Dental Billing Support - Insurance Tips

This blog is geared toward anyone working in the dental industry, whether they are Dentists, Office Managers, Insurance Coordinators, Dental Billers, etc. It will help a lending hand to anyone that has any dental insurance questions.

Blog By:
Davy Clay

As everyone tries to grow their practice or start fresh with a new location, many docs have the same questions in regards to “How and Where” do they get started on insurance. I was looking at the Dentaltown message boards today during some free time and noticed a similar question. 

It was a doc starting a new practice and seem to know little about dental insurance and essentially, “How do I get started?” “Where do I look to learn about claims?” 

In addition to Dentaltown, I was also helping an existing practice transition into a new location (across the street) and a new tax id (new owner).  The two scenarios were quite different but also very similar.  The first office wanted advice and know how to send claims to insurance, the second office needed proper setup to make sure claims are being paid to the correct new location AND under a new Tax ID.  Quite obviously the common goal is obviously the same with every dental office, “I want to send claims to the insurance company and I want them to reimburse me for my services.”

However, setting up a new office and getting paid from insurance requires a certain few steps to be taken to ensure proper setup and a properly trained person to get the correct files, in a timely manner, to the Provider Relations departments at each insurance. 

    
1.     

   To go in PPO or not to go?

       

This is the question. The number one, BIGGEST question in fact, a dentist will face. The stereotypes include; The old school way vs. the new school way vs. the DSO way. 

The old school way - Most dentists who consider themself “old school” didn’t want anything to do with PPOs. They would not be caught dead accepting a lower fee schedule than their normal UCR (usual and customary fees).  If we hang a “Dentist” sign outside, the patients will come.

The new school way - Most younger dentist realized getting in-network was their marketing. That’s how they are able to get New Patients.  Getting New Patients is how you make money, right?  In this example, more volume = more money, or so you think. Most however are steering clear of the Medicaid mess/headache.

The DSO way - Accept everything you can, it’s all about New Patients! No plan left behind! Insurance, Medicaid, CMO, HMO, or Discount Plan - whatever you have, we take it!

    
2.     

   Credentialing

       

The most overlooked process any office often makes is credentialing.  It seems easy that you chose to be in network with X, Y, and Z insurance companies - you filled the paperwork out, sent it in - got accepted. Now what? They sent you a fee schedule, you entered it in the software. You’re good to go, right?

It’s not that easy.  Credentialing is like the fine print of the fine print. Because we know you probably didn’t read those contracts word for word.  Credentialing is necessary if you want to go in network with any insurance (which I do recommend for most, but not all locations) however you cannot start credentialing without research.  You MUST research before signing your name to a contract! Research employers in your area, what insurance will most of your patients have? If only 3% of the patients in the city/county have “X” insurance, do we really NEED to be in that network?  If “Y” insurance company fees are lower than minimum wage, do we really WANT to be in their network?  If we really like “Z” company’s fees and most of our patients have it, are we automatically in?

The biggest problem I see regularly with credentialing is 1) time and 2) you signed up for more than you bargained for and had no idea.

    
1.     

   Time - You can’t wait.  If you are planning to open your doors next week or next month and haven’t started credentialing, you waited too long.  Credentialing is sometimes a lengthy process and can last up to 90 days! (Depending on the insurance company!)

       
           
   1.         

      Even if you hire a doc to work in your practice, start the credentialing ASAP!

              
       
       
    
2.     

   You signed up more than you bargained for and had no idea - This happens way too often.  In today’s insurance world, fee schedules rule. Just because you signed for X insurance, you also (accidentally) checked the box that you would sign up for Z insurance on X insurance’s fee schedule! Or you signed up for all 3 fee schedules that X insurance was offering! Confusing, right?!  

       

    
3.     

   Billing Setup on Claims

       

This is something I cannot harp on enough.  This is a huge mistake I see day in and day out when a new office, OR a new doctor(!) is added.  Or the setup has been wrong for years and you’ve never noticed but insurance companies are actually paying your associates instead of your business, all under the wrong NPI 1 instead of you having a proper NPI 2.

You want insurance companies to have the right information from the start because any change that needs to be made could take months to fix, and you could be missing out on thousands of dollars by setting up your billing (also print UCR on all your claims) and claims incorrectly.

My point is to know what you’re doing.  Or hire someone that does. Do your own research but please don’t hire someone who thinks they know how to do credentialing or thinks they know how to properly send claims, post checks, or thinks they can figure it out.  You may will regret it.