When you’re running a PPO practice, getting insurance claims accepted and paid quickly is one of the most important factors in whether you’re profitable and productive. Without your claims being paid, your entire practice can struggle.
The fact of the matter is, claims are denied all the time. This leaves dental professionals frustrated as they wonder why the insurance companies aren’t paying. Rightfully so. They do the work, take care of their patients, and deserve to be paid.
In the Nifty Thrifty Dentists Facebook group, practice professionals and experts regularly discuss ways to improve practice profitability. And many of those discussions involve improving insurance claims. So, if you’re struggling to get your claims paid, here are some common reasons claims are denied and strategies you can use to improve your chances that your claims will be paid.
Common Reasons Insurance Companies Reject Claims
Claims get rejected for several reasons. Many reasons are common, such as limitations, exclusions, frequencies, or untimely filing. Others are surprising. For example, sometimes technology prevents the insurance company from receiving your full claim. For example, sometimes, companies aren’t set up to receive electronic attachments so your x-ray doesn’t come through. If they don’t get the x-ray, there’s a good chance they’ll deny the claim.
Additionally, many times, claims processers are evaluated based on how much time they take to process your claims. They have to process so many claims in a certain amount of time, otherwise, they could get fired. So they’re rushed and under a lot of pressure. If they don’t have the information they need to accept a claim right in front of them, they will just deny the claim and move on. So, if your paperwork isn’t clear or an attachment is not received, they will just deny your claim.
How to Improve Your Chances of Having Your Claims Paid
The best way to improve your chances of having your claims paid is to lean the most common reasons your claims are denied. If they’re denied for limitations, exclusions, or frequencies, understanding those things before doing the treatment can help so you can help your patients plan their care in such a way that claims are more likely to be paid.
Are your claims being rejected because they are incomplete or untimely? If so, develop systems and processes to ensure everything you need to collect is collected and claims are submitted in a timely fashion as a matter of habit.
Do you keep getting claims rejected as incomplete when you know it was complete when you sent it? If so, research the insurance companies' preferred claim completion instructions. Then, make sure you are delivering them in a way that will ensure they are received. Remember, if the person processing your claims has to figure out where everything is on your claim, it is much more likely they will just reject it.
Additionally, be extra careful with procedures that are more likely to prompt claim denial. For example, buildup claims often get denied. But there are little things we could have done to avoid denial, such as including pre-op x-rays, before and after pictures, and an explanation of why you did the buildup. Many practices omit pictures, but they can help let the insurance company know it was necessary and performed properly. If your denials tend to involve the same procedures, improve your chances of acceptance by including enough information to let the company know it was necessary as a matter of standard process.
Do you struggle to get claims approved?
If you struggle to get claims approved and paid in a timely fashion, take the time to learn why your claims are being denied and put systems and processes in place to address those reasons.
If you want help, connect with your peers in the Nifty Thrifty Dentists Facebook group today! There, you will learn from the collective experiences of thousands of other practices and dental experts. You’ll also get all the latest deals in dentistry to help you reduce costs and improve cash flow!