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Teresa Duncan, MS, FADIA, FAADOM is an international speaker who focuses on revenue, dental insurance & management issues. She is a Fellow of the American Association of Dental Office Managers. Her memberships include the Association of Certified Fraud Examiners, National Speakers Association and the Academy of Dental Management Consultants. She has been named one of the Top 25 Women in Dentistry by Dental Products Report. Teresa received her Master’s Degree in Healthcare Management.
Teresa Duncan, insurance editor for Dental Products Report, offers advice on how to lower some of the pain that dental insurance causes for so many practices.
As the New Year launches, practices are gearing up for another year of patient care management.
For many offices, this includes updating brand new insurance plans or plans that have reset for the year. What can you do to ensure that your insurance systems are set up efficiently? A few easy precautionary measures can help you avoid uncollected copayments and rising accounts receivable. A common theme throughout all of my seminars and consulting is that “copayments are meant to be collected.” Remember that as we discuss how you can stay ahead of the dental insurance game.
Continue to the following page to see the top five things you can do to make 2016 easier when it comes to insurance.
1. Reset calendar year deductibles and maximums
This sounds easy and many of us rely on our practice management systems (PMS) to handle this task. But if you don’t close out December or double check your treatment plan totals before handing them to the patient, then your estimates will not be accurate. Your team will never be confident in asking for copayments if they feel that the estimates are always wrong.
2. Review plan designs at the beginning of the plan year
Your patient who has always had Cigna insurance comes in after the new year. His deductible and maximum reset. His plan must be the same, right? Not always! The beginning of the plan year (usually calendar year) is when percentages and maximums change. A plan that covered restorative at 80% one year could very possibly cover the services at 60% the next year. If you are not checking the plan benefits at the start of the new plan year, then you will miss this and will have to chase the remaining copayment after the insurance pays its portion … and that’s if your staff recognizes the error and doesn’t just automatically write it off.
3. Once a year, run your insurance utilization report
This will help you to determine how many patients are coming to you via an insurance company. We talk often in my classes about not having your practice dominated by one insurance company. You won’t know if this is happening unless you track how many patients are covered by which insurance companies. My rule of thumb is to not have more than 20% of your practice in one participating plan. In certain states, participation in Delta blows this number away simply because dentists feel that they don’t have an alternative.
4. Electronic everything
If you aren’t submitting claims and attachments electronically, now is the time to change that. It is concerning to me that I still have team members come up to me and say, “I wish I could put into practice what you’re teaching but my doctor won’t sign up electronic anything.” You can check eligibility and benefits online as well as submit your claims. Printing an attachment such as periodontal charting or a radiograph should be a rarity, not the norm.
Existing electronic users could look into their system to see if they are utilizing all the services that are available. Many services now offer the ability to obtain benefit information for plans that are not easy to access online or via phone. Imagine not having a phone line (or two!) monopolized by hold time with insurance companies. Your colleagues are seeking this service for a reason … it makes financial sense. Your administrative team is more valuable talking to patients and working on your practice.
5. Reinforce your insurance knowledge
Insurance networks are often changing and evolving. We are seeing mergers and acquisitions that will likely impact your practice. If you or your insurance coordinator can’t stay plugged into the environment, then your receivables will suffer. Take seminars, webinars, and continue to read articles such as these. My company offers a newsletter that gives you updates on networks along with insurance tips. You can sign up for it here. Another very popular site with detailed participation explanations is Unlock the PPO. You can also click on my name on this page to find more insurance articles to read.
Operating a practice has become more difficult in the past decade as fee schedules are squeezed and patient copayments are raised. In order for you to be efficient in your insurance management, you will need to actively monitor the process. I heard from many of you in 2015 who shared their success stories and tips. I always pay those forward in articles and seminars and I hope to be able to share even more of your experience in 2016. Remember, copayments are meant to be collected!