Scanning, Printing X-Rays Streamlines Insurance Filing By: Marty R. Lipsey, DDS, MS
Modesto Dental Group

Our office is very busy and averages about 100 new patients per month. Our group consists of two general dentists, two orthodontists, an oral surgeon and me, an endodontist. As a group, we see a very wide range of cases and submit insurance claims on approximately 80% of our patients. As with many practices, this presents a challenge, because most insurers require the patient’s x-rays to process claims.

Our practice, like many others, could only choose to submit original x-rays or copies with our claims. We tried a number of options to make this process run smoother. For example, at one point we tried using duplicating film to make copies of our x-rays. This solution never really worked to our satisfaction because it was very time consuming and the image quality of the dups was not satisfactory.

Making copies though did give us one important advantage–it meant we were not parting with our precious originals. Nonetheless, for many years, sending out originals is exactly what we did.

Unfortunately, there are no hard and fast rules about WHEN to enclose x-rays with a claim. In some cases, it is necessary in others it is not. Therefore, the first step in filing a claim was for our business office staff to make a judgment call about whether to include x-rays.

After a claim with an original x-ray enclosed was mailed, our staff would monitor its status to make sure the x-ray would be returned. Sometimes x-rays would turn up missing during this process resulting in calling the patient to reschedule an exam just to take additional x-rays or scheduling more time to take additional x-rays at the patient’s next scheduled exam.

Even when the x-rays were returned safely, the ordeal was not over. Next came the task of refiling. All of our incoming insurance claim documents were initially placed in a plastic organizer. It’s no surprise, given the size of our practice, that the organizer was often bulging with envelopes. As our staff had time, they would re-file the returned x-rays. This part of the process again introduced the possibility of human error. We have wonderful, competent staff but from time to time an x-ray would be misfiled, again raising the possibility an imaging exam would need to be repeated.

Fortunately, mistakes like that were rare. A more common annoyance occurred when an x-ray hadn’t been re-filed by the time the patient returned for a follow-up appointment. More times than I care to remember, I have opened a patient’s file only to realize the x-rays were not there. Then we would need to re-trace our steps to figure out where they might be located. Sometimes, we’d find them in the plastic organizer. Other times we would finally determine they simply had not been returned from the insurer.

Either way, the search was time-consuming. Our business office staff estimates they spent 5-10 hours per week tracking down x-rays.

To me, even worse than the waste of time was the disruption. So often, we’d find ourselves scrambling, looking for x-rays while our patients waited. It was unpleasant for us as well as our patients. Even if the delay didn’t appear to affect our patients, there is no doubt it did send a negative message that we were not capable of moving patients smoothly through their appointment process. I knew there had to be a better way.

Investigating the Options
I keep an eye on the dental publications and became aware that a number of vendors were offering new ways to produce copies of x-rays. Some solutions involved transitioning to direct digital radiography. In our case, though this solution was not viable. We are very satisfied with our x-ray imaging procedures, equipment and the quality of our films. We use Kodak InSight Intraoral Dental Film for our intraoral exams and Kodak Ektavision G Extraoral Imaging Dental Film for our extraoral x-rays, so our radiation dosages are already very low.

Another recommended option was to digitize our x-ray film and then print copies from the digital files. Clearly, this technology was maturing to the point where the image quality issues were surmountable; after all, the images published with the articles looked terrific. It seemed to me this might be a solution to our procedural issues.

I began to seriously research the technology and started talking to other dentists who had already implemented this type of procedure in their offices. Armed with a lot of information and favorable recommendations, I started digitizing x-rays in our practice with a scanner we already owned. I soon learned many scanners do not have the functions needed to handle dental x-rays. First of all, the scanner must be equipped with a transparency adaptor—a device designed for scanning transparent media. Because we take extraoral x-rays in our office, the scanner bed also had to be large enough to accommodate panoramic films. After trying a number of different models, I selected a professional quality scanner built to handle legal-size documents. After the image was scanned and stored in the computer, we made a hard-copy print of the image.

I also learned to replicate the clarity of the images I’d seen in dental journal articles, selecting the right paper is crucial to the final quality. When I started digitizing the x-rays, they looked great on my monitor screen. But when I printed them out, I was very unhappy with the quality of the prints.

I started experimenting again and tried printing the x-rays on a laser printer with high quality laser paper. Not satisfied with the results, I switched to an inkjet printer. Finally, I combined the inkjet printer with a medical grade paper (Kodak DMI Inkjet Paper for Dental Imaging).

I was amazed at the results using a different paper made in the quality. I finally had found a combination that would really serve our group well. In fact, I took one of the first x-rays printed on Kodak paper to the oral surgeon in our group and he said “it’s better than the original.” Technically speaking, of course, creating copies better than an original was not possible but it was an excellent and accurate copy.

Despite dentists’ training at interpreting x-rays, I suspect we are more comfortable viewing reflective images as well as transparencies. By producing a faithful and high-quality positive print, we create a copy that not only reproduces the imaging information of the original, but is also comfortable to view.

A New Process
Once I was satisfied with the quality of the prints, I showed our office staff how to use the scanner and the printer, and they were ready to use our new procedure for filing insurance claims. Today, when an x-ray is needed for documentation, a staff member scans the x-ray, prints it and encloses the print with the claim. The original are placed back into the patient file.

Although we’re fully computerized and networked, we don’t maintain digital copies of the scanned x-rays. If another copy is needed, we just pull the original from the file and scan it again. The entire procedure is very easy and only takes a few seconds.

The best part is that original x-rays never leave our office and we no longer play the odds with insurers to return our x-rays. At the same time, the image quality of our duplicates is very high. When we send them to insurers or other doctors, I have confidence we are demonstrating the high level of care and professionalism we aspire to at our office.

Marty R. Lipsey, DDS, MS is a practicing Endodontist and owner/director of Modesto Dental Group, a fee for service G.P./Specialty Group. Dr. Lipsey can be reached by email at DrSmile@pacbell.net.