Running a dental office requires multi-tasking. From acquiring new patients to negotiating an office lease and managing your employees – there are a myriad of challenges involved. Effective management of these activities can put your practice on the road to success, but how do you do that? These aren’t typically skills taught in dental school, and they can feel overwhelming at times.

How do you effectively manage it all and provide excellent dental care? 

You’re not alone in feeling the sense of challenge here. Rare is the business that can do all these things well. That’s why practices will sometimes choose to outsource certain activities they don’t have the time or expertise to do. It’s costly, but it does free up your time to focus on patient care. So how do you weigh the costs and benefits to determine what and if outsourcing is a good option for you?

Take, for instance, insurance verification (IV). When it comes to IV, there’s a range of options: from having your front office staff do 100% of it to outsourcing to a partner like Opencare. And there’s quality to consider; how much more valuable is IV done right in spite of higher costs? There are real tradeoffs to this decision.

Why is insurance verification Important?

Insurance verification is an essential aspect of revenue cycle management that helps avoid claim denials, reduces patient ineligibility-based rejections, and speeds up the billing cycle. This improves office processes, optimizes patient retention strategies, and goes a long way towards optimizing profitability. In short, IV saves your practice time and money.

Don’t forget about accuracy

There are generally two parts of the equation to optimizing your practice performance: generate more revenue or decrease costs. 

Often, when we speak with dentists, they consider insurance verification a cost center – something they need to pay someone to do to run their practice. However, at Opencare, we think of it as a revenue enhancer, where high quality, even at a higher cost, can be MORE valuable.

Let’s run through an example: let’s say your office manager is completing IVs and paid $20 per hour. You have the opportunity to switch this to a service that can complete the same IVs/hr but it costs $30 per hour. Most of us would do the quick mental math and keep it in house, it’s $10 cheaper.  

But consider accuracy – what is the accuracy rate of your office manager vs. that of the service provider?  Remember, there are already fixed costs like hygienist salary, rent, etc. you’re paying, so wasting an appointment slot or not being paid by insurance on the back end because of an incorrect IV is quite expensive!  

Going back to our example, let’s say the difference in accuracy is 10% between your office manager and service provider.  And each can do 3 IVs per hour, so it costs $67 for your office manager and $100 for your service provider to do 10 IVs each.  That’s a difference of $33 – which is easily covered by having 1 more appointment or being able to collect the fee from insurance for that appointment.  So in many instances, even paying more, your practice is realizing more value from improved accuracy.

The benefits of in-house IV

First and foremost, doing IV in-house is beneficial because you have more control of the entire billing process. This allows you maximum customization of the process to your schedule, needs, and systems.  In addition, employees can address any issues right away. 

Second, an in-house IV expert can help resolve a patient’s queries before their dentist appointment. In-house experts are often intimately familiar with each patient and their individual history, needs, and circumstances.

Finally, doing so in-house is generally cheaper – especially if you have front office staff who have some free time. Going back to the example above, even the cheapest outsourced options will cost a bit more than you’re paying your staff.  

How much does in-house IV typically cost?

When Opencare has asked our dental practices how they evaluate this, dentists often will cite salary against the cost of the outsourced option. That’s a good starting point, but there are numerous hidden costs associated with in-house IV that are harder to discern. Make sure you’re factoring these in, as it may very well affect your decision.

Let’s look at these hidden costs:

Recruiting

How much time does a dental practice spend hiring a qualified front office person? Consider time spent on advertising, reviewing resumes, completing background checks, pre-employment assessment tests, and other recruiting activities. Do you want to spend the time and energy to do this not only upfront, but if your staff leaves?

Training

What training and skill development does the employee need to manage this position on an ongoing basis? On-the-job training and continuing education requirements can add significantly to cost and reduce available hours to work on IV.

Benefits

The obvious cost of taking on a new employee is their salary. However, there are numerous other employment costs to think about as well. Standard employee taxes and benefits like insurance add ~20% in salary, which doesn’t include additional perks that you may wish to provide.

The indirect costs of in-house IV

Besides the direct costs, there are also some additional factors to consider:  

Management time

Ever have to fire an employee? Or have to go through an uncomfortable compensation discussion? People management can be tricky, time consuming, and just plain stressful, which is why there are professionals who specialize in this. If this comes natural to you, great. But is it something you want to carve out the headspace for? 

Opportunity cost

Insurance verification processes take away a valuable asset from your front office staff: time. Your front office staff could be doing more efficient and valuable tasks, like talking about treatment plans or spending time helping patients understand their treatment plans. This is known as opportunity cost.

You always want to take into consideration the potential value you are losing when you have missed opportunities in your office.

What can you gain from outsourcing IV?

Once you’ve adjusted for all these factors, you can begin to understand the true cost of the in-house option. Compare that to a fully outsourced managed service can provide:

• High quality insurance verifications with accuracy of, maximizing the number of patients you can see 
• Limits incremental staff time, which can reduce compensation cost and/or free staff to do other activities
• Eliminates need and time for upfront and on-going training
• Reduces management time

Furthermore, insurance verification outsourcers like Opencare have the knowledge and experience to help you collect payments more quickly and reduce claim denials. And by reducing time spent on IV, it can enable you to focus on offering exceptional patient care and building stronger relationships with your patients.

What’s the right choice: in-house or outsource?

There are times when it makes sense for you to do tasks in-house, and there are advantages to doing so with IV. It gives you more control and options to customize the process and can be cheaper. 

However, there are real costs as well which we often see dentists ignore. Some things may not be so obvious at first like accuracy, management overhead, and additional costs – to the detriment of their practice.

Ultimately, every dental practice has unique needs, and you need to decide what’s best for you. To get the most benefits of IV for your dental practice, conduct a thorough cost analysis and weigh the factors we’ve discussed here.

If you have questions, reach out to us. We’d be happy to help you evaluate your options.

The post Hidden costs of in-house insurance verification appeared first on The Floss By Opencare.

When it comes to running your dental practice smoothly, it’s important to verify and keep on top of your patients’ dental insurance. It can feel monumental sometimes, but general maintenance in verifying your patients’ insurance will help you avoid bigger headaches later. 

Too many patients, insurance plans can be confusing; lots don’t even know the specifics of their insurance plans. 

Because many patients are unaware of their insurance benefits and can’t answer questions about them, it becomes essential to understand how to verify dental insurance before their appointment.

One advantage of dental insurance verification is that you’ll better understand the patient’s benefits and you’ll be able to educate them about their coverage during their dentist appointment. Also, knowing patients’ eligibility information helps you to inform them of their eligibility for a dental procedure. 

Let’s discuss the benefits of verifying dental insurance. 

The importance of verifying dental insurance benefits

Insurance verification is essential when it comes to dental care. If you fail to verify patients’ insurance benefits, you won’t know if a deductible applies to a new patient’s first visit — and the practice may lose money later. You’ll also prevent getting less than expected payment from insurance. 

Often, we find many patients are ignorant about the four insurance payment concepts. They include:

• Deductible
• Co-insurance
• Co-pay
• Out-of-pocket maximum

However, you can only explain these payment concepts to your patients if you know their insurance benefits. Here are some things you stand to gain from patients’ insurance verification:

• Prevention of a denial of payment from patients’ insurance providers for root planing and scaling
• Prevention of a denial of payment for an emergency appointment and limited exam for existing patients
• Prevention of reduced payment for cleaning and examination visit
• Prevention of a denial of payment from insurance for a new patient’s preventive visit

How do I verify dental insurance benefits?

You can use fax, in-house, automated services, or an online portal. Furthermore, consistently ask your patients if there are any changes in their information. Also, verify their insurance plan by getting in touch with the insurance company. Here are some ways to verify patients’ insurance benefits:

Automated services

You can use automated services like DentalXChange.com for insurance verification. All you have to do is log in to your account and check your patients’ eligibility. However, automated services don’t provide stipulations and aren’t detailed enough. 

They aren’t 100% accurate when it comes to waiting periods. Also, automated services require you manually call the insurance company to determine stipulations with some types of procedures. 

Form for in-office dental insurance verification

Your team has to call the insurance company of the patient to fill this form. It’s the best insurance verification method that provides you with all the details you require. However, it takes up considerable time compared to other methods of insurance verification.

IV Services

Insurance verification services allow you spend more time with your patients, and less worrying about insurance. These services call payors on your behalf to get any eligibility information you require. They also call payors on your behalf to get any eligibility information you require.

Online portal

Not many dental insurance providers have a portal online where you can go through patients’ claims. Your office must have online records for the insurance companies you work with. 

It will also help if you didn’t depend on this method to get information. This method isn’t reliable for some stipulations like waiting periods for root planing and scaling.

Fax

Several companies may provide only a certain percentage of information about different procedures via fax. Also, they may not include the history of service prior dates. 

What information do I need when I call the insurance company?

You’ll need the following for proper insurance verification:

• Your office tax ID
• Name of subscriber
• Date of birth of subscriber
• Social security or ID of the subscriber.

Use a printable dental insurance verification form

A printable dental insurance verification form helps you keep a record of patients’ benefits information. It is useful as you can use the same template for all your patients. It will save you time and minimize compliance issues. 

You’ll need:

• Patient’s name
• Appointment date
• Contact info of insurance company
• Social security number, etc.

In addition to the above, the insurance verification form should also include:

• Payor ID
• Claim mailing address
• Tooth implant coverage
• Cleanings, crowns, and build-up coverage

• Frequencies for x-rays and panoramic
• Insurance plan benefits. It includes annual deduction amount in dollars, policy duration, annual maximum, waiting periods, fee schedule.

Without this information, the insurance provider will not give out the patient’s correct benefit information. Therefore, get patients to supply this information when filling their insurance verification form. It all makes the process easier.  This is why most patients in Canada want to find a dentist with experience in insurance verification.

Essential terms regarding insurance verification

Some terms are vital when learning how to verify dental insurance:

Deductible

Ensure you verify from the insurance company whether or not a deductible applies. And ask if it applies to preventative treatments or not. Note some insurance companies even apply a deductible to cleanings or exams for preventative services. You must verify this when calling the insurance company.

Additionally, not all insurance companies cover 100% preventative services and do not apply deductible. Although most do, some only apply deductible to certain preventive services. Some patients assume insurance covers their yearly or twice in a year x-rays and cleaning at 100%. Ensure the insurance company verifies this to prevent any unpleasant surprises on payday.

Dental benefits as-of date

Also, remember to write down the exact date you called the patient’s insurance company. Benefits change from time to time, depending on if the patient changes their insurance plan. Also, insurance companies can decide to change the patient’s benefits. 

Additionally, keep a record of any changes you make to the sheet. If, for instance, the patient decides to change insurance policies, open a fresh template. The new template should include the patient’s benefits on the new insurance plan.

Benefits used to date

This applies to new patients who recently left their old dentist during the benefit period. You’ll need to inquire how much the patient used during the rest of the benefit period. 

Afterward, update this information on your office’s record. It will help you know if the amount for treating the patient is above the maximum their insurance covers.

Secondary or primary insurance

It’s crucial to know if the insurance is the patient’s primary or secondary insurance. Most patients are not sure if their insurance information supplied is the primary or secondary insurance information.

If it’s their secondary insurance, the insurance company will deny your payment. You will have to tender a statement of Estimate of Benefit from the primary insurance.

How long can it take for insurance to approve dental work?

Major procedures may have a waiting period of six months to a year. In contrast, basic procedures have a waiting period within the range of three to six months. For preventive measures, there are no waiting periods.

Final thoughts

Insurance verification is crucial when it comes to preventing payment denial. There are available options to pick from on how to verify insurance. You can decide to use fax, automated services or an in-house insurance verification form. 

When you know your patient’s insurance benefits, you can educate them on their insurance coverage. If their insurance plan doesn’t cover the procedure, you can discuss other payment options with them.

Additionally, one benefit of dental insurance verification is you receiving payment after scaling and root planing. Also, it prevents you from getting less than the expected amount from insurance. The insurance verification process requires that you get the patient’s information.

At Opencare, we can make the dental insurance verification process easier for you. We can help you verify a patient’s dental insurance before they attend their appointment.

The post Dental insurance verification: how to verify your patients are covered appeared first on The Floss By Opencare.