In a perfect world, submitting claims to insurance companies would be fast, seamless, and simple. The reality is that claims are frequently kicked back with a request for more information. Here are some strategies to get paid more quickly and consistently.
Beef up insurance verification protocols
Taking a scan of a patient’s insurance card, or entering the details into your database, is a good first step in verifying coverage, but the card itself does not tell the whole story of a patient’s coverage. Some issues that arise include:
The dates on the card are current but coverage has been terminated
Patients may have already reached their annual maximum benefits
Certain treatments may not be covered
Some treatments may require pre-authorization
Avoid these potential headaches by verifying coverage directly with the insurance company upfront.
Ask about dual coverage
When a patient has dual coverage and fails to disclose this information, various issues can arise. Some secondary insurance plans only pay out once the primary coverage has been exhausted.
Examples of patients with dual coverage include:
Medicare patients with a supplemental plan
Government employees
A young adult who has dental insurance of their own while still being covered under their parents’ plan
Coverage under a spouse’s plan
In some cases, people are not even aware they have dual coverage, so be sure to run through these common scenarios when onboarding a new patient.
Double check forms
The smallest error in patient information, or using the wrong code, can lead to a delay in processing. No matter how busy your billing department gets, proofread claims before they go out.
Attach it
When it comes to submitting claims, the more information you provide, the better. Any additional documentation you have available to attach will improve the chances of payment. Commonly requested attachments include:
X-rays
Referrals
An explanation from the doctor for why treatment was necessary
Proof of pre-authorization
Posted by
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Mar 29th, 2024 2:28 pm
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