5 Ways To Maximize Your Dental Claim Reimbursement

Amidst the challenging sphere of dentistry billing and expensive care, dentists encountering the difficulty of limited insurance coverage or no coverage available at all for accommodating patients' many procedures is a threat. Considering insurance reimbursement and patients as the only source of income for the stability of dental facilities, dentists aren't happy with the insurance companies' conduct to prevent patients from receiving the required reimbursement for care. According to the American Dental Association (ADA), one-third of adults aged 19 to 64 don't have any benefits at all amidst the expensive dental care. Consequently, this leads patients to empty their pockets even to cover costs for certain essential procedures, including dental restoration and oral and maxillofacial surgeries, or eventually put off care due to its expensive nature. On the other hand, the recent report from ADA highlighting 65% of Americans with one or the other type of dental insurance or dental benefits significantly implies the need to consider the improvement in dental claim and billing procedures. Insurance companies may deny reimbursement for various reasons, such as a patient's pre-existing condition, other risk factors associated with the dental procedure, costly dental procedures, or dental practice's failure to explain the medical necessity of the procedure. However, the reasons still may vary from one insurance provider to another as per the unique requirements of each; your primary responsibility as a dentist and business-holder of your practice is to ensure each step in claim documentation, submission, or appealing claims is transparently handled and meeting the reimbursement criteria of the insurance payer you are in contract with. Keep reviewing the guide to enhance your knowledge of how your practice can reduce the denial ratio and improve claim management so that dental insurance providers can consider standard amounts to pay as per the care requirements.

Understanding The Common Reasons Why Dental Claims Get Denied By The Insurance Companies

Many reported reasons for claims to be denied by dental insurance providers include issues in claim information, timely submission, lack of explanation of the medical necessity of the procedure, and so on. However, below are the clearly mentioned steps to get your practice to decline in income:

• Sending outdated or inaccurate insurance claim forms to the insurance companies.
• Your practice fails to verify a patient's insurance coverage.
• Missing the insurance company's deadline to submit claims.
• Procedures may not be covered by the patient's insurance policy
• Sending unreadable information and documents to insurance companies
• Missing explanations on the dental claim reimbursement form.

Strategies To Enhance Your Practice Dental Claim Reimbursement

MedsDental's comprehensive guide informs you on the latest procedures and trends to follow in your claim management to increase reimbursement and patient care quality. Moreover, we have a record of assisting dental practices in clean claim filing and submission to reach the level of reduced denials and errors in information, consequently providing the desired benefit of patient insurance reimbursement. Here's how we manage our process of claim filing for a successful practice revenue.

Use Updated ADA Claim Form 2024

The American Dental Association (ADA) is introducing a new ADA claim form effective January 1, 2024, which is a new update for dental teams to stay compliant with the practice rules. Using the updated claim form in the process of claim submission isn't only a necessity but also security for dental practices to prevent costly consequences and many other reasons, including:

• To stay compliant with industry standards and avoid misunderstanding with payers. /li>
• To improve accuracy and efficiency in the claim process
• To get faster reimbursement from insurance providers
• To reduce appeals processes and save time.
• Get fewer claim denials from insurance companies.

Educate Your Patients On The Best Dental Insurance Plans

Keep educating your patients about the benefits of taking the best dental insurance plans that not only offer higher reimbursement limits and comprehensive coverage with no-waiting periods but also lower the costs of expensive dental procedures, including crowns, fillings, and implants. Consequently, wealthy patients will result in your practice increasing revenue and stability. Have a look at some of the best dental insurance plans for your patients:

Guardian Direct

The plan includes 50% major dental work coverage on every plan type except the preventive-only plan. These plans cover procedures such as oral surgery, implants, crowns, and dentures.

Delta Dental

The plan is popular across the country because of its comprehensive dental benefits and no upper age limit for braces. Delta Dental is an excellent choice for individuals and families with orthodontic care needs with its different types:

Delta PPO Premium covers - 100% of routine care and 20% to 50% of basic and major procedures.
DeltaCareUSA (HMO) - Offers fixed copayment rates for preventive, basic, and major services without deductibles and annual limits.

Humana Dental Plan

It offers seven dental plans in which five plans cover in-network and out-of-network dentists while it also offers a dental saving plan and a low-cost HMO plan with limited provider network.

Dental Insurance Narratives

Dental claims are the first priority insurance companies use to determine reimbursement after figuring out the procedure and treatment details. As a dentist, you are well aware of documenting an approvable claim while focusing on the necessary information like dental coding. However, according to ADA standards of claim submission, a well-documented narrative must be attached to the claim form. A dental insurance narrative must be well-written with a description of the patients' problems, diagnosis, and treatment in detail.
For instance, a narrative must be documented in a story format, including the medical necessity of the treatment and details like a patient's specific problem, the reason for a certain procedure and prescription, and your practice to resolve the issue. However, concentrate on using a fresh narrative with each patient visiting your office instead of relying on a "stock" narrative to attract trouble for your practice. It's a common mistake among dental practices to use a stock narrative, leading to several fraudulent claims and reimbursement for practices.

Appealing Denied Dental Claims

According to professional dental billing companies, appealing for a denied claim two to three times before meeting the resolution is a common practice among dental facilities. Proper documentation as per the plan's requirements can provide most of the claims overturned with the first appeal. However, if your claims need a second appeal to get approved, your practice must consider focusing on the strategies, including paying the claim on the first submission, reviewing your contract and denial carefully, and explicitly demonstrating the patient's medical necessity. Furthermore, involving a professional medical biller in the appeal process can make a significant difference in your practice's cash flow. Here's how to appeal a denied insurance claim:

• Follow the instructions on each plan carefully.
• Don't use your self-made template unless it meets the plan's directives.
• Submit a written request to reconsider the claim.
• Provide additional documents clarifying the need for why you recommended the treatment.

Be Wary Of The Top Dental Procedures Denied By Payers

Dental insurance providers deny many claims due to the patient's lack of coverage. Moreover, the reason why insurance payers deny claims is that many procedures are deemed "unnecessary" or "experimental" by the payers, even if they hold a significant value for patients. Some of those unpayable dental procedures are:

Dental Sealants

The procedure is viewed by the payers as elective or unessential to pay coverage. Moreover, Sealants are expensive and the reason for denying coverage for the procedure by payers is that these can be covered with other preventive measures available.

Orthodontics

The procedure is denied coverage because of its cost and complexity. Plus, dental insurance payers consider it as cosmetic and elective in nature and not medically necessary to pay reimbursement.

Dental Implants

These types of procedures are restorative and can cost thousands of dollars. The reason why dental payers deny the coverage for the procedures is its additional cost associated. Moreover, the plan requires additional costs apart from the implant itself such as the placement of implant and restoration of the tooth.

Let's Learn To Take Control Of Your Reimbursement From Insurance Companies

Dental insurance companies may have various reasons to deny your claims. However, you, as a dentist and dental service provider, own various opportunities to make improvements. By understanding the specifics of dental claims documentation, claim submission, and the appeal process, only your practice makes the difference. Plus, a comprehensive understanding of these processes will help you resonate your steps with the latest trends and guidelines to follow in billing and claim management for acquiring an increase in reimbursement and improvement in patient care.
Shake hands with MedsDental billing, the first-rate billing service provider in the US, to serve dental facilities with efficiency and accuracy. Our timely operations of claims filing and submission and appeals help dental businesses to make quick progress in reimbursement and their practice health.