Claims billing is a multi-step process involving several people and types of data like patient-related information and clinical documentation. Not setting up a robust claim filing and billing system can possibly be the worst mistake that a practice can make in their revenue cycle. Understanding the fundamentals can help providers and practices ensure that the number of claims that go unpaid or denied remains as low as is possible. Understanding claims billing starts with learning about the various steps involved and improving the efficiency of each step.
Maintaining Thorough and Accurate Data
This is a continuous process that starts at the outset of a patient’s and provider’s relationship. All the relevant information collected before and during the cycle of services provided, needs to be entered into the billing system accurately. During this process, all the documents must be scrutinized and verified. These documents include:
- Social Security numbers of patients
- Tax Identification numbers of providers
- Addresses of patients and providers
- Details of procedures done
- Any X-rays or charting that needs to be done
- Pre-authorization documentation, when required
It is always better to provide more data than less when it comes to the services provided at a practice.
Any errors found must immediately be rectified and any missing information should be collected and included. This helps in preparing more accurate claims, thereby reducing the risk of claim denials.
Applying accurate standardized codes
CDT codes are a collection of codes used to identify the various procedures and services provided for oral health and dentistry. There is a vast array of these codes which go through frequent additions, deletions, and modifications each year. Staying on top of these changes and ensuring that the right codes are used, is another vital step in the claims billing process.
Looking for limitations, frequencies, and exclusions
The amount an insurance provider pays out depends on several factors, not least of which are limitations on the amount covered for certain procedures, the number of times some procedures are covered in a particular policy year and even the patient’s age. These limitations, frequencies and exclusions affect every claim, and this is the reason information on these is usually collected before a service is provided. Unrecognized exclusions or limitations in the insurance coverage could result in claim rejections and denials.
Quality check
The final step, pre-submission of bills, is always a review of the prepared claim. This is done as an attempt at ensuring that all possible mistakes are eliminated, reducing the chances for claim denials. Vital pieces of information that need to be reviewed are:
- Accuracy of procedural codes
- Patient information and data
- Insurance provider data
- Provider data
- Insurance limitations, frequencies, and exclusions
Evaluating and resolving denied claims
Submission of claims can be incorrectly considered as the last step in the claims billing process. However careful a practice is while preparing and submitting a claim, there is always the possibility of claims getting denied and procedures going unpaid due to human error. Reworking such claims is another step that gets added due to such denials and non-payments, and this rework needs to be done without any delays.
Periodic review of previously denied claims is also a great way to learn from mistakes made in the past. Implementing the learnings from such reviews helps build a better claims billing system, which in turn reduces the chance of future denied claims and unpaid procedures.
Maintaining continuous communication with patients and the insurance provider
While continuous communication may not be an established custom in the billing process, it is an important phase for the dental revenue cycle management of a practice. It helps reduce the time and effort that is necessary to file claims. Staying in touch with your patients not only improves the reliability of your practice but also quickens and improves your revenue cycle.
Having a well-managed and efficient claims billing system is the key to a successful revenue cycle management. It helps minimize the workload of your staff and helps to ensure that the focus is always on what is most important, excellent dental care and patient satisfaction.
