Lost Dental Insurance Revenue

Imagine that your ability to reinvest in your practice or put aside retirement funds was hampered by lack of cash flow. I recently evaluated two practices to identify weaknesses in their revenue cycle. Both offices had decreased cash flow – which prompted the call – and the doctors were told by their team members that the ‘economy was impacting payments’ and that ‘patients just don’t have money right now.’ While both statements may have played a factor in practice revenue they didn’t fully explain the bigger issue: decreased cash flow.

What was happening? Insurance claims were not being filed in a timely manner. Information requests from the insurance company were not being answered. Inaccurate patient data was causing claims to come back rejected. In both cases the administrative team member stated that they were doing the best that they could. Unfortunately their performance was keeping claims from being paid which greatly impacted the practice’s bottom line.

How do you keep this from happening in your practice? Let’s evaluate three basic necessities for proper insurance revenue management: time, tools, and tracking.

Do you have one administrative team member that seems to do everything? It’s almost certain that this person has too many job duties to perform. Insurance management can easily take up 1-2 hours per day. Why so much time? Verification of benefits and eligibility, gathering supporting claim data (such as radiographs and periodontal charting), and insurance payment entries can easily fill this time period. A solo doctor with 1-2 hygienists on staff can generate enough claims to maintain a part-time person. Your solo administrative member is also answering phones, checking people out, sending statements, running the recall program …. whew! You can see it all adds up. Consider adding a part-time accounts receivable and insurance position to properly manage billing and cash flow.

Have you provided the tools for this position to be as effective as possible? Claims and supporting documentation should be sent electronically. The learning curve for these programs is relatively small and the payoff is huge. Claim turnaround time is greatly reduced and the team member knows immediately if a claim is rejected because of lack of correct data or missing information. Offices still submitting paper claims are delaying payment by 3 weeks or more. Make the switch to electronic claims and attachment and make sure that your team member receives training from the companies.

Finally keep up with tracking the receivables in your practice. Ask your administrative team member to run an accounts aging report on a biweekly basis and present it to you for evaluation. You want to make sure that delinquent accounts are being actively ‘worked’ to obtain payment. The insurance aging report should be run weekly to identify which claims are overdue. As the doctor, you should ask to see these reports even if they look like Greek to you! The message that you are sending is that you are interested in the process which prevents your team member from letting it slip through the cracks. I find that when an employee knows you are tracking these numbers they do not neglect or delay their revenue efforts.

Good managers are often vigilant with practice metrics and so should you be. Track your insurance and receivables balances to avoid reduced cash flow surprises and to be able to reinvest in yourself and your practice.

By Teresa Duncan, MS, FADIA, FAADOM

With over 20 years of health-care experience, Teresa addresses topics such as Insurance Coding, Fraud & Embezzlement and Revenue Management. She is a Fellow and Educator for both the Association of Dental Implant Auxiliaries and the American Association of Dental Office Managers. You can visit Teresa’s blog at http://www.thedentalimplantblog.com or her website at http//:www.odysseymgmt.com. She can also be reached by email at teresa@odysseymgmt.com.