Discover the Dental Bill Format for Research and Development

Dental bill format for Research and Development

if you accept dental insurance in your practice dental insurance verification is probably the most important process you can implement in your practice to prevent future headaches here's what we're going to talk about how to systematize the process of insurance verification using a template the specific details you need to know to make sure you get paid how to best use the insurance verification template to avoid wasting your team's time over on the phone and how you should customize it for your office before getting into the details let's first get into why you need to verify dental insurance for patients in a perfect world you can tell your patients they're responsible for finding out their own benefits um sort of like how it's in the medical world unfortunately for as dentists it just doesn't work that way you'll quickly find that patients don't want to move forward with their treatment especially if they don't know what's covered and what's not and what their out-of-pocket is going to be so consider these scenarios denial of payment from insurance for a new patient's preventive visit denial of payment from insurance for sealants placed on a 10 year old patient even though coverage was at 100 percent denial of payment for scaling and rule planning even though there is 80 coverage for a patient with no history of periodontal treatment denial of a payment for a recent of a crown on an emergency patient these things happen every single day in dental offices and i've had every single one of these happen in my practice when i started when i first opened the doors to my practice i did a lot of the insurance verification calls myself how did i do them well i was actually an associate at another practice while my practice was open okay so on the days it was closed i would take patient phone calls you know i had a voice over iphone system so i would be able to take the patient phone calls from my cell phone and i know i would have missed calls so what i would do during lunch time is i would call these patients back get all the insurance details and then i would call the insurance companies and actually hand write this benefit down on a piece of paper and this is what it looked like not sure if you can read the handwriting but here i've got some very basic information so that's the percentage of coverage and categories like preventive basic major et cetera preventive history history on x-rays so on it's a mess but i did whatever i had to do to make sure that patient was eligible for an active under the insurance as well as we were going to get paid for the services we're gonna provide if you're the doctor i can't stress how important it is to do this exercise yourself so you understand how insurance works yes we all wanna focus on dentistry that's what we went to school for uh we did not go to school you know to learn the business the insurance side and all of that stuff however um if you're the owner you are in your own practice which is your business and unfortunately no one cares more for your business than you so i've actually written a detailed post on dental insurance verification but since then i've received lots of emails about people asking me why do i have to know this can't i just outsource this to another agency can't i just uh you know leave this up to my team to understand what they're supposed to do yes you will delegate this to your team eventually but when you're starting out it is important to understand how this process works because otherwise you would not know where the mistakes happen okay you need to understand why that insurance payment is much lower than what you expected okay back to what i was saying earlier after i did this process myself repetitively over and over again you know i turn it into a nice template okay uh by the way this template is available for download you can find the link at the bottom of this video um you should be able to download it and follow the template um and do it in your practice and i know what you're thinking that's a whole lot of information for each patient that you have to fill out or your team has to fill out okay and it's going to be very time consuming over the phone especially with the insurance wrap just bear with me till the end and i'll go over some techniques you can use to save time okay and speed up this process and in fact i've split this video into two parts in the second part of this video i'm actually going to show you how i've moved away from using the template and using other techniques to speed up this entire process of insurance verification so what we're going to do is we're going to take the template and break it up into pieces and we're going to go over each section so you understand what the information is used for if you grasp if you understand the whole concept it becomes super simple for you and your team to together modify this entire process in any way you want to customize it for your practice okay and again i'll show you some of those techniques in the end and also i'll cover some of that in the second video so let's start so there are a few different ways to verify patients dental insurance benefits so one is by filling out the insurance verification template like we just discussed okay it's the most time consuming because of all the details you're gonna have to fill out or your team is gonna have to fill out but again more on that later second is fax different insurance companies are going to give you varying information on their faxes some insurance give you a whole lot of detail that you may not even need to call the insurance rep some in some companies are going to give you not much and you it's like a waste of time reading the facts and you still have to make the phone call look at the online portal etc then there is the online portals most of the insurance companies are going to have online portals from which you can pull up patient information at least uh verify their eligibility find out make sure they're active on the plan and get varying amounts of information regarding their benefits you should have online accounts for all the insurances you network with for your practice okay and all the username passwords should just be stored in like an excel sheet so it's super easy for your team to access on a daily basis like i said earlier there's things you should not rely on the online portals for like for example you should not rely on stipulations for scaling and rule planning because sometimes the online portals are not going to show you that hey you're supposed to wait x number of days after pro fee or etc there are also automated services these integrate with your practice management system but they are not as accurate okay i have personally never used them however they do not give accurate details such as stipulations when it comes to for example perio or pros dentalexchange.com or claim connect is the service i use in my practice for sending claims and they also have an integrated service that integrates with open dental that provides eligibility checks however i have heard although i have not personally used it i have heard that it's not accurate when you download all the insurance details into the patient's chart so i'm going to start with the first method which i mentioned which is following the insurance template starting at the top is your basic insurance info that identifies the plan the patient has to make the call to the insurance company you'll need the subscriber name the subscriber date of birth subscriber id the source or social security in some cases if the patient doesn't have the subscriber id and your dental practice tax id i'm not going to cover every single item but i'm going to cover the most important items that you need to understand to make sure you can go through this template dental benefits as of date you should always write down the date when you are verifying the patient insurance benefits reason why this is because if the patient is coming back to your practice every six months let's say let's say patient upgrades their plan and it does happen the group number may not change okay uh but their benefits have changed all right so let's say you go back and call and refer verify the benefits you're going to look at the date and say okay yeah it's been a year and a half or two years since i last verified let's go ahead and call up the insurance make sure everything is still same okay so the writing down every time you call the insurance or your team calls the insurance company you should just write down get in the habit of writing down the date you're making that call benefits used to date how much of the insurance dollars in the year the patient has already used as of today why is this important if you get a patient in your practice that has just left another practice and has shown up at your door saying hey they want to continue with your office now well you need to find out if they let's say the patient left in the middle of some work and they've already used up some of the insurance dollars from the previous dentist well now your office needs to know how much they've used uh because if you're doing a crown for example and the insurance reimbursement is going to be estimated 400 but they've only got 300 left on their plan and you don't know that well when you're sending that claim your payment is going to be lower than what you expect what your team should be doing is you need to know at the time of verification whether or not any benefits have been used up to date this information should then be updated in the practice management system i use open dental in my practice so there's a way to do that and i'm assuming all the other systems out there do the same thing like ventrix ecosoft et cetera you want to do this so to be able to accurately tell the patient that hey this is what's remaining on your plan this is what's expected and this is what your out-of-pocket is going to be so you avoid any financial surprises primary or secondary insurance a patient can be covered by more than one insurance plan one of the plans may be their own meaning their employer is offering that dental insurance plan they may also have additional coverage from their spouse's employer i'm going to leave the details of the primary and secondary details for a separate video but when you're verified dental insurance benefits you should write down whether or not the plan you're verifying is the patient's primary or secondary plan if it happens to be secondary you need to find out what the primary plan is and then call up that information and do the same exact thing so sometimes what happens is let's say a patient calls your practice to schedule an appointment and your team goes ahead and collects the insurance information so they can verify their benefits what happens is the patient may not even be aware that the insurance details they're giving you is their secondary insurance okay they don't know that um and what happens is you go ahead and verify the benefits but you you you don't find out whether it's a secondary or primary so now let's say the patient comes into your practice you do some work and you generate a claim now what's gonna happen is that claim is gonna get kicked back and the insurance company is gonna say hey you need to send it to the primary first and then send it to us you know send to the secondary insurance the eob from the primary insurance again these details we'll get into in another another video but uh it is a detail that you need to find out what whether the plan is primary or secondary for that patient fee schedule when you call up an insurance company to verify benefits you're going to ask hey what fee schedule do you follow for example if you called up delta dental of new jersey you can pretty much assume they follow the fee schedule of debt to dental of new jersey okay however there are certain plans that you may not even be aware of let's say the patient calls your office and to say they're par they have this insurance plan and your team is not aware of it you know what happens is if that insurance plan is following a free schedule of a plan that you are in network with then you actually can take that insurance okay so whenever you have a patient that calls your insurance that calls your office for example this is what happened in the beginning to my practice you know i was still learning and uh there were some names that came up and i would say uh you know what i would never say no that we don't take that insurance especially if i didn't know the name of the insurance company so what i would do is i tell the patient let me go ahead and find out i would write down the provider relations department phone number i'd call up the department and say hey uh what fee schedule do you follow it turns out they follow the fee schedule of another bigger insurance company that we are in network with okay and then i can go ahead and verify those benefits then let the patient know yes we verified the benefits let's go ahead and schedule that appointment so the most important thing in the beginning that you should take away from this is this is that don't ever say no to a patient let's say you haven't heard of the patient's insurance company don't just say no get the provider relations department phone number get all the details from the patients you can actually make the call to the insurance company and find out the details maybe you can find out whether you should enroll with that plan maybe you'll get multiple patients like hey you know what i'm getting more more than five six patients who are asking if we take this insurance and i haven't heard of them let me find out let's get their fee scheduled maybe i should credential with them okay so don't also assume that you're not in network with them because you just have to find out what fee schedule they follow because the fee schedule they follow may be uh of the one that you are in network with so i'll give you an example and in the beginning when we started um my even i didn't notice my front desk she took a call from a patient who called to find out whether or not we take principal financial insurance we had not heard of it we were new um and so was my front desk and um what ended up happening was when we called the company principal financial when we called the insurance rep uh they followed emeritus fee schedule now a merit as we knew because we were credentialed with them so then we called the patient back and let them know that hey yes we verified your benefits and then we went ahead and scheduled the appointment now over time you'll learn uh to know most of names that pop up from the patient in your neighborhood around your practice but when you're new and you're starting out you need to understand this so you don't turn patients away all right let's continue deductible when asking insurance whether deductible applies or not make sure to verify whether or not it applies to preventive services for preventive services some insurances will apply deductible to x-rays and not to exams or cleanings so make sure to verify with the insurance most patients assume their cleaning x-rays are covered twice a year 100 so make sure to verify with insurance to prevent any surprises in the office moving on let's start with the category of services starting with preventive when it comes to preventive services verifying frequencies how often the service is allowed within a benefit period and history of services is extremely important the most commonly used exam codes are 0120 which is a periodic exam the 0140 limited exam 0150 the new patient comprehensive exam the template file has checked boxes for the common frequencies i've encountered so far some plans have a separate frequency for o140 and o120 which is great but most plans have a shared frequency among all three exam types which is usually two in a benefit period calendar year or by consecutive months the code d0150 which is the comprehensive exam is usually every three years per single provider however i've also seen every five years per provider as well as just once in a lifetime while the patient is on his insurance which is ridiculous you also need to find out whether or not x-rays are included in preventive most plans are going to consider x-rays under preventive and if preventive services are covered at 100 then the x-rays are also covered at 100 panos fmx when you're calling to verify insurance find out the last date of history and frequency for both the panel and fmx most plans have a shared frequency between pano and fmx okay let's keep going sealants you should also get the history of any of last placement of sealants even though coverage may be listed at 100 you should know if the new 10 year old patient in your chair had sealants placed last year upon clinical exam you don't see any sealants on the first molars you ask mom if the child has had any ceilings plays mom says well i don't remember history of sealant should be on file for the patient before you let mom know if they'll owe anything out of pocket alright that's enough for preventive services let's move on to basic services you may notice on the template i've grouped perio endo restorative and oral surgery under basic services that's because that is the case with majority of the insurance plans however i have come across plans that will have different coverage for periodontal services than for oral surgery services for this reason i've created a section for each of the four types of services so let's start with periodontal services scaling and root planing which is srp code d4341 in addition to coverage percentage you'll want to find out if there's any stipulations some insurances require the patient wait 15 to 30 days after general cleaning or profi to be eligible for srp benefit i've learned this the hard way so make sure this is filled out when verifying insurances doing all four quads in one day some insurances do not allow all four quads to be completed in a single appointment so make sure to have this filled out frequency and documentation knowing how often the procedure is allowed is important especially if the patient has a hard history of scaling most insurances will require period charting and either fmx or panel so make sure to have this filled out just in case you don't have an fmx panel on file perio maintenance d4910 some insurances will allow frequency of payroll maintenance visits in addition to profit frequencies but for majority the frequency is shared stipulations apply to pairing maintenance also patient needs to have history of periodontal therapy some insurances will dictate how many days you must wait after scaling or active perio therapy so make sure before you give an appointment for a parent maintenance visit this requirement is satisfied up next is endodontic services now this is pretty straightforward some insurances actually have different coverage percentage for anterior teeth versus premolars and molars so make sure to have this filled out all right let's talk about crown and bridge when getting coverage for crown and bridge make sure to find out if there's a downgrade most insurances will downgrade 2750 to a 2790 or 2792 insurances may downgrade all posterior teeth or only the molars so make sure that's filled out correctly let's talk about core buildup where you have just the core buildup d2950 or a posting core which is a 2954 some insurances have a different coverage for post core and buildups than for restorative or crown coverage so make sure to find out exactly what it is be careful with core buildups lots of plans are increasingly bundling the core buildups and crowns what this means is that plans will not pay a separate payment for core buildups aetna for instance have increased their documentation required to get paid on a core build up they want a pre-op photo of the tooth after root canal a post-op photo of the tooth after core build up okay not an x-ray a photo prior to the common prep pre-op x-ray a post-op extra of the tooth and a narrative okay and after submitting all this the insurance still may deny payment on this what i've done for core buildups in my practice whenever a core buildup is treatment planned i assume no payment from any insurance whatever fee for that core buildup is for that specific insurance i quote that plus the out-of-pocket for the crown together to the patient and i still submit the claim for the core build up and if there is a payment which means now the patient will have a credit on their account okay so this is something we started implementing literally the second year into practice because i learned this was happening quite a bit and i always like i mentioned earlier i always always try to avoid financial surprises with patients so this is something we started doing and it's worked really well i haven't had any trouble or issue with any patients what ends up happening is uh when the insurance does make a payment toward core build up there will be a credit on the patient account and i rather have credits than balance on the accounts let's move on to oral surgery simple versus surgical extraction some insurances have different percent coverage for simple versus surgical so make sure this is filled out when verifying insurances find out if the patient's medical insurance needs to be billed first for extractions that's why we've listed different codes for extraction some insurances may say for example for partial bony and complete bone impactions medical insurance needs to be built first i've also seen some plans requiring medical insurance to be the first for any surgical extractions for code d7210 let's talk about implant and grafting services bone graft 7953 for ridge preservation versus d4263 periodontal bone graft they're both different and some insurances cover one and not the other so make sure to verify this implant benefits implant placement d6010 the custom abutment six zero five seven the prefab abutment six zero five six the implant crown six zero five eight or six zero five nine verify if there are any implant benefits some insurance provide no benefits towards placement but may provide benefit towards the implant restoration in my practice whenever i treat implant patients for implants and they often have dental insurance i always always send in a pre-authorization with the code 6010-6057-6058 so now your office will know exactly what the dollar amount estimated coverage is going to be for these services orthodontic services when verifying orthodontic benefits make sure to verify how the benefits are paid most insurances do not pay in one lump sum they will pay periodically but you need to find out whether or not you need to submit a claim if the representative states the benefits are paid automatically periodically you need to find out how frequently the payments will be made so let's talk about how to streamline this entire process of insurance verification you've obviously realized that answering every single question on the template for each patient it's going to be super time consuming and if you do this for more than one patient for the same plan while you're on this phone with the same rep you're pretty much going to piss off that agent and this has happened and they will just tell you that hey they can't continue to do this and they're just gonna appoint you to go to their online portal not that we should care whether they're pissed off or not but it's their job but they're trained to tell you to go to the either the fax or the online portal so here's some tips on how to use this template in the beginning when you're on the phone with the rep and you're doing this for all the new patients time yourself write down the amount of time it takes you to verify each patient's benefit and see where you can improve for each patient if a mom calls for an appointment for a 15 year old it doesn't make sense to get benefits on periodontal implant ortho extractions etc if the parent makes the appointment for themselves later it's okay to come back and get these detailed benefits later what you should do for the 15 year old is just access the facts or and get the information from the online portal so it's not always possible to verify patients insurance businesses before they visit because if you have a walk-in for example what your team is going to have to do is they should call the insurance company get their fax at least make sure they're eligible make sure they're active on the plan and access the online portal to get as much information as possible to make sure you can see them at that day for that limited exam or emergency visit what you should also do is during the day set aside a time to do these kind of calls like if you if you find any downtime over time you'll realize that hey around three to four p.m or you know we tend to get not getting not that many phone calls so around that time your team should be making insurance phone calls and getting insurance benefit breakdowns for patients okay and try to group these phone calls by uh by insurance so if you if you've got two metlife patients those should be grouped together so while you're on the phone with the rep you can do multiple calls with the same insurance plan now over time you're gonna develop your own process for doing insurance verification even if you're using this template the template is only meant to organize information okay so you can add to it or remove details that are unnecessary for your practice for instance in my practice i no longer do molorando or wisdom teeth so i actually skip those details all right so some closing statements always bill for the work you do on your patients to the insurance company to prevent future headaches with patients especially when it comes to accounting details always remember as i mentioned earlier as much as we want our patients to remember their dental benefits they will not remember them even if you've gone over a treatment plan told them line item by line autumn everything they will not remember they're not going to remember that their perio is only covered at 80 percent or they have a stipulation they've got to wait they just don't care all they care about is the bottom line cost this one is the most important uh patients hate financial surprises it's in your in best interest as the practice owner the manager or even the front desk team member you verify the patient benefits accurately so you can actually tell the patient what they're going to owe and most importantly you know that you're going to get paid for their services either your doctor performs or you perform for your patients like i mentioned in the start of this video i had to split this video into two parts because this is going to become too long um the second video i want to go over how my office actually has stopped doing this template we no longer use this template and i'm going to go over the specific examples within open dental and few uh shortcuts to streamline this whole process just because i no longer fill this template out doesn't mean that it's no longer important always remember whenever i have a new trainee in the office this is what they do this is where i have them start so it's super important for you as the owner the doctor or even for your team to go through these template the details in the beginning so you understand how the process works and then over time you can customize it for your practice you can take the details away and make it make it much more concise and that's it for today guys if you found this video helpful please don't forget to share with your friends don't forget to subscribe and i'll see you next time