Discover the Best Dental Bill Format for Product Management

Dental bill format for Product Management

welcome everyone to the claims acceptance boot camp The Ultimate Guide for dental billers um we are really excited to help you get really in the details because as people say Devil's in the details and that's really the case when it comes to claims acceptance and making sure that you're properly reimbursed for the hard work that all of you do every day and so we're gonna help you get into those details today we are very fortunate to have a couple of experts here so I am Neil kotari the Chief Operating Officer of practice web and I'm going to briefly introduce Karen then she can talk about her background as well Cara is with us from Dental exchange one of our partners going back uh decades now and she's a senior director of Channel sales there um so Karen would you like to briefly introduce yourself relatively new to dental exchange but I have 20 years in the clearing Health industry previously with change healthcare trisetto provider Solutions and waste are all on the medical side so happy to be in the dental space these days great uh and we're happy to have your expertise and then we also will have um the chance to hear from our currently our marketing manager Jen Simpson she has background in uh Dental Care as well she used to be in clinical practice as a as a dental assistant in other roles in the dental office so she'll also be able to share her expertise in when it comes to building up a claim so with that being said I wanted to briefly introduce practice web um those of you who use practice web would be familiar with our background we are an industry leading practice management software since the early 90s innovator really in that space and we've throughout that time we've been helping all types of dentists uh Thrive and and so we're really here to serve all of you and we are on all-in-one practice management solution and I think the software combined with their support has led to us getting a 98 happiness rating consistently and very good reviews about our service so we really try hard to help you thrive and this webinar is just one example of that is giving you amazing information to help you do better than yesterday so uh with that I'll turn over to Kara to briefly introduce Dental exchange as well thanks Neil uh Dental exchange and practice work have been strategic partners for over 12 years we have made significant Investments to build tight Integrations which create a better client experience for your practice for those familiar with dental exchange you will notice a new look where the same company same support just a modern brand we are now considering ourselves the dental payments platform awesome yeah and I I can definitely vouch for how hard Dental exchange works every day to help all of you uh both on the patient payment side and the insurance payment side get reimbursement get payment improve your collection so we're very happy to work with them uh if you're watching this video on YouTube please do like the video subscribe to our YouTube channel which is practice web and uh subs and also click that Bell icon so that means you'll get immediately notified anytime a new um video or webinar is published on our channel so I want to cover the agenda what are we going to uh focus on today so the first topic is um the background on acceptance then we're going to look at provider info kind of issues that might come up then incorrect coding or incorrect code usage claim forms uh bad benefits or maybe even wrong benefits lack of benefits uh missing tooth claws narratives treatment dates how important that is for claim acceptance documentation and then how to set up your how to set yourself up for Success so this is going to be a very comprehensive webinar on claim acceptance and we're going to cover all of these 10 topics so the first uh Topic in terms of background I'm going to turn it over to Cara and it's regarding the electronic claims processes and adoption snail so when most people think of electronic claims they only think about claim submission it's no surprise that 89 of practices are also been in claims electronically the claim submission is only one component of the digital Insurance process a full workflow includes eligibility and benefits verification claim attachments like x-rays Imperial charts then the claim submission claim status inquiry after the claim submitted and even the payment and last but not least the era or electronic remittance advice even though we're seeing a high adoption rate with claim submission we don't see the same thing with other areas of the revenue cycle management yeah we can see some percentages there it's very interesting to to see that in terms of um you know how many people are doing what but uh yeah I definitely see that it's lagging in terms of adoption in an analysis T minutes per process per claim is saved going fully digital saves a total of 36 minutes per claim on average but there are other costs involved such as mailing claims paper envelopes and even postage when you add these costs to the total labor cost difference it works out to 13 19 cents per claim so you do the math if you're submitting just 20 claims per day that's 12 hours and 264 dollars back to your practice or 260 hours and 5716 in a month in a year you're looking at 3 120 hours and sixty eight thousand dollars 588 in a year over 2 million in the course of a dentist's career that's that's tremendous and I think um the important thing is you know there's as Jen said they're about uh 95 I think it was that are um doing e-claims on this webinar but if you look at all the other things that add up like attach electronic attachments and even they're like having integrated versus non-integrated attachments in practice so I can save a lot of time and then all the other things that less and less practices are doing like the eras and all that um I think everyone has something sometime that they need to recover here and to me more important than even the money is the time right time is money and I think that's true like imagine spending 12 hours a day or 260 hours a month with patience and doing more important kind of patient care related items or patient interaction instead of being behind a screen or be being you know at a desk doing all this stuff manually so yeah it's a big big deal okay so practice where I've recently performed an analysis of analysis of hundreds of online patreon use and found that that using these processes impacts how patients perceive their experiences and how they review a practice as well for instance a bad review often means inaccurate estimates and receiving bills after service a good review specific specifically means the practice went for the extra mile to find out the benefits prior and provide good estimates because this influences online reviews 9 in 10 patients read these reviews before booking print workflow can influence how many new patients your practice will attract in addition to how how happy your current patients are yeah and I think that this is interesting because it's not just about saving time we were talking about saving time and money in the last slide but here it's really about providing real-time proper estimates you know making sure that the the benefits are clear to the patient um also getting that whole process very efficient so that every everything's resolved and you don't have to keep you know bugging the patient about it so it's really all the other intangible benefits of going fully electronic with your uh with your claims and and just be having a good workflow there which we're going to talk about okay so now we're going to look at the difference between validation errors and denials some of you are asking what's the difference a validation error is caught by a practice lab and or dental exchange prior to submission it can be corrected instantly and then submit it to the to the payer a denial it's the claim that was processed to through the payer and it was determined by the insurance carrier that it was not valid it can be reported back through Dental exchange to the practice and addressing the denial can and resubmitting the claim can sometimes actually result in payment there's a big difference yeah great point and I do see some examples there in the bottom left for validation and I think you mentioned you know there is a validation feature within practice web and all definitely on Dental exchange portal where we try to catch these things because we don't want you know we don't want to have uh Tiki tag denials for you guys so we want to make sure that we catch these um fixable mistakes ahead of time so um great point there and and yeah I think denial is is more commonly like when the patient or service is not covered or uh there's really no um reason for the insurance to pay ing to their policies at least okay so let's say you have a practice that bills 1.5 million your Revenue will come from insurance so that works out to nine hundred thousand dollars a year in insurance claims we know on average that 13 of claims either have errors or and or denied which means a typical practice has a hundred and seventeen thousand dollars in Revenue that's either not getting paid at all because these patients weren't expecting bills or it's coming in very slowly while the office resubmits sends statements and unfortunately sometimes goes to collections that's more than 3.5 million dollars over your career but let's go a step further and say you're dealing with all these errors and doing everything manually you're now looking at over 5.5 million dollars it's a lot of money yeah this is one of those um I think it's one of those hidden costs that even practice owners office managers building coordinators they it's it's hard to quantify this which we're trying to help you realize the big the the gravity of the problem but it's it's really one of those hidden costs on a practice and it really Bears weighs you down there so we want to essentially help avoid this problem so through clean connect through Dental exchange you can actually use the action tracker report in Clan connect to review the health of your practice these reports can be run on a daily weekly monthly or quarterly basis and it actually tracks your validation errors and the revenue impact that your errors are causing to your financials if so if you're using dental exchange today you should start making that a best practice yeah this is a great great tool to help you know see how you know how bad the problem is and maybe see where there could be gaps in the processes that you're it starts even at the point of you know when when a patient is filling out their intake forms and registration and it starts there really when they're giving you the information are you inputting it correctly is it complete information and it goes all the way through the whole float so we want to help you guys identify how big the problem is for your practice so definitely and if you have questions about this feel free to reach out to dental exchange um and if you're using a different uh Clearinghouse then reach out to them but reach out to your Clearinghouse to see what is going on here and I'll I'll just plug one thing in practice web for this as well um you know in general a lot of the a lot of those analytics are great in Dental changes and also we have um great ways to look at so if we go from the manage module send claims area this is just um the pending claims but waiting to send but here's also validation that can be done you can validate from here you can check a lot of things before you send out um the claims and so you can see an example here where one of the claims uh there's a lot of things missing and prosthesis or initial replacement date um or sorry prosthesis whether it's initial replacement the patient information etc etc so there's there's going to be things that you catch here before sending it out and then you can also track things here and we're going to talk more about claims tracking after they're sent out but this is kind of before you send it out oh sorry there's yeah so there's the validate uh claims button there as I was referring to and then um here you can also obviously in the account you can track these things as well so with the the next topic here we're going to cover on this webinar is the provider info uh problems that can arise and that's a you know big issue that can that can be hurting your practice I'll let Kara talk about that as well so Neil it is a big issue the good news is it's easily solved something as basic as having a mismatch or incomplete provider information will trigger a validation nearly 1 in 10 validation errors from practice web providers are related to the provider mismatch required let's say Dr lawhead is treating a patient and the treating dentist section looks like this in Dental exchange we have this information any difference in the data will trigger a validation error yeah in this case I think um what we're showing here is the data points that matter I think in this case they're um the same but in general if one of these things is off right then you're going to have a issue so you want to make sure your claims what you're submitting from practice web is matching up with what you have on file with dental exchange or your Clearinghouse so here's the good news is you'd only need to validate the provider once you do it it'll change it'll be validated for the rest of the of the time so it's only a one-time fix yeah great and then that's and it's really regarding the billing provider and so if you have a new billing provider or you change your billing provider just make sure that you have a provider match um completed so that you don't have any validation errors there okay so now um we're going to look at how to correct the information and practice web on this point so um here as I was mentioning the billing dentist on the claim form uh is showing up in this section 48 starting in that section and the way to correct it in practice web or to let's say you have a new billing provider we frequently get a support call about this where how do I I want to build under my entity or I've changed my entity so this is all done from the provider setup screen under the list menu in practice web and there in the provider edit provider screen you'll be able to make sure all the information is correct um and it goes out correctly sorry it goes out correctly there so just make sure that this is done correctly and then um in the practice info screen you can set your default billing provider as well um and that makes sure that all the claims have that correct billing provider on it so the next topic is incorrect code usage and this is a this is one of those topics where we could actually do a whole webinar on this maybe we will in the future and have an expert for that but um we're just going to touch on this as best we can in this webinar and so um Kara has the first example here that she's going to cover but in this example the dim not called code errors that are most often fall under one of two buckets wrong code used or coding conflicts let's look at the first example of the wrong coding it's a pretty easy one to spot you can see d2393 is being build that that's a three surface composite we only have two surfaces let's look at the second example you'll probably catch this one too it's the same tooth number four but we're building D two three three one the interior code right and then we have um so we have so this is the issue right and I think a lot of you are familiar with this issue potential issue and so what we do in practice sub is we have alert that we provide to change the code to the potentially correct code and then we also have this feature called Auto codes which are defaulted in practice web which help you avoid this issue so for composite you can add your own Auto codes and customize them and that's itself a whole another tutorial but you can definitely call support to help get help with this but we have some defaults the composite one is very common so we have a default auto code which detects the surfaces and the tooth number and or location of the tooth position of it and then provides the right decode and that's if you're using that auto code maybe within a one of your procedure buttons or somewhere in your favorites there in the dental chart so we try to help provide uh avoid that issue now here's another example that Cara is going to cover regarding a full mouth debridement and this is more like a uh sorry this is more like a coding conflict so it's a little bit different than the last example it's more of a coding conflict that we want to point out yeah it's more of a cutting conflict you can see on the first one we're building a fdm with the comprehensive oral exam and on the second one we're building an fdm at the comprehensive period exam which one if either is right the Ada just made a change to this on January 1st 2023. the first one is actually not a coding conflict as of January 1st the Ada adapted The Stance you can Bill a comprehensive exam on the same day it's a full mouth debridement the second one is a problem you need to you need to perform and build a perio exam at a later date after the tissues have healed and you can get an accurate probe depth reporting yeah and I think this is um this is important as how how subtle how subtle these things can be right so um you know there's there's definitely a potential slip up here and and the Ada we're going to talk about a couple Ada examples and they provide great coding guidance we'll talk about where to get this information in a few moments but this is one great example they've um they've talked about so here's kind of the the good and the bad so the top is the proper way to Bill ing to the Ada in the bottom is the incorrect way so this this can actually result in claim issues right so if you're not billing correctly that's a big um a bit a big risk you're taking so the this code this this uh example I'm going to cover so this is regarding extractions um this is one where you know there there are multiple codes you could be using for extractions which are listed here and we'll we'll provide these guidance documents in the post post uh webinar email but just as an example you have these different codes that you can use which you'll be familiar with um and so what the ad has actually done is provided a kind of a decision tree where you can see based on what's being done uh what's what is to be extracted the clinical condition of it that that will determine exactly which code you want to report in so this is very important when you're doing those claims so that uh they don't reject it for uh miscoding so just be careful in in you know educate your team on these kind of uh scenarios especially this is an extraction example another one is um you know the Ada itself I think they they recognize where there's confusion they try to periodically provide these guidance documents so there's one uh confusing scenario that they've identified recently with a natural tooth born versus implant-borne prosthesis and so for natural tooth-borne prosthesis you would want to use the codes that you see here 5863 and 5862 and there's some more detail about that usage in the guidance document but then if you're using an implant-borne prosthesis it's an entirely different set of codes and different type of reporting that's done and so they've given an example here of the you know process of that type of procedure and there's you know essentially five codes that would be used which are different than the natural tooth born prosthesis so that's a another precise coding kind of example now this one is regarding 3D imaging so it's very real recent in this year uh so they replaced one code for 3D imaging with four codes and so you want to make sure that um you provide that greater as I say greater specificity and procedure documentation reporting and then um you know they also wanted to recognize that photographic in the naming of it does not acknowledge other image capture capture Technologies so a bottom line is that when you're doing 3D imaging you have to be careful uh this year with these new codes so this is these are CDT changes you need to be aware of and whoever is doing your billing needs to be really up to speed and so I'm again I'm going to talk about where to get this guidance in a minute another thing I wanted to point out here is all these guidance documents have great q a section to clarify more about how to use these different codes and then another one another interesting example is palliative care so this d9110 you had previously in the description emergency and minor procedure they removed that and so um there could be an example here where for example if a patient came in because they were in pain and the doctor you know usually this would be um used in the scenario where the patient came in because they were in pain and Doctor couldn't you know perform the procedure on the spot so that you do some palliative emergency treatment now perhaps it's arguable that you could um have someone come in for a crown and then the the patient says Hey doctor the tooth um or a tooth on the other side hurts can you take a look at that so that might be palliative treatment of dental pain so there is um you know some changes here on palliative care that that can be helpful to your practice encoding and when you when you code for this um so that's just as I said a quick um point on how important is to do proper coding so a couple of tips here would be definitely use the latest CDT codes we have a tool which you can you can get help on support if you you're not familiar with this tool but there's a tool to update your codes every year and we always have the latest CDT codes available so you choose list in the main menu procedure codes then you go to the tools section select the decodes check box click run now and then um you can update those codes now the other thing is that uh with the Ada coding education they have a great website and they have webinars and everything documents um so again you should have your billing person or team uh be following that and we've put a link there to the website but we'll include it in our post webinar email so definitely you know get up to speed on that so the next topic is claim forms it's pretty straightforward topic so Cara if you want to talk about that yep so using the wrong claim form back to us so there was an issue for most curators it means you're using the 2019 Ada claim form don't use an old version of the form they're not identical and be mindful of carriers that require special forms like Medical Dental yeah those are some examples there so we usually see this happening when it's a recent claim form thankfully they haven't updated this form for the last four-ish years so uh you know it could happen anytime you know they don't really uh warn you about it so it could be a new one this year next year so just really it's not like 2019 is going to be the last form they ever used it's going to always change every few years so it looks like we might be due for a change soon um so just be aware that this needs to be updated uh ASAP immediately and we always include that in the latest version of practice web so in practice web the way you do this just to uh be aware is you go to the setup screen then Family Insurance click on claim forms and then you're able to set your default there as you can see on that error or sorry Arrow um and that will make sure that you're always using that so let's say you had it on 2018 you move it or you change it to 2019 and then you can also adjust it by plan as Kara said you know different plans like Denny Kell may be using uh or a denical plan would obviously use a dental claim form so you want to make sure your insurance plan is set to the right claim form if needed next topic is going to be on bad benefits yeah but we kind of covered this a little earlier but about two percent of validation errors are related to the person not being covered by insurance or having pending coverage well that doesn't sound like much it actually comes up to be about eighteen thousand dollars a year for a typical practice that's something that manifests itself as a rejected claim or a denial and as we explored earlier earlier this can result in an unhappy client experience yeah and then that that definitely uh we want to avoid that it's easily avoidable I think um and and just uh as we we mentioned earlier in the reviews um that we the real reviews that we found you know a lot of people uh find a lot of frustration when this happens so we want to avoid this um and if you do it electronically it definitely helps you avoid that or have a very iron-clad process um to do it manually but one way or another you want to get this uh verified so um you can yeah Carrie if you want to talk about patient happiness and collection success here yep we know that a typical practice potentially leaves 18 000 on the table at the tape but why aren't they checking it's easy to understand it's time consuming the caqh index shows the time varies from a minute to 37 minutes to confirm eligibility manually but it's something you can do electronically and it drops from an average of three minutes typically for dental exchange under one minute responses for comparison that's more than three hours a day versus one hour a day why and this is why adoption of electronic eligibility as the poll just showed and benefit verification has grown by Leaps and Bounds adoptions at 29 in the last five years yeah that's that's huge and I think um uh I I think we're I think that caqh is being generous by saying that it takes one minute to do it manually I think offices will find that it definitely takes uh a good amount of time to do this in 10 minutes on average and so we we want to avoid I know this is a pain point for a lot of uh billing folks and dental offices so um you know the the point here is that when you make something easy when you make something simple and make it fast then it's going to be done more often right so no matter how good your team is if it's going to be a tedious thing and then it it will things will slip through because the den offs is so busy and there's so many other things to pay attention to and I think we've kind of touched on best practices earlier and then on an annual basis check benefits yeah those are um so those are good uh benchmarks kind of and we we're going to talk next about how to implement this in practice web um so whether you uh whether you use Dental exchange and other Clearinghouse do it manually this insurance verification list can be very very useful and I'm always surprised how few people are using it regularly but it can change you know I even know of practices that are they have had us create custom reports to help them do this or they're using some other report but we have a fully built out screen just for this purpose so first thing you want to do is set your defaults for this so you go to you set up appointments and then Insurance verification uh screen section there it's more of a settings menu so this is going to help determine when you go to the actual Insurance verification list it's going to have these defaults already showing up for you so you don't have to change those criteria every time so for example show me all appointments that are scheduled in seven days so as we said there's a one week Benchmark there one week um process you should follow one week before you should verify this stuff because if that gives you enough time if you need to inform the patient if you you need to change the appointment replace it you can have enough time and then another thing here is plan benefits haven't been verified in so you can as we said one year is pretty good because usually plans don't change their benefits mid-year so one year is a pretty good process and then eligibility can change because people change jobs things can change with insurance plans so that could be maybe a month the patient eligibility hasn't been verified in a month for those patients and then you can also look at past due appointments so there's all these uh defaults here and then once you set up your defaults then you go to the list menu an insurance verify ins verify and then over there you can go through your list now here you can have someone checking basically it's like a great checklist just go check check check check check and once you have verified you can just right click click on verify patient eligibility or both whatever it needs to be verified and then that kind of takes it off your list so it's a really great built-in to-do list or checklist for verification um so and then you can and then you can uh watch the appointments to see if uh there's a way to within the appointment view setup screen um you can actually have a little symbol that shows whether something is verified or not on the schedule go ahead sorry was there another comment from either carrier Jen that was me piping up we actually have a bunch of questions pouring in there okay great great so let's let's uh take a quick pause here and then um like we can answer you know we may have already covered the topic so I want to make sure it's a real time and relevant so go ahead um so the first question is we don't check eligibility through Dental exchange does it give remaining Insurance amounts does it give remaining Insurance amounts oh in Dental exchange so Cara um Can chime in on that I think I know some information about it but if Kara wants to chime in yeah it just depends on the payer and what the info yeah I think that's that's what I also know so it depends on the pair so every pair provides different level of information when it comes to real-time eligibility check and so I always tell people that the proof is in the pudding you can try it out and we have a great offer I think we're going to mention at the end where you can try this thing out so um I would say try it out and you know see how your set of pairs interacts with the service and what kind of information you're getting what's the next question Jen can electronic benefit checks provide extra information for example are there any downgrades for fillings crowns Etc yeah I think I think the same answer kind of which is that it depends on the payer but I have seen myself I've seen um that kind of information come through I've seen ex definitely exclusions limitations all kinds of detailed code based uh benefits information in that service so again I would just try it out and see what kind of information you're getting back for your specific pairs okay um how they get onboarded with the benefit checks when when can they access this sort of thing yeah so that will cover at the end of the webinar but essentially we'll give you some information to get that set up and it kind of depends on if you're using dental exchange already or not if you're using it it's just kind of like adding a service to your plan if you're not using you just get set up with them and then they'll get you you know whatever Suite of sources you want and that'll be one of them so we'll also touch on that again at the end and doesn't check hmos there's actually a pair list I've seen with dental exchange which we'll link to in the post webinar email and that will actually list all the payers that have the electronic benefits and um eligibility service or or they kind of work with that service so you can actually search for your pair there and then see if it shows up and that'll give you a perfect answer to that question um anything else I think that covers it for now okay great so I love the questions keep it coming and we'll check back in and Jen will Jen will feel free to interrupt us uh because it's not interrupting that's what it's all about so just she can chime in when when there's some more questions so missing tooth Clause is the next topic here um so this is basically you know everyone pretty much knows what that means it's it's uh when dental insurance company will not cover essentially the the cost of replacing a tooth or treating a kind of missing tooth if that was the case before that patient got on the plan so um you know this can impact a lot of procedures Dentures Dentures Bridges implants so the way to handle this in practice web is you want to put a plan note so when you're doing your verification process uh whether you're calling insurance companies checking their portal going through Dental exchange you want to look for this missing tooth clause or ask about it and then you want to put that in the plan notes section in the insurance plan because that's where you'll kind of be aware of that and then you can deal with it so if that scenario comes up then you know that um there may be a lack of coverage there so it'll show up you know in the family module and other places if you put that type of note there or missing tooth class so that was just a short but important point there and the next one a lot a lot longer point is narrative so for that I'm actually going to turn it over to Jen who has I cited at the beginning of the webinar she has had experience doing this while she was working with dental offices so uh Jen go ahead and uh if you can share on the on this point absolutely thank you um so yes I did used to do um Dental billing back in the day and then I worked with a dental billing specialist to help kind of shore up what's happening in the Here and Now on these parts the first thing that we need to address when it comes to having good narratives is that the back office staff needs to be doing really good detailed clinical notes if you aren't already doing soap notes um the practice should be using those that's subjective like what's happening with the patient what they're saying are they in pain are they experiencing a horrible Pace um the O is objective it's what you're actually seeing so can you see the Decay um in an x-ray can you see it on a photo um do you see you know other issues happening there um the A is for assessment and that is basically the diagnosis so the provider is seeing in this case do decay um and says that it will need some kind of restoration the P um is typically for plan though I've also seen it done up as prognosis um so in this case it's the plan is to do a do composite the prognosis for the patient is good this tooth is gonna be fine in the end one thing that is Gonna Save you guys a ton of time is to use the auto notes feature um if you aren't already using Auto notes it is customizable and it works like a template in practice web so you basically started out with um maybe your s for soap um subjective and the default text patient reports and you just pop through it like a fill in the blank exercise you're done in minutes and that way your whole team is doing notes exactly the same way and you'll not only have what you need for billing but you will also be protecting yourself um from litigation or being able to demonstrate with insurance companies or if your charger ever looked at by the board like doing these detailed soap notes are essential for a bazillion reasons so use the auto notes feature if you can you should also have a deadline for entry for your team generally you're probably going to want to go with a same-day entry rule with the team that means that whatever happened that day needs to be in the system before everybody leaves for the day and educate the team as to why they need to do that and why it's important but also use lock dates in practice web to enforce it lock dates are in the user settings and you basically set it up to say um they have one day to do their notes and then after that nobody can get in there and change things and then after that once those claims are locked or those um chart nodes are locked the next day your billing person your claims manager can go in and they should have all of the data they need to start processing and getting you guys paid so now we're going to look at some details for narratives the best practices for narratives what you need to include in each one um The Specialist that I was talking to yesterday described this as being like the TSA if you're going through the TSA you need to have everything you need with you and absolutely nothing that you don't need with you so like you don't want to be describing things such as uh cosmetic concerns with the tooth because insurance doesn't care about Cosmetics they care about what's happening so you package up what they need in the bundle so the first thing that you're going to want to mention if it's relevant is if the patient is experiencing any symptoms we talked about that just a second ago you're going to want to talk about the history of the truth or any related structures so if the truth already has a um a crown a filling something else happened with it or if they already had scaling root planing whatever you're going to need to note that the next part um is a diagnosis and again that's going to come from your soap notes so what happened with the tooth why it needs the problem how severe the problem is this last one or next one trips a lot of people up when it comes to crowns and buildups and root canals oftentimes insurance companies want to know how much of the natural tooth is going to be left after the Decay is removed and the tooth is cleaned up so that's something they should include in their soap notes and something you should include in your narratives whenever it's relevant to do so insurance companies also want to know what kind of diagnostic tests you performed and so x-rays are a pretty obvious one but a lot of times you know especially if you're dealing with broken and cracked teeth you're going to want to mention that you did Endo ice on it and the patient reacted to the cold or that you used a bite stick tooth sleuth and that the patient reacted to the bite pressure [Music] um and then you're also going to want to discuss the long-term prognosis what the outcome for the patient is if it's relevant to the treatment and lastly or almost lastly it's um any treatment dates so like your prep your seat and delivery dates um if you're doing perio maintenance a lot of insurance companies want to hear the scaling and route planning date in every claim and the last thing that is becoming more of a concern now is all of the conditions that influence oral health we know that um it's not just what's happening in the mouth that influences the mouth that's the patient's Whole Health so if they're diabetic if they're going through chemotherapy if they're on medications that create oral health care issues if they're dealing with dry mouth those things impact um the diagnosis they impact the patient's health and including those types of concerns can not only help get your claims paid more often without issue but also show that you're treating the patient as an individual because none of your narratives should be stock narratives you don't ever even template them but you don't want to have stock things and so including this patient has this problem will help you show that you're actually paying attention to what's happening with this patient right so if we um look at a full mouth debridement example um we had the deep cleaning required which was a terrible narrative compared to a good narrative one that would likely be approved and the important thing to note is that there is no guaranteed narrative that's going to get you paid every time what works for one company is not going to work for another company every time um it's just too important to use best practices have some idea of what they're looking for most of these insurance companies will put stuff out there so that you can research what they're going to want to hear in advance but in this case with a full mouth debridement we are looking at um the Ada code changes and so the latest one on that is that we covered earlier about how the debridement is being done to enable the comprehensive perio evaluation at a later date so if we compare these two narratives here we can see um that there's no history in the first one um and then there's also no indication as to why the full mouth the Broadlands is needed um and we don't know the expected outcome or why we're even doing this procedure but if we look at the second one we can see that we do have a history um we can see the diagnosis and the degree to which the condition is impacting the patient and although we don't know the prognosis yet because obviously we can't perform the the comprehensive perio eval at this point we know um what the next step for this patient is going to be or what the ultimate outcome will be scaling in root plating now this one is a lot trickier because you're not just following the checklist insurance companies and this is a Delta example right here this was a literal screenshot from Delta um they need proof that there's bone loss and they need proof of clinical attachment loss and so we will cover how to send X-rays and paracharting later but you're going to want to mention these in your narratives as well um and then the next point is that a lot of carriers right now are denying if you do more than two quads in a visit so like if you do um four quads the second two will get denied unless in some cases you're able to justify why somebody needed to get all four quads done in one visit and so when we're talking with um Jasmine Gonzalez at our Dent billing she mentioned specifically that diabetes is a good one that gets approved more often for the four quads um it doesn't work for everybody but the point being that if somebody has diabetes then it becomes much harder to control their blood sugar if they don't get their scaling and root planing done all at once um and so you really want to get them put through much quicker so that they can restore their overall health through taking care of their oral health um so if we go back to the checklist we can eliminate some of the things that don't apply so you can see the sample narrative here that we did um the first part is patient presents with periodontal disease so we've got our diagnosis we talk about the generalized five to six millimeter Pockets um and so that meets their explanation of clinical attachment loss that they need we talk about Crystal bone loss um and so that also meets their other requirement for showing bone loss and along with this again we would be sending them the perio charting and we would be sending them x-rays um we also mentioned that this is necessary to prevent further attachment and bone loss and then lastly we mentioned that all four quads were done at once because this patient is diabetic and we want them to start feeling healthy faster and so this type of narrative should probably get a pass even from the insurance companies that are difficult about doing more than two quads crowns um are also another tricky point for insurance companies again this one is a Delta example and this is literally copy paste these are the reasons Delta says that they will pay for a crown I don't want to read through all of them verbatim here it also mentions um like missing tooth structure they have to have more than 50 percent including loss of or undermining one or more costs and a compromised mesial or distal marginal Ridge so as you're drafting your narratives these are the things that you have to keep in mind that's not to say that you should be inventing reasons you should not um but obviously if these things are present make sure that they are in your narrative because that's what's going to get you paid so if we look at an example of a crown narrative we've got the denied example the approved and the checklist but we also want to make sure that we are including a qualifying reason because there was a qualifying reason in this case so we've got the history um placed eight years ago we've got the diagnosis that there is um recurrent Decay we even talk about the severity of the decay in this case um we mentioned the amount of remaining tooth structure and in the process we talk about our um qualifying reason are that there's going to be 40 percent of natural truth structure left after it's cleaned up we also mentioned the diagnostic test that it's an x-ray we talk about the prognosis and we also provide our dates again this one is one that would probably be approved by most but you're always going to want to check what the insurance company is looking for and include the details that they want yeah I just want to plug again that auto auto notes make this super simple in practice web because or at least consistent because you can have default Auto notes for various types of procedures like this and that'll ensure that it's more like a checklist where you have to answer the prompts to qual to uh to kind of complete these different sections of what's what we think is required so I think using Auto notes using quick paste notes is a very good way to make sure that these things are followed um so there are a couple things to be aware of when you're doing these um if you look at what a standard claim form is um that remark section down on the bottom that is where most of your notes are going to go um you do this from the claim notes section of the claim edit window and you'll see there that we just type that into the claim edit part and it appears on the claim um and then Neil just talked about quick notes the auto notes with the prompts does not work in this section I don't believe but you can use Quick notes which is also super easy you just type a question mark and then your prompt whatever your prompt is you could have it as like a sieve reclaim and Crown and then it'll pre-populate all of the text but of course you are going to want to edit that because it's not like um it's not like the auto notes where you have prompts and you fill in the blank quick notes just gives you a static block of text yeah and inside of quick notes you can have uh like uh there's an some method where you can have asterisks where it requires you to fill certain so it kind of mimics an auto note it's not as user uh kind of obvious but it does mimic an autonote process so you can do that with quick paste notes yeah so it's like a little hidden feature within quick Pace notes um obviously some of these are going to be really long narratives like especially if you're dealing with like one of those longer um scaling and route planning or sometimes Crown claims so those You're Gonna Want to add as an attachment if you're using the electronic attachments that is from the claim attachment screen and you can see here all I did was paste the shorter um or the description like on the the crown narrative from earlier that filled up the whole screen here you can see that it's only 253 of the 2000 allowed characters so your longer narratives can go here and we'll get submitted and I think that's kind of it from this end great so that was a lot of helpful information on narratives um and the next uh next Point here is regarding treatment dates so this is another uh simpler point which is that you know there are obviously certain procedures that require dates uh to get that claim accepted you see a few examples here perio maintenance Crown replacement restoration so you need those dates and so um there are ways to make sure that this gets tracked and entered properly so for example in the procedure itself I'm sure most of you have seen that there's an option to do um a date for prosthesis replacement there you can see it on the screen and put that in and also Mark whether it's an initial replacement uh procedure and then um let's see so yeah you can you can put a note there as well uh for the e-claim notes so let me go back so if you see there below the process replacement there's an e-claim note option and then that can be then automatically transfer showing up in the the claim so these are the two things that I was pointing out um in that procedure info screen they ultimately end up on the claim to take care of that treatment date requirement now next point is documentation with attachments you know those can be uh challenging as well so we do have a validate that validate claims feature within the insurance claim screen under manage module you do have a validate claims button which is really really helpful I don't know if all of you are using that or not but if you're on Dental exchange or claim connect then we do have that and that allows you to see all your claims that are not yet sent what requirements the insurance companies are telling Dental exchange that you need to have such and such attachment with this um claim so that'll help you catch that um and then also on the dental exchange side they they will let you know that this claim also needs an attachment so there's kind of a double uh quality check they're going on go ahead and uh if you want to touch on this yes so one of the benefits of demos change is that you can customize your own attachment rules but Provider by payer buy practice or even by Clean tight so when you're in clean connect go to the claim services Tab and then Manage attachment rules and you can create your own rules great so uh and then I just uh reminder that you can use integrated attachments with dental Exchange in practice web just makes it a lot easier than going outside to a separate portal doing the attachment and grabbing the number and putting it into the claim this is much much faster much easier so feel free to explore that option um and that's that's something you know Jen was referring to this feature earlier but you can click on ADD image you pick your image or you can even do a little snipping uh of that and then you just identify what that image is for the insurance companies and then that will upload the attachment to the claim so the last point which is fairly brief is about claims acceptance success what are some tips so we've we've been harping on this point about full spectrum so Cara you want to touch on that yeah the point is use the full spectrum of the right of the eligibility all the way through payments and eras and this is essential because it means you'll know when something's rejected right away it receive your denials quicker you'll improve your cash flow and improve your client experience yeah great great important point there and then I would say that it's important to keep practice up current we have free upgrades with paid support but even people on paid support are not always regularly upgrading and that's uh you might be missing out on things like the latest CDT codes these are some examples of just from the latest version but if you go back like last two years there's a ton of claims related features that will help your office but you here are some examples patient level overrides for frequency limitations um there's more information displayed for claims waiting to send primary secondary validation warning in the send claims window when a carrier does not support attachments attaching claims to eras when they're imported is a lot easier so there's so many just features like every version of practice of that will affect your claims process or help you with claims acceptance um this point is uh Cara is going to touch on about to basically follow the process Jen mentioned earlier about the soap notes having a deadline for injury and managing the claims after charts have been locked yeah these three things will will ensure that the documentation at least that point is not going to be a reason why you have a denied claim um then allocating resources yeah make sure make sure you have the full spectrum of EDS AI if you don't have the RCM pieces get the pieces you're missing train your team effectively invest in team training so that everyone knows their roles and getting the claims paid including the clinicians responsible for charting and then time ensure your billing person has time and ability to focus on claims excellent so and then uh here existing features use existing features in practice Hub here's an example of the there's one report a lot of you are using this but the outstanding insurance claims report is super useful for tracking things after they've been sent out and then you can also use a custom tracking feature which we we like and so custom tracking allows you to create different statuses and then um and then show that in the report so there could be you know many different statuses that you choose for your office but definitely use it to just see what is the situation with that claim and then uh this is regarding the benefits verification so just a couple tips here be thorough with this you know payer ID has to be correct and that means like sometimes the pair ID you have a correct one but it's not the correct one for that plan so sometimes you might need to ask the insurance company or just verify that um this this Clause uh sometimes companies have least expensive alternative treatment and so just be aware of that cause unusual codes so like if the doctor's billing for nutritional counseling or nutrition counseling um if there's some unusual codes just be prepared of how you're going to handle that if if the claim is not accepted for that like how are you going to set those expectations for the patient and then frequencies frequency history there's a lot of features there in practice web uh which which you can start using to track that and make sure that that shows up in the estimates as well and then if you need to add the treatment as history uh in for that patient then we do have that section in the family module to do that there you can see it there at the bottom uh bottom right of the screen uh and as I alluded to earlier have a plan for unusual codes so you know talk to the doctor if you're gonna write off balances or build a patient if it's not covered as I gave the example of nutritional counseling um so just be on the same page about that inform the patient sorry inform the patient what's going to happen as well last Point here is that we're going to have an upcoming webinar on Dental PPO negotiations Made Easy how to maximize earnings as an in-network provider that's going to be on April 19th at 11 Pacific 2 pm Eastern so if you want to you can scan that QR code you can actually just scan that QR code and then um get a get registered for that but that's another one coming up next month um and then with that I think you're ready to transform your claims processes and get better acceptance I really want to thank care again for joining us Jen for chiming in on on narratives and all of you for attending the webinar I'm hoping that it was helpful to you and I'm sure there's a ton of information you may not have caught all of it watch this again and when it's available and you'll be able to share this with your team as well so thank you again for your time and we look forward to uh you know educating you more on the next month's webinar thank you again everyone thank you Kara thank you Neil thank you have a nice day goodbye