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Dental insurance billing is something many dental offices struggle with because it can be so complex. When do you bill? What rates do you bill? What if the patient has two insurance coverages? How do you keep your office organized and implement a system? It’s a lot to remember. Colleen Huff joins me in this episode of Talking with the Toothcop to answer some of those questions—and help you simplify the process.

Colleen Huff has been everything from a bookkeeper to a scheduling coordinator, with extensive experience managing practices. In her management role, she saw a severe lack of training—to the point dental offices were engaging in illegal billing practices and didn’t know it. So she started educating others on proper practice. Colleen has been a dental insurance coach for the last 17 years.

Outline of This Episode

  • [0:20] Colleen Huff’s background
  • [5:05] Can you simplify the dental billing process?
  • [15:45] The biggest mistake dental offices make
  • [19:20] Anyone engaging in fraudulent billing is liable
  • [22:10] Understanding insurance breakdowns
  • [26:20] Dealing with multiple insurance coverages
  • [28:05] Common issues offices struggle with
  • [30:55] How do you systematize and organize?
  • [34:20] Connect with Colleen

How do you simplify the verification process?

We’re at the beginning of the year right now, when many clients have switched to new insurance—which typically means a mad scramble to verify coverage. Coleen does everything she can to make sure insurance is verified weeks before a patient’s appointment so they can contact them about any problems that arise.

If a client has a Medicaid policy—which can terminate at a moment’s notice—you must be sure to verify it the day of the appointment. She also recommends doing this for commercial insurance plans because they no longer run on just a calendar year. Many are contract year, benefit year, or even a rolling year based on employee hire date.

It is preferable to know ahead of time whether or not there will be a financial challenge for you and your patient. You can notify the client upfront, instead of billing them later and dealing with an angry client. With the real-time eligibility systems in place, the process has become much easier. Listen as Colleen and I chat about how she documents the process and communicates problems with patients.

The biggest mistake dental offices make

The #1 problem Colleen sees in dental offices is not submitting claims on the proper completion date. Many offices send claims before the work isn’t completed, citing that “everyone does it” or “no one ever gets caught”. Doing so is dangerous for your practice. You need to submit the claim for the proper date the procedure(s) was completed or face the consequences when you’re caught. It will be jail time.

It’s not just the Dentists that can be prosecuted. A billing staff who knowingly submits fraudulent claims can be found at fault. Whining that “The Dentist told me to!” will not protect you. If you are part of the billing staff you must be reviewing claims before you send them.

It comes down to integrity. The more you allow and the more “little” discrepancies that you let slide will make an impact. Make sure your morals and beliefs align with how you are operating your practice. We talk about an incident where a provider did end up in prison and the reason behind it—keep listening.

Why insurance breakdowns are important

Colleen and I agree: you must know how much a procedure will cost a patient. Run the verification, make whatever calls necessary, and print out a breakdown of what a client will owe. Then, collect whatever copay is necessary. Your billing will be more accurate. This also removes the chance of most—if not all—surprises and helps you avoid a patient getting an unexpected bill.

Some offices struggle with moving into the 21st century and claim that “Patients should understand their insurance and what they charge”. Colleen is more familiar with insurance than most people, but even she doesn’t know everything—and you can’t expect your patients to either. Gathering information on the front end is important.

Is it time-consuming? It can be. But most insurance companies have a way for you to check verification and coding online. Sometimes it may take a phone call. But it saves you future hassle and makes your patients feel relieved and secure in your ability. Referrals come from happy customers, and the more you simplify the process for them, the happier they’ll be.

Your dental insurance billing questions answered

Colleen took some time to answer common questions and issues that dental offices struggle with:

  1. If a client has two insurance policies, which is primary and which is secondary? There are a few simple rules. First, a Medicaid policy is always secondary (except for a few rare circumstances). Your plan is always primary to your spouses. For a minor child, unless court-ordered differently, the parent with the earliest birth date in the year is the primary insurance.
  2. Should you bill your full fee or the contracted rate? Always bill your full fee. The insurance company will pay the contracted rate and you adjust off the rest based on the contracted fee schedule.
  3. How do I negotiate fee schedules? Colleen notes that you must be billing your full rate. If you don’t, an insurance company will see that they’re already paying you what you’re asking, and you have no leverage for negotiation. It takes time, but if you go through the proper channels you can see a fee schedule increase.
  4. What is the difference between a write-off and an adjustment? A write-off is when you bill the insurance for something that’s not covered according to your contracted agreement or the patient’s policy. If the service was carried out, you may NOT bill the client for the cost and must write it off. An adjustment is an amount that is adjusted off the bill sent to the insurance company. They pay you the rate your contracted for and nothing more.

Listen to the whole episode as Colleen shares her background in the industry, strategies for staying organized, things to keep an eye out for, and much more!

 

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email: toothcop@dentalcompliance.com