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When Every Penny Counts: Streamline Your Dental Insurance Verification Workflow to Limit Denials

When Every Penny Counts: Streamline Your Dental Insurance Verification Workflow to Limit Denials

Dental insurance verification ensures a high level of patient satisfaction when it’s done the right way.

There is no denying 2020 has been a financially challenging year for most dental practices. The American Dental Association (ADA) predicts1 dental spending will decline by up to 38% this year and up to 20% next year (2021). We all know that it’s impossible to control the economic impact of the pandemic. But, there is something dental organizations can do to protect their revenue during this time – control eligibility denials.  Limiting eligibility denials is a pathway to improving financial performance and, when dental insurance verification includes benefits retrieval, will make your patients happier.  But did you know…

It’s estimated that only 50% of dental offices verify patient insurance2. With the negative financial consequence of denials, you may wonder why only half of dental practices perform them. Looking deeper into workflows gives us the answer – and the solution.

Dental Insurance Verification

The top reason why dental offices fail to check eligibility – time

Time is the number one factor that prevents staff from performing eligibility and benefits checks. Often, payer web portals have outdated or inaccurate information, so a phone call to the payer is required. In order to reach a representative, dental office staff is frequently put on hold for extended periods of time; it’s not unheard of to wait 20 or more minutes for an available representative.

Getting accurate information is only the first part of the process. It’s critically important to input the data into the patient record, which is also time-consuming because offices need more than just a simple “yes” or “no” eligibility confirmation. They must know the deductible, co-pay, coinsurance, frequency limitations, covered services, plan maximums, and waiting periods associated with the patient’s plan. And, since each insurance company offers a wide array of plans, it can never be assumed that the benefits for one plan will be the same for others. Eligibility and benefits checks need to happen for every encounter.

Eligibility and benefit verification is the single most expensive activity associated with dental practice claim generation. According to the 2019 CAQH Index3, manual verifications cost dental providers $8.07 per transaction. If a dentist sees 20 patients a day, that’s approximately $160 a day to verify insurance for just one provider’s daily schedule.

When you consider the time, frustration, and cost associated with eligibility and benefits verification, it’s easier to understand why only half of dental practices perform them.

The consequences beyond revenue

Failure to check eligibility has many consequences, including revenue interruptions from denials and high labor costs for claims resolution. But for some practices, the impact on patient satisfaction is the most concerning. Patients that receive surprise bills from denied claims are more likely to stop providing referrals and leave the practice. Competition in dentistry is increasing, and most practices can’t afford to lose patients.

The solution – remove eligibility from your workflow

The best solution for many offices is to remove the burden of checking eligibility and benefits from their staff workflow and use a trusted partner instead. Dental practices that made the workflow change have reported benefits such as:

  • Increased staff focus on patient satisfaction rather than encounter paperwork
  • Smoother interactions with patients because eligibility and insurance information is inserted into the patient record, and office staff can discuss charges with patients before visits and treatment
  • Peace-of-mind knowing the practice is using the most accurate information for billing
  • Improved efficiency which has lowered labor costs
  • Payments received faster because claims were paid upon the first submission

The right partner ensures that eligibility checks are performed thoroughly and consistently for every patient. Dental practice staff no longer have the hassle of managing the process and can avoid tedious phone calls with long wait times. Inevitably, patient satisfaction improves when there are no surprise bills due to an eligibility denial or lack of awareness about eligibility issues. Removing eligibility from practice workflow increases revenue as well as employee and patient satisfaction.

Medusind: your dental insurance eligibility and benefits verification partner

Medusind is a leading provider of dental insurance verification services and works with virtually every dental software platform. Our QuickVerify proprietary technology is combined with our large team of experienced agents to ensure dental practices get complete and accurate insurance information. Plus, our agents make sure the information is entered where it belongs – in your practice management system.  Our clients use us to perform 45,000 verifications per day, and many have been with us for 5-10 years or more.

Learn more about our Dental RCM Solutions and dental insurance eligibility verification services then contact us for a custom quote.