesia and many antibiotics are safe during pregnancy. If a procedure is not simply cosmetic, it should be performed during pregnancy in order to protect maternal and fetal health.
What does this mean for your practice? Well, in the first place it suggests that certain dental procedures may be especially necessary during pregnancy. Obstetricians urge pregnant women to receive necessary fillings, crowns, and root canals to protect their health and the health of their unborn children. In addition, more intense cleanings and scalings may also be medically necessary if there is a diagnosis of a periodontal infections. Keep in mind that:
- If a woman has gestational diabetes, that may form another piece of the medical billing puzzle, since controlling oral infections can help improve blood sugar, and obstetricians urge expectant mothers to carefully control their blood sugar to ensure healthier pregnancy outcomes.
- For women suffering from blood pressure issues, control of pain and infection can help regulate their blood pressure. Dental care is essential for these women.
- When you provide dental care to a pregnant patient, be sure to document how you’re complying with the standards of care recommended by ACOG and the ADA. This will help make your case to insurers and protect you from liability down the road.
- It’s helpful to keep a list of ICD-10-CM codes that could apply to pregnant patients handy, so you can refer to them during exams. Some common codes that you might use include: (Insert coded here)
You care about your pregnant patients and you want them to have great outcomes, both for their teeth and their pregnancies. Now, more than ever, that means aggressively and thoroughly treating any sources of oral pain or oral infection. Listen to the OBs. When you take excellent care of a woman’s oral health during pregnancy, you improve her future, and the future of her child.