5 Steps to a Healthy Insurance System
Your insurance system is one of the most important systems in your practice. This is the system that makes sure that you’re getting paid by the insurance companies for the work that you're doing. I see many variations of the insurance system in the practices that I work with. My recommendation to them and to you is that you have a very specific protocol on how you handle insurance receivables so you know that those claims are going to be paid in a timely manner and won't negatively impact your overall accounts receivable processes.
The first thing that’s important to this process is data entry. You have to make sure that you have a team member that is skilled and understands what information is important to put into the computer when they’re entering the patient’s insurance information, They need to know how to find the group number or plan number, and where and how to enter information so there aren’t any missing pieces that could potentially delay a claim.
The second step is to have a protocol for your attachments. We know that insurance companies are going to make requests on certain types of procedures. So, it’s important to be prepared with necessary supporting documentation such as an x-ray that needs to be sent automatically, a narrative, periodontal charting or any other supporting documentation that the insurance company might need in ajudicating the claim. When in doubt about whether or not they'll need supporting documentation, I recommend that you send it. It’s better to over-send those supporting documents than to get a request 30 days later for more information.
The third step in having a solid insurance system is to send your claims in a timely manner. I am so surprise when I go into an office and look into their batch process and see days and days’ worth of claims sitting there that haven’t been sent yet. Those claims need to go out either the same day, or at the very least the morning of the next day, to ensure that you keep that cycle of revenue moving in the practice. Just sending the claim to the batch is not enough. It has to go out - preferably electronically - as soon as possible to make sure that you’re not holding back the process of getting paid.
The fourth step is to print your insurance aging report once a week and call on any claims that are over 30 days. It’s important to stay on top of this weekly because when you do it’s a manageable system that doesn’t take a lot of time. It’s easier to keep up with it than it is to play catch up. I’ve been in lots of offices that were playing catch up with 10 or more pages of past due claims. This is a really big project, and it takes a lot of time to get through that kind of volume. So keep up with it – work on it once a week.
The last tip that I have for you is how to deal with the correspondence and requests that you get from the insurance companies. Unfortunately, when you’re opening the mail from the insurance companies, they’re not all checks. You often get requests for more information, or a denial that you know the doctor would want to appeal. I recommend that you place the same urgency on managing the stack of correspondence that you get each day as you do with the new insurance claims. If at all possible, requests should be processed the same day as received or, at the latest, early the following day.
Lastly, I recommend that your goal for the dollar amount of insurance that’s over 90 days – the money that's owed to you - is zero. Your aging report should reflect a zero for claims over 90 days, and have very few claims in the 61 to 90 day range. You want to catch claims over 30 days very early in the cycle, so you can start proactively following up with those claims. I’m surprised sometimes to see that practices' protocol for a past due claim is to refile it. Then they wait and if they don’t hear back from the insurance company after refiling, then they call. I don’t think that’s the best way to do it. What I recommend is to be more proactive in your approach to get those claims paid and the money in the practice as soon as possible. So if a claim is 31 days past due, pick up the phone and call the insurance company. If they didn’t get the claim the first time, don't delay it further. Find out what’s missing, and get it to them to keep things moving forward.
When you follow these tips your insurance receivables will be healthier making it easier to manage your total receivables and your patient balances. These systems all work together to keep the practice paid for the dentistry that you’re providing.