Insurance and the paperwork that accompanies it can be a burden for many dental practices. So, a recent NEA Powered by Vyne survey explored the biggest pain points and the most pressing issues such as security that practices face with claims management.
D4341 (periodontal scaling and root planing per quadrant), D2740 (crown-porcelain/ceramic substrate), and D2950 (core buildup, including any pins when required) are the top three claim procedure codes that require the most supporting documentation for adjudication and the claims most often rejected by payers after first submission.
Specifically, D4341 causes trouble because more dentists and hygienists are using periodontal scaling and root planing as treatments to help patients control their periodontal disease. But according to many respondents, many practices also are experiencing insurance-benefit issues related to the claim number. While most indemnity carriers cover D4341, restrictions and requirements for payment are abundant.
Also, more than 40% of respondents said that, on average, 10% to 25% of their claims require supporting documentation or attachments, while 36% said that between 26% and 50% of their claims require additional documentation. NEA further asked practice leaders what their greatest pain points were in dealing with insurance. The 10 most commonly reported issues, in no particular order of importance, were:
- Claims processing delays
- Following up on unpaid and rejected claims, or rejections causing slower turnaround for payments
- Verifying eligibility, or verifying coverages prior to procedures and then being told the procedure is not covered after the practice received verification that it is
- Payers claiming they did not receive documents that were sent
- Reimbursement levels that are lower than originally expected
- Rejections or requests for additional information
- Long hold times, not getting a person on the phone, and the payer’s automated customer support systems
- Coordination of benefits
- Dental insurance downgrades
- Medical billing for dental and the challenges of CDT versus CPT coding: what gets billed to medical, and what gets billed to dental?
With today’s greater emphasis on data security for health information, 50% of the respondents said they use secure email to communicate with referring or other dental specialists. However, 20% said they use standard (non-secure) email, which can be a compliance risk for their practice and the data they manage.
“The insurance pain points and claim-related issues faced by dental practices can seem overwhelming to even the most tech-savvy and experienced practices,” said Robert Patrick, Vyne’s president of dental operations. “Even those using technology to alleviate the burdens of claim processing are not immune to the challenges of dealing with insurance. Persistence is key when it comes to managing accounts receivable and insurance claims.”