When you work in the complex world of oral health treatment, you understand how tough it can be to properly file insurance claims. It can feel like a constant battle with private insurance payer, government agencies, and even your own team when things don’t go smoothly. You need to know how to handle your basics, like complete and accurate coding, speedy filing, and more, but even when you have that covered, it might not be enough. Going beyond the requirements can help you to maximize the effectiveness of your office.
If you’re ready to make some improvements, call Dental Auditing Solutions in Arlington, TX. Our office understands that you’re not only a place for patients, but you are also a business, and that means operating efficiently. From your daily tasks through to any potential audits, we are here to help your practice thrive, so when it’s time to make a change, give us a call.
Make more of your operations. Find ways to maximize your claim reimbursements with Dental Auditing Solutions.
Describe Your “Why” In Detail
While codes can tell insurance companies and government offices what was done, they don’t tell the whole story. Sometimes, there is more information that needs to be told, and in dentistry, this can be an important thing to bring up. If you experience post payment audits or your claims are being routinely denied, even though you know your patients could benefit from your care, ask about your approach.
These agencies want to know that a procedure is medically necessary, and sometimes, you need to plead your case. If there is a reason, for example, when a dental crown is more advantageous to a patient over a filling, it can be helpful to bring evidence. Including mitigating factors and detailed documentation can help payers to understand your reasoning. Our team is here to help you make sense of the situation, so when you have questions, reach out.
Being Proactive In Verification And Pre-Authorization
You also don’t have to sit around and wait for a denial. By taking a little time to research, you can find out beforehand whether or not you will be denied, and this approach can help you and your patients to work together to find a solution. Payers can have limitations on frequency or materials or even annual spending.
Pre-authorization can also be a help, here, as well. High-cost procedures frequently require prior authorization. Working with their insurance before you make a move can help you to know your steps at the right time. You still must have documentation to support the procedures even with an authorization. Your authorization needs to be for the service you provide or you must obtain a new authorization prior to the procedure.
Reverify insurance in situations where you have a prep and delivery, such as a crown. Payers want to be billed on delivery not prep. Several have processes or specific CDT Codes to use if the patient loses coverage between Prep and Seat/Delivery Date.
Questions? Call Dental Auditing Solutions
If your team has been dropping the ball lately, find your way back to an efficient office. If you are experiencing payer audits and need help assessing a plan of action to reduce those future audits and respond. To find out more about maximizing your reimbursement claims, call Dental Auditing Solutions at (972) 459-1508 today.