MMM [Medical & Dental Billing] 5 Steps to Fast and Clean Insurance Approvals in Your Office

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Show Notes

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In this episode, Jasmine Smith, from Versa Solutions, breaks down 5 actionable tips that we can use to ensure a smooth insurance relationship.

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Get Credentialed - Yes, credentialing can be tricky, and it may be temping to bill under your name instead of the associate performing the treatment, but don't do it! This results in a messy claim and can be a red flag for future audits.
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Sign up for EFTs - Electronic Funds Transfer methods allow payments to be easily processed and can eliminate the travel time and restrictions of physical delivery.
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Verify Benefit Eligibility - Always double check a patient's benefit eligibility. Even though they might say they are covered, making sure can avoid future disappointment.
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Document Everything - The more documentation on procedures the better! Always keep good notes to avoid claim denial.
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Review AR Weekly - Be sure to review your Accounts Receivable balance at least once per week. If this is close to zero, meaning no money is owed, your account is in a good place!

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You can reach out to Jasmine Smith here:

Versa Solutions Website

Facebook

Twitter

Instagram: @versasolutionsinc

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Episode Transcript (Auto-Generated - Please Excuse Errors)

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Michael: Hey Jasmine, so talk to us about medical and dental billing. How can we utilize this, or what advice or suggestions can you give us that will help us with doing medical and dental billing?

Jasmine: Right. So Michael, my experience as a, billing company owner, uh, involves mostly helping practice owners get to the bottom of their slow insurance and patient collections, and not only implement systems, um, to help achieve faster cash flow, but actually keep those systems running smoothly for them.

So, We put the work in and do all of the work, . So, um, we help all kinds of specialties, practice management softwares, practice types, whether they're fee for service, p o, Medicaid. So we've seen it all, done it all. but the common denominator I noticed between all of these practices, it's staffing issues.

It seems like everybody's having an issue with that right now. Mm-hmm. . So you can't keep your biller who or your office manager who's gonna make sure your claims go out, who's collecting from the patients. Who's sending statements and making follow up calls to the patients about their bills. Um, 1, 2, 3 years go by and you realize you've only gotten paid six to 7 cents of the dollar that you've actually worked for.

So the other side of the staffing issues is, um, hiring someone who has good intentions, and they believe they know the ins and outs of dental billing, but they really don't, and they can create some costly mistakes for their practice. So, If as the practice owner, you're not auditing the work, things can pile up really quickly.

So we've seen that happen as well. But I'm here because I wanna share five tips that every practice owner should implement that I wish everybody knew about. So the first one is get credentialed. I heard on one of your other podcasts of someone, um, really going into this point, going into depth.

That was great. Don't go off and hire an associate. Allow them to treat patients in your office and then bill under your name as the treating dentist. That's not a clean claim. That's an easy way to flag an audit with the insurance company because, um, if you're attaching your narrative for, you know, a procedure whose name is at the bottom, whose name is signed at the bottom of that narrative.

So, um, and if you accidentally. A batch of claims with, you know, your associate on them and you get it back and it's out of network or, you know, um, there's a denial. Then you wanna send a batch of, corrected claims with your name on it. That may cause suspicion as well. the a d a has a pre credentialing service, C A Q H, so that's a great, um, tool to use to get credentialed applications.

Second one is sign up for as many EFTs as possible. We've seen a claim go out same day as the date of service, and then you get paid the very next day. We've seen these bank accounts get funded the very next day after you see the patient. So that's very, very quick. Um, a lot of the insurance companies are getting crafty with insurance, credit card payments or v c virtual credit card.

Um, that's when they send you like, Hey, here's a credit card. You can process your credit card machine, for payment for this, you know, procedure. Um, but you actually. , charged a lot of fees with your merchant service. Mm-hmm. , if you do a annual, you know, credit card mm-hmm. , transaction, so there's no charge to receive EFTs from an insurance carrier.

Um, and then, you know, when disaster strikes in an area which we've seen, there's been hurricanes lately. Um, the mail stops, that's tens of thousands of dollars that's waiting To get to you. So, you know, imagine if you just had that direct deposit and you can access it immediately and do what you need to do.

Also, the paperwork of getting paper claims and checks all the time. It's just a bummer, . So, uh, my third tip. Is to verify. Uh, when a patient comes in and hands you an insurance card, you really need to verify the eligibility and benefits. You can't just take their word for it, that they have coverage and everything's covered. don't bill blindly don't update the benefits in the system by blindly, uh, yeah, it's the patient's job to know their benefits, but I assure you less than 10%, maybe even 5% of people actually know their benefits. , they're still gonna be upset when they have to pay that 25 dollar deductible that you didn't tell them about.

So just find out beforehand. What their insurance is all about, who you're billing, even before they're seen. And if you can't do that, if you just have no time, outsource it. There's many companies that do this. Um, and my fourth tip is documentation. I also heard another one of your podcasts or someone really, um, honed in on this point.

not only do x-ray. Need to justify a procedure being completed, but the clinical narrative needs to paint the picture as well. So, for example, we usually see the most denials with crowns and buildups. then we see the narrative template and we're like, oh, that's why , because the insurance carriers want to see whether it's an initial. Or replacement with the prior placement date? Was it a fracture? They need the location of the fracture. I've seen sometimes they were asking for the length and depth of the fracture. was it a fail amalgam restoration, recurrent decay? How much of the tooth had decayed before removal? How much of the tooth was remaining before the buildup?

Just so much needs to be in the narrative for processing, and that will make sure that you. Your payment quicker, and if you have a denial, it would be far and few in between. And then my fifth point is with patient billing. Um, we offer a service for patient billing with our company. So we've seen it all in this area as well.

Um, at the very least, you should review your new accounts on your AR on a weekly basis. So these are. Accounts, ideally that you know insurance has paid, um, and you need to review the ending balance. Every pr uh, practice management software really has a easy way for you to check this. and then you can send your statements out immediately after you re you reviewed the account.

what we do is make notes on the account, just showing us where the balance is coming from. And when the patient does call, we can just locate our note and explain where the balance is coming from really easily and quickly. Um, and then when you make a rule, stick with it. Like, if you deem contacting the patients three times is enough, maybe statement, call statement, write the balance off or send them to collections.

Don't let the balance linger. That's how your ar will increase over time. So just take action, you know, make some rules, set a system up with your staff and, um, your AR would, you know, look pretty clean. If your patients overpay you, this is the other hand of it, pay them back. Um, keep your AR as close to zero as possible.

So not too many credits, not too many debits. Let's just, you know, keep it close to zero, which is what we try to do with our company as.

Michael: nice, Jasmine, I appreciate that. Out of these five, I, I kind of wanna rewind a little bit. When you mentioned, um, the number two sign up for as many EFTs you said Yeah.

As possible. Okay. Can that ever backfire or no?

Jasmine: Um, I've not seen it backfire. Only when there is a recoupment that needs to happen. you know, patient. Plan actually terminated, but the insurance paid the office, they'll just take it out of the next payment. So you really have no control over that.

Usually if you get paper checks, they'll ask for the money back in another check. So you really have no control over that. But you know, they'll take it out of something anyway, . Gotcha.

Michael: Okay. Do you guys do medical billing too?

Jasmine: Um, we send medical claims for some of our oral surgery offices, when needed, but we don't really dive into the medical billing part of it with the coding and I c D 10.

Michael: Gotcha, gotcha. So then where do you see out of these five tips, like people mainly have the

Jasmine: most hiccup. most hiccups is probably the verification. Um, there are so many claims that go denied or rejected because the verification wasn't done in the beginning. probably second one would be the credentialing

Mm-hmm. , um, hiring an associate and not putting them on the claim. It's just kind of, I see that a lot. I know it's a headache trying to credential all of your new, employees, especially if, um, you're going out of network anyway. but it's just good to put them on the claim form. And then documentation would probably be number three.

why

Michael: documentation, like what is not

Jasmine: enough detail or not enough detail? Um, some doctors have their assistance right in the details of the narratives, and maybe they're not just, they're not trained enough or not enough was communicated with them. Um, but yeah, I, I would recommend, you know, at the end of the day, just review all of your notes.

Make sure. It's completely, filled out to the brim . Yeah. Too much information is good. Um, especially when trying to get these claims paid the first time. You don't wanna have it denied and come back and wait another 30 days for that to process. So. .

Michael: Yeah. Because I feel like that can be a headache, especially when you get a lot of denied claims.

I mean, you're on the phone, you're at the front office, you're getting another denied claim. You know, you're, you're dealing with that and people are coming in calling and all these things. Right? So it can be tough. I like what you mentioned when you said make a rule, stick with it to you.

From the many practices that work with you guys, what have you seen to be like a really fantastic role when it comes to this?

Jasmine: So we, uh, contact patients six times, right? So that's our role as our billing company. If we contact the patients, we we're probably sending three statements, making three follow-up phone calls.

that's our role. We stick with it. The offices tend to agree that yeah, that's a good amount of times to contact a patient about their bill. If they're not paying by then, then you know, how many other times do it. So, That's the rule, and that's good. It, when we're done with it, we exhaust all attempts.

Patient either gets sent to collections or if the balance is too low, it's written off. Lots of notes are written on the, um, on the account. Popup notes are created, so before the office or the patient even comes in, they have to pay the bill. So it's smooth. It, it works. . I think that's a, that's a good rule.

Sometimes they're like, did we contact them enough? I mean, we sent one statement. We, we called them, they said they'd pay it, but they never did call four more times. . Mm-hmm. . That's the rule. And then if they don't, then send it to collection. So, yeah. The amount of times of contacting a patient I think is a good rule to.

Michael: Do you ever recommend like texting or emailing them or

Jasmine: no? Yes. Um, now, in this day and age, take advantage of as many resources as you can. A lot of dentists have, dental intel. They have a payments feature. Practice by numbers also has a great payments feature. Um, I know we use our offices, if they have Weave, we'll use that on behalf of their office to text, you know, um, the patients and send 'em their bills.

So, take advantage of, of that mailing statements is, gonna be a thing of the past

Michael: now. Yeah. So then would you recommend, is that part of the six? So like, would it be like, . Then number two would be like text and th like that, or,

Jasmine: yeah, yeah. Usually you can send an email and a text at the same time.

That'll count as one contact, and then we'll follow up with a phone call and then send another email, text, um, we call, because we wanna make sure they're actually receiving their invoices. and if that method isn't working, we change it up, you know, especially if the patient's older, they probably need a mailed statement, so we'll, we'll change it up for them and send 'em a mailed state.

Michael: Okay. Awesome. Any final piece of advice you wanna give to our listeners about medical and dental billing?

Jasmine: stick with the pros. If you can't, um, do it or you feel overwhelmed with it, with your office, you don't have to worry. You know, you can outsource it. It's often cheaper than hiring a billing coordinator for your practice, um, or care than, you know, training someone to, um, do everything correctly.

Hire, outsource it. If you can't, like I did, like I said with the verifications, we don't do verifications, but a lot of our offices outsource that and they see much more collections in a lower AR because of it. so yeah, don't be afraid to ask for help .

Michael: Awesome, Jasmine, I appreciate your time and if anyone has further questions, you can definitely find her in the Dental Marketer Society Facebook or where can they reach

Jasmine: out to you?

Um, our website is www.versussolutionsinc.com. Uh, also on Facebook, Instagram, LinkedIn, Twitter, , everything there. So, um, yeah, feel free to reach out. We're everywhere.

Michael: All right. That's gonna be in the show notes below. And Jasmine, thank you for being with me on this Monday morning marketing episode.

Jasmine: Thank you.

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