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    8 ways to make insurance less of a pain

    Insurance can be frustrating for any practice, but these tips can put you and your patients at ease.

     

    Documents

    1. Include solid documentation 

    “What I have found to be most helpful is documentation,” says Erinne Kennedy, DMD, a dentist at a community health center in Boston. “The insurance company is looking for specific criteria in your documentation, so if you are able to give them exactly the information they need with the correct verbiage, reimbursement is easier. Accurate and detailed documentation, including radiographs or intraoral pictures, reduces an opportunity for the insurance company to deny the claim.”

    Patti DiGangi, author of “DentalCodeology,” calls documentation one part of the “two Ds” —  documentation and diagnosis. “What’s the diagnosis, and what’s in your documentation to support that diagnosis?” she says. “That’s called a dental medical necessity. We don’t think that way in dentistry yet, but we need to because there’s not a medical claim that’s paid anywhere that doesn’t have a documented medical necessity.”

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    She believes that documentation and coding is a team sport that can’t be left to one person. “The clinical professionals have to provide the information and the data that needs to go on claim forms,” she says. “The one thing we’re missing most often in dental offices is diagnosis. We’re not currently required to use diagnosis codes, so all we think of is procedures. The biggest question I get is about how to code things, but they don’t know the diagnosis, they just know the treatment.”

    If you’re not sure of the criteria that insurance companies require for documentation, Dr. Kennedy advises calling the insurance company to ask.

    “Personally, I keep a little list in the office of the insurance company’s criteria,” she says. “When I send in a pre-treatment estimate or claim, I know that I am sending the exact documentation needed for that procedure.”

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