The dental billing revenue cycle is a challenging but essential procedure for a consistent and steady revenue stream. It is one of the first steps in the revenue cycle management process; which means that any mistakes or errors made at this level can lead to complications and have a significant impact on the entire revenue cycle. Inaccurate insurance eligibility and benefits verification can lead to delayed payments, denied claims and even nonpayment.
Errors made during this process can cost your practice more money than you might think. Most claim denials occur, directly or indirectly, due to insufficient or inaccurate information gathered, which is, basically, eligibility and benefits verification. The first step to reducing the number of claim denials is to establish an efficient eligibility and benefits verification process.
Here are some of the common eligibility and verification errors:
Inaccurate patient information
Verification is done to guarantee that your patients receive accurate billing for the services rendered. At times, errors can occur at this step; one of the most common errors being inaccurate patient information. This may happen for a lot of reasons, including a mix-up in the patient’s dental records. Something as simple as a middle name not being mentioned can lead to denials. Avoiding this problem will require that information is gathered diligently. Patients and the insurance providers must be contacted directly in case additional information is required. This also ensures that the data gathered is up to date.
Inactive insurance policy
Inactive insurance policies could be another reason for claim denials. In their hurry to submit claims, a lot of practices fail to check if the policies were active during the date of service. Information like the address for the submission of claims become invalid if the plan itself has become inactive. Contacting the insurer prior to providing the service is the best way to ensure that claims are not billed to inactive policies. Remember to verify the patient’s eligibility at the time of the visit before performing the treatment to make sure that the policy you are billing on is current.
Failure to properly check the coverage
Eligibility and Verifications is not a process that should be done once in a year. There could be several changes that are made on policies by insurers within a plan year. Practices often make the common mistake of not properly checking the insurance coverage of their patients. This again happens for a lot of reasons, but is often due to incorrect or outdated information. This could also lead to frustrated patients, as they would have to pay out of their pockets. It is always better to contact the insurance provider and get confirmation in case there are any doubts about patient coverage. It is also important to keep up with the changes to insurance plans. If a patient has a new plan or their coverage has changed, be sure to verify that the coverage for the services provided is still in place.
Another common mistake that practices make in eligibility and benefits verification is to duplicate data entry. Duplicate data can lead to delays in billing and payment, and can also cause confusion for both patients and your staff. This may seem like a simple mistake but it can happen very easily, leading to claim denials. When entering patient information into the system, make sure to check for duplicates and correct them before moving on.
A claim that doesn’t have the necessary documentation would most probably get rejected. The only way to rectify this situation would be to resubmit the claim with the proper and complete documentation. This can delay payment collection and make your patients irritated and frustrated. Information regarding documentation for each procedure needs to be collected during the eligibility and verifications process in order to avoid this problem.
Neglecting to ask about a secondary policy
Some patients may have more than one active dental insurance plan. They are usually identified as the primary and the secondary plans. In such cases, claims should be billed initially to the primary insurance provider. Claims could get denied if the claim is billed to the secondary insurance provider. The practice staff must inquire about any secondary coverage during their eligibility checks to guarantee accurate claim filing.
Remember, eligibility and benefits verification errors can cost your practice a lot of money. There are simple things you can do to help reduce the number of errors on your claims. Firstly, make sure that you identify and understand the eligibility and benefit requirements for the services provided to each patient. Secondly, verify that the patient’s policy meets the requirements before you provide the treatment. This can help your practice reduce the number of errors on your claims and save money in the long run.