Written by Alan Vogel, DMD, MPH Friday, 30 September 2005 19:00
For dental offices looking to take advantage of the efficiencies of the Internet, many administrative activities can become a cost-effective reality. These include real-time patient benefits information such as eligibility, plan design, and estimates of benefits payable; electronic claim submissions; electronic claim reimbursements via direct deposit; and continuing education classes and credits available at a time and location of your choosing.
Surveys of dental providers conducted by MetLife reveal that approximately two thirds have access to the Internet, but less than one third of those surveyed use the Internet in connection with the dental benefits portion of their business operations. Considering how the efficiencies of the Internet have the potential to help streamline dental practice administration, decrease overhead costs, and improve patient satisfaction, many providers are failing to take advantage of an important tool that may literally be at their fingertips.
Even before a patient arrives for his or her dental appointment, real-time information obtained via the Internet or automated phone systems enables a dental office to obtain patient eligibility and plan benefit details from the patient's insurer. By knowing the details about the patient's benefits plan (such as frequency limitations, maximum allowances, and deductibles), dental offices can better inform patients of their anticipated out-of-pocket costs, if any. This information can help eliminate the element of "financial surprise" for patients after a procedure is completed. This is important for all patients, of course, and particularly for those who believe that they are "100% covered for everything." This knowledge can also help dentists make up-front payment arrangements with patients.
In addition, the ability of a dental office to obtain a real-time estimate of benefits encourages a valuable dialogue between patient and dental practitioner about treatment options. Patients and dentists can learn in advance whether a procedure is fully, partially, or not covered under the dental plan, and discuss treatment options. For example, when providing a patient with the choice between an amalgam filling and a white filling, the dentist can help improve a patient's satisfaction by letting the patient know the amount that his or her dental plan will reimburse for each treatment option. In addition, dentists can learn immediately whether the insurance carrier will require additional diagnostic information to make a benefit determination, thus eliminating time delays. Dental radiographs, periodontal charts, and other attachments can also be sent electronically when needed.
ELECTRONIC CLAIM SUBMISSIONS AND PAYMENTS
Dentists can now submit claims electronically to insurance carriers and third-party administrators—a process that helps speed claim processing and reimbursement. Electronic claims can be processed more quickly than paper claim submissions because they are usually more accurate, more complete, and often require no human intervention. For example, by using electronic channels for receiving and processing claims, an insurance carrier or clearinghouse can identify potential problems on a claim sooner and have the information corrected before the claim enters the system, leading to better quality control and faster turnaround time. These electronic claim submissions are available through many different types of dental practice software systems and clearinghouses. It is understood that in order to be effective, technologies that insurance carriers offer as a value-added service have to be compatible with the practice management software systems in dental offices today. After all, one of the benefits of using the Internet is to simplify, not complicate, the dental practice operations.
The cost for an electronic claim submission through various channels can be less expensive than the cost of a stamp, and some carriers have further reduced the cost to encourage the use of electronic claim submissions. Savings can also be realized through decreased staff time to complete administrative tasks; using the Internet or automated phone systems to complete these tasks generally takes less time. Dentists, patients, and employers all benefit directly or indirectly from the efficiencies of electronic claim submissions compared to paper claim submissions.
Electronic claims can be processed quickly, especially those that are auto adjudicated. Payments can then be sent electronically to the dentist via direct deposit. Claim processing to claim payment may take as little as 3 to 5 days in these circumstances. E-mail alerts can notify dentists that the claim has been paid, helping offices keep track of their reimbursements.
For dental offices that may not want to use the Internet or may not have access, the telephone can still provide some of the same electronic functionality of the Internet. For example, carriers can make plan benefits, claim status, claim submissions, and real-time estimates available through an automated phone system. For offices that like the reassurance of "paper in hand," in many cases these functions can provide a "fax back" option for dentists so they have a printed copy of the information they hear on the phone.
CONTINUING EDUCATION CREDITS ONLINE
As we all know, continuing education is an integral part of staying current on clinical and professional developments, and is a licensure requirement for most dental practitioners. Like other types of distance learning programs, continuing education classes that the ADA has recognized under its Continuing Education Recognition Program are available in some instances online, and therefore dental practitioners can take them at the time and location of their convenience. For example, certain self-study continuing education classes are designed so that dental practitioners can read through the materials posted on a Web site and then, when ready, take an online test. Results are immediate, and certificates can be printed on demand. The ability to receive continuing education credits online naturally saves dental practitioners the time and expense of traveling to these programs.
Because of the elements of supply and demand (limited supply of dental chair hours and increasing demand by patients), dental providers can be selective in working with carriers and third-party administrators. One feature to look for when choosing which of these to align with is the optimizing of technology for all stakeholders, helping make the paperless dental practice a reality for those who desire it.
Dr. Vogel is vice president of MetLife Dental Product Manage-ment. The MetLife Web site for dental providers is MetDental.com. He can be reached at avogel@ metlife.com.
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