Tuesday, June 23, 2015

Stop giving the insurance companies so much power

Will whoever gave the insurance companies the power to do whatever they want please stand? Oh yeah … we did. We have given and continue to give them power when we don’t have proper documentation to justify our treatment plan or confirmation showing that our claims have been received. If we don’t manage our systems properly, we have to do what they tell us to do because we can’t prove anything.
The easiest way to have some leverage with your insurance companies when it comes to claims processing is to use Dentrix eClaims. The claims reports and support you get will give you a leg up when you have to follow up on an unpaid claim. When you use Dentrix eClaims, you receive a lot of reports. When I am training out in the field, I ask the team, “What do you do with these reports?” The most common answer is “Nothing” or “I don’t know”. These reports give you the information you need to be in charge of your claims and attachments, but you need to know what to look for.
The two most important eTrans reports for you to look for are the Payer/Clearinghouse Report and the Attachment Status Report.

Payer/Clearinghouse Report – You will receive this report about 24-48 hours after a claim is sent out and it contains some very important information. This report will give you the INSURANCE REFERENCE NUMBER also called a DC#. The DC# you are looking for is one that has the source as the insurance carrier. This is the only number the insurance company will be able to use to track your claim. My recommendation would be to copy this DC# into the claim status note so you have it readily available if you need it, then you can shred the rest of this report.

Attachment Status Report – This report will give you the NEA number assigned to your attachment within 6-24 hours after you send your claim. If the insurance company states they did not receive your X-ray or perio chart, you can use the NEA number to prove the attachment was received and they should be able to track it. As stated above with the DC#, my recommendation would be to copy this NEA number into the Claim Status Notes on the claim so if you need it, you don’t have to track down your reports.

Don’t give the insurance companies the power to manipulate the situation. If they say they do not have the claim and you have the DC#, do not resend another claim. Ask to speak to a supervisor or call the Dentrix eClaims support team and they will help facilitate the situation.

Another great resource for you to use is the Insurance Manager with eCentral and have the reports archived for you.

Tuesday, June 16, 2015

Medical Billing . . . the new shiny toy

Medical billing is definitely the new shiny toy that is getting lots of attention lately. Each week, I receive several e-mails from offices asking if they should or shouldn’t use medical billing in their practices. The answer is … well … it depends. It depends on whether you have medical necessity. You can’t just bill medical for an oral appliance because it is covered under a patient’s medical plan. You must have medical necessity and proper documentation.
There are many considerations when deciding to take on medical billing. The office I worked at for 18 years performed a lot of neuromuscular, head, neck, and facial pain treatment and medical billing was an integral part of our billing process. I think medical billing can be a huge value-added service. However, I want you to go into it with eyes wide open.
  • You must have a medical diagnosis – If the patient is being referred to you for an oral appliance from his or her physician for sleep apnea or TMJ, usually the physician can provide you with the diagnosis code and any clinical documentation that will be necessary for the claim. However, if the patient is not being referred, then your doctor will need to provide the diagnosis code for claims processing.
  • Medical is billed on a different claim form – If you are going to process the claims for your patients, you will need to send them electronically on a HCFA1500 claim form. Medical insurance plans will no longer accept paper claims from the practice, but you can give patients a paper HCFA1500 claim form to submit to their insurance if you choose.
  • Be prepared for denial, denial, and more denials – Medical is worse than dental when it comes to stalling payment. You may want to consider having the patient pre-pay for treatment, then reimbursing him or her when the medical insurance pays.

If I haven’t scared you off yet and want to pursue medical billing in your office, check out an article I wrote last year on getting started with the setup in your Dentrix software by CLICKING HERE. E-mail me directly if you want one-on-one training for your team to learn medical billing in Dentrix.

Tuesday, June 2, 2015

Expand your Medical Alert Notes with G6 and Questionnaries

When I first saw all the new and exciting features with Dentrix G6, I was eager to learn how to apply them into my everyday workflow. There is a new feature that enhances something I have been teaching for a long time and that is the health history update. If you have been reading my blog for a while, you know that I love using the Questionnaire Module for updating the health history update because it is a secure location, keeps a chronological history, and is super easy to use.

Watch my video to learn about this cool new feature.


If you are new to Questionnaires, please read these articles to learn more.

Creating a form - CLICK HERE
New Patient Forms - CLICK HERE
Documentation - CLICK HERE