Handling denied claims is one of the most difficult things an employee in the dental billing and coding profession will come across. Each denied claim can translate to a loss of time, additional paperwork, and possible bill loss. Alas, these are not the obstacles I am unable to overcome. Once practices understand why claims are denied and apply the correct course of action, these denials become approvals and do not disrupt revenue cycles.
In this article, we’re going explain more details about the primary cause of claim denial, ways to address such problems, and how The Medicator’s can assist your practice in streamlining your dental billing.
1. Why Are Claims Denied?
To reduce and address those problems one should know why the claims are denied. Here are the primary reasons dental claims face rejection:
Inaccurate or missing any detail of the patient
Claim denials due to patient demographics include name, date of birth, and insurance ID number.
Coding Errors
Paying too much attention to the formats bc of coding mistake like incorrect/old CDT codes lead to rejection as well.
Failure to Produce Required Papers
Any of the following are likely to be uncovered and which can lead to rejection of claims; Lack of X-Ray, treatment chart or narratives.
Policy Restrictions
Sometimes a particular procedure may not be on the insured’s plan, or the facility and insurance company may have reached the limits allowed for that particular insurance plan.
Duplicate Submissions
Submitting the same claim again without responding to the reason for denial will result in other rejections as well.
Timeliness Issues
It is important for the insurance companies have set time limits within which claims are supposed to be presented to the firm. Whenever you submit your work late, you automatically get declined.
2. Steps to Handle Denied Claims
When the claim is denied, there should be actions that must be followed in a certain manner or order to solve the problem. Here’s a step-by-step guide to handling denied claims:
a. Also look at the Explanation of Benefits (EOB)
The first thing that one has to do to appeal against an EOB or denial notice is to read through the document thoroughly in an attempt to rule out the fine details of the rejected claim.
b. Second-Confirm Patient and Insurance Data
Ensure that the demography of the patient matches with what he/she has on the insurance card. This is true since most personnel enforcing the political tests will reject any policy application with even the slightest mistakes.
c. Analyze the CDT Codes
Make certain that the code numbers placed on the CDT forms are correct for the services provided.
d. Address Missing Documentation
Check the insurer’s guidelines on paperwork and make sure that all the attachments filled (for instance, X-ray, and clinical notes) are provided.
e. Make Necessary Corrections
Correct any mistakes and missing parts and send in the claim again where possible accompanied by an explanation as to the changes.
3. Appeal Process of Denied Claims
If a decision is denied even in its second instance, then appealing is possibly the ideal next step to take. Here’s how:
Know the Insurer’s Appeal Guidelines
Appeals vary depending on the insurer of the particular health plan. Every client should get acquainted with the timeline of the insurance company’s work and the deadlines proposed.
Prepare a Detailed Appeal Letter
In writing a professional appeal letter, there should be reasons put down why the procedure should be covered. Such items as treatment notes, patient history, and X-rays should also be uploaded.
Track the Progress
As you wait to hear from the insurance provider follow up with them to know the progress of your appeal.
Usually, when the appeal is filed, one stands while the other becomes steadfast and makes their argument based on substantiated facts.
4. How to Prevent Claim Denials in the Future
An ounce of prevention is worth a pound of cure or how prevention matters in dental billing. Here are some proactive strategies to minimize claim denials:
Go into extensive training
Make sure your staff is familiar with claims in dental billing and coding procedures as well as constant changes in CDT codes.
Use Advanced Billing Software
Use A/D to submit claims and have a layer that alerts the system on the likelihood of mistakes before submitting the claims.
Conduct Regular Audits
General audits of the billing and coding process will be important for detecting either ongoing or emerging issues within the system.
The Insurance Must First Be Checked
This also applies to insurance details and coverage limits with patients when deciding on performing particular procedures for which clients are unlikely to be prepared.
5. The Medicator’s: The Preferred Partner for Dental Billing Services
Claim management is sometimes very challenging and takes a lot of time especially when claim have been denied by insurance companies. That is where The Medicator’s come into the picture.
We are focused solely on dental billing and coding services; Thus, we provide a comprehensive service that can enhance your operational efficiency and revenue cycle. Here’s how we can help:
Claim Submission by the Expert and Management
Our team safeguards every claim we make to eliminate any errors leading to denial of payment with the aim of timely payment.
The denial analysis and resolution process can be explained as:
We review denied claims carefully, determine the reasons and address claims resubmission or appeal on your behalf.
Customizable Solutions
Whether you’re a small practice or a large dental group, DSDC chooses services that are relevant to your particular situation.
Training and Consultation
We augment your internal team with the most current knowledge of dental billing and coding.
Working with The Medicator’s allows you to concentrate on your patients while we take care of all the details concerning billing and coding.
6. Final Thoughts
Claim denials are a challenge, but they do not have to impede your practice. In order to avoid falling prey to denials and maintain a healthy revenue cycle it is important to know why they occur, follow a proper structured path to address them, and access expertise such as The Medicator’s.
Contact The Medicator’s to ease your billing processes and allow you to reach your goals in this area. Come to themedicators.com to discover more or give us a call today!
