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August 2017

Top 20 Tips for Dealing with Dental Insurers

When insurance claims aren't being paid in a timely fashion the resulting financial domino effect can cause stress on the dentist and staff. With an ever-changing insurance climate, knowing the how, when, and what to bill is more important than ever.

To help you navigate through the dental insurance maze, the MDA has put together its “Top 20 Tips for Dealing with Dental Insurers.” These tips cover a range of topics including patient/payer communication; billing; timely payments; coordination of benefits; focused review; and non-par BCBS checks.

Patient/Payer Communication

1. Read and understand the insurer's participation agreement/contract.

2. Have a written payment policy and communicate it to all patients so they have a clear understanding of their payment responsibilities.

3. Ask about coverage changes at recall visits and verify eligibility and covered benefit.

4. Communicate with payers and document your communication with payers: include the name of with whom you spoke, date, and time.

5. Know the plans; they may vary within the same insurer based on the employer or third party. The more you know, the more you'll avoid untimely and costly hassles. Examples of what to know: Less Expensive Alternative Treatment (LEAT), bundling, downcoding, frequency limitations, and date-of-service policy.

Billing

6. Bill for what you do. Simple, but important.

7. Report your full fee, not the allowed fee/reduced fee. This provides for better understanding of prevailing fees and enables proper payment when allowed fees are updated.

8. Compare and coordinate documentation of services with CDT Codes and their descriptors.

Coordination of Benefits

9. Initiate contact with the payer at 30 days and keep notes on all contacts with payers: date, issue identified, and carrier representative contact name. If EOB stated "coverage was terminated," follow up with the patient immediately.

10. Always submit the full fee for services.

11. Post contracted write-offs after all plans have paid.

12. Benefits may be up to the higher fee from two or more contracted plans, but the patient is only responsible for up to the negotiated lowest fee.

13. Submit the claim first to the carrier that you believe is primary. The plan in which the patient is enrolled as an employee or as the main policyholder is the primary carrier. The plan in which the patient is enrolled as a dependent would be secondary. Be certain to complete the section of the claim form for other coverage, whether or not you plan to submit for payment from the other carrier.

14. Always include the EOB from the primary carrier with your claim submission to any additional carrier.

Focused Review

15. Code for what is done. "One size fits all" miscoding will impact the practice utilization profile.

16. Consult the literature on the services under review. Be sure your understanding of a service matches accepted practice.

17. Before service, double check that the doctor documents the clinical findings and explains why the care is recommended. Preoperative radiographs, photographs and study models will provide support.

18. Include all the documentation you gathered and the rationale for care as supported by the literature. If the predetermination is denied, appeal that decision, but realize that sometimes care is disallowed as a result of contract coverage limitations and not because of the appropriateness of your recommendation.

19. Keep track of all the claims and know the percentage of those that were rejected for the services in question. Be sure to establish contact with a reviewer and professional relations representative at the carrier so you can consult with them about specific claims, and track your progress to bring your time on focused review to an end.

Non-Par BCBS Checks

20. If you are non-par with BCBS and you chose to cash or endorse the reimbursement check, you are choosing to participate for that claim and you cannot balance bill. If you are non-par with BCBS and you intend to balance bill, don't check box 37 on the claim form, and have the reimbursement check sent directly to the patient.

As an added convenience, the MDA also makes these tips available in a flyer format that is perfect for keeping handy at the front desk.

DOWNLOAD THE TOP 20 TIPS FLYER


Register now for 'The Best of MDA’s HR Hotline' Seminar

It’s no secret that human resources can be one of the most difficult jobs in dentistry, and it often takes something going wrong before real attention is given to managing this part of the practice.

Join Jodi Schafer, SPHR, owner of Human Resource Management Service, and Brandy Ryan, MDA director of human resources, for “The Best of the MDA’s HR Hotline: Learning from Others’ Mistakes and Safely Admitting to Some of Your Own,” coming Nov. 17 to MDA headquarters in Okemos.

This full-day seminar will share the most common human resources questions Schafer and Ryan receives from office managers and dentists alike. They'll cover the legal/ethical aspects of disciplining and firing employees, smart ways to approach the hiring process, methods of communicating effectively with staff, and what to do when unkind comments are made about the doctor or the practice on social media! No topic is off limits in this frank training seminar.

The cost to attend is $299 for dentists and $169 for staff. To register or for more information, visit the CE Courses section of the MDA website.

REGISTRATION AND MORE INFORMATION


Dentists Need to Update their ADA Find a Dentist Profile

Make sure the doctor(s) in your practice have updated their online MyADA profile to ensure that he/she is correctly listed on the ADA and MDA Find a Dentist tools.

The ADA recently upgraded its Find a Dentist tool to make it easier for patients to find member dentists online. Searches on the MDA’s Find a Dentist tool at smilemichigan.com also link to the dentist’s ADA profile, so be sure to have the doctor(s) take five minutes now to do the following:

  1. Log in to the MyADA profile page using his or her user ID (member number) and password. If the doctor is unsure of the user ID or password, he or she should call the ADA Member Service Center at 800-621-8099.
  2. Complete all fields, including contact information, office hours, and the types of payment and dental benefits the office accepts.
  3. Most importantly, be sure the doctor uploads a photo! Profiles with photos get 11 times more clicks and also show up higher in search results. Members with photos will be listed first on searches.

GO TO PROFILE LOG IN


Contact Information

MDA Practice Management Department
Ginger Fernandez, RDH, RDA
Manager, Professional Review and Practice Management
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MDA Human Resources Department
Brandy Ryan, PHR, SHRM-PC
MDA Director of Human Resources
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