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Simply Overlooked Task-Electronic Claim Submission

Posted on March 12, 2018 at 8:30 PM Comments comments (4525)

One of the most important tasks in dental billing, to ensure fast insurance payment, is the claim submission. You are probably thinking it is the easiest task and takes no time. But that's exactly it! If it takes you no time you are probably missing something. Let me explain. The claim submission task is a 4 part process.
1) all completed procedures must have a claim created and batched
2) specific procedures must have supporting documentation to obtain payment
3) rejected claims must be corrected and resubmitted
4) the electronic remittance advice has to be reviewed and managed to clear the report

Creating Claims for all completed procedures
For some reason, teams somehow miss creating claims at checkout and sending them for batch processing. What happens, is that the claim never goes out and doesn't really appear on any aging reports that are commonly worked. One place you will pick it up, is the patient balances. Since the claim never went out, the balance is assigned to the patient. If you do not consistently work your patient balances you might overlook this and pass the claim's timely filing. Then, you get an angry patient. Each dental software is different, in some softwares there is a separate report that lists all the procedures without claims attached to them for patients with insurance. If not, you will have to count on picking this up when you work the patient balances. Therefore, team needs to pay attention that a claim is created for the appointment at checkout and batched.

Supporting Documents for Dental Procedures
Nothing is more annoying to your front office team than submitting a claim for a crown and not having an x-ray required to submit with the claim or a missing diagnosis for a narrative. Or submitting for scaling and root planning and not having perio charting to accompany your claim. A claim without supporting attachments is delayed and in the batch processor as rejected. Most dental softwares have an automatic setting to prompt for the supporting documents with certain ADA codes. Your front office will then need to ask the clinical team to either bring the patient back or basically submit the claim without the information knowing that payment will be delayed or denied. On the other hand, many offices have the documents, but do not pay attention to this step. Or their software is not setup to prompt for documents on specific ADA codes. That is sloppy billing, increases your AR, and decreases your cash flow. If you do dental billing long enough you know exactly what information needs to go with claims to expedite the payment. Look into this important setup in your software. Ask what codes prompt attachments and make sure this is setup correctly.

Managing Rejected Claims
After you hit the submit button, you need to check the submission report. It will show you the unsubmitted claims due to rejections. We tell the offices to track the number of rejected claims in one week to see what their submission success rate is and what their rejection rate is. The rejection rate should be less than 5%. A claim gets rejected for one reason: the information that the insurance has does not match what the provider is submitting. That means that your insurance setup for that patient is incorrect, patient or subscriber demographics are incorrect, or the provider information is incorrect. Every single rejection must be corrected. Many offices do not take the time to resolve this report. What will happen is the claim will not be on file and will need to be resubmitted at some point. So why not do it at the time of original claim submission? You may have to call the patient or the insurance company to verify the insurance, patient's demographics, the subscriber demographics, or provider demographics. It boils down to the insurance verification process and insurance setup when the patient is first establishing or when they provide you with insurance changes. Does your office verify benefits? What information does your office gather when the patient arrives? Does your office know how to properly setup the patients and their insurance in your system? Do they understand the coordination of benefits and birthday rules for dual insurance assignments?

Electronic Remittance Advice Management
You are not done yet! Everyday, your e-claim submission software should have the ERA reporting directly from insurance companies. If it doesn't, see if you can sign up for that service. Let me explain the importance of this. The insurance companies report back to your software that they received your claim, give you a claim number, and they tell you if they need any additional information, they send you EOBs on payments, they send you denials, and preauthorizations. This is a very useful tool for claim correction and resubmission, obtaining EOBs or EFTs, scheduling treatment off of pre-authorizations, and initiating appeals on denials. Most insurance companies send this ERA information within 2 weeks of claim submission. That is 2-3 weeks earlier than snail mail. It is also an electronic paper trail record. It will save you hours on the phone and speed up payment. Now you are done with the claim submission task. I call it pay-it-forward, spend the time in the front end so you will not need to spend time on these claims in 30 days. And that is because unresolved claims will get paid within 30 days and will not show up on your claims aging report. Hope this Helps!

Dr. Dorothy Kassab
3649 Erie Blvd East, Unit10 Dewitt, NY 13214

Claims Not On File After Submission-Big Struggle with Insurances

Posted on August 21, 2017 at 2:10 PM Comments comments (1556)

Electronic claim submission is amazing and provides a tracking mechanism for claim submission.  However, many insurances are still non participating in the electronic payer process.  In fact, it probably works to their benefit to keep it that way so they can delay claim payment.

The most frustrating aspect of dental billing is the "claim not on file" claim status.  We work diligently to send clean claims and when the claim is unresolved for over 30 days, we call the insurance company to find out why the claim has not paid.  It is the most annoying answer that our specialists hear from the insurance reps-"Your claim is not on file".  

What do we do then?  This often happens with claims that are mailed due to the insurance being a non electronic payer. The mailed claim is always "lost" somehow.  The first thing that needs to be done is the patient's demographics and the office demographics must be verified with what insurance has on file with the subscriber and the provider.  Request the claim be faxed to a supervisor.  Do not hang up until the fax is received or you get a supervisor's contact information.  If supporting documentation is necessary especially xrays, the fax will not work since the xrays are non diagnostic off of a fax transmission.  But that is ok, first get the claim on file via fax, to avoid timely filing issues, then you can follow up in a few days and submit the supporting documentation via mail certified mail to the supervisor.

Interesting Dental Billing Tips

Posted on April 25, 2017 at 10:50 AM Comments comments (6796)

Medical & Dental Billing News


For insurances that have a long wait on hold to speak to a representative, try calling the patient line instead of the provider line. Then, ask to be transfered to the provider extension. Your wait should be significantly decreased. Also, find out what the hours are for provider line and patient line. We have found that the patient line is opened 1 hour earlier than the provider line, giving you the opportunity to get right to a representative.


For patients with dual insurance, in a situation where there is a dental rider on a primary medical plan, you can submit to both, primary and secondary, on the same day. This is because the secondary dental insurance has the allowance table of the primary insurance and can configure what the dental rider on the medical plan will pay. Sending both claims at the same time will decrease your time waiting for both payments. Normally, you have to wait for the primary EOB and send it in with the secondary insurance claim. In this situation, the secondary insurance does not need to see the primary EOB because they can estimate what the primary will pay. Therefore, the secondary insurance proceeds to process the claim without the primary insurance EOB.


Pearl of the day: When submitting corrected claims for procedures, make sure to put the original claim # on the corrected claim so it is not reprocessed as a duplicate. If the insurance determines a claim to be a duplicate, and does not recognize that it is a corrected claim, they pay nothing and do nothing. Therefore, all efforts, requested additional submitted information, is ignored, delaying payment. It is the insurance companie's tactic to delay payment. Ask how we know.



When asking for patient's name, make sure to ask the patient how their name is filed with the insurance company. If claim is ANY DIFFERENT i.e. how it is spelled or hyphenated they will not process the claim. Has to be exact.


When taking a Pano and Bitewings on same day --- Insurance may give you the most comprehensive benefit applied. Which means they will give an alternate benefit of a FMX which has bitewings included. Therefore if the patient has reached their frequency on FMX limit - both the pano and the bitewings won’t be covered.

If the bitewings where submitted to insurance by themselves then they would be covered if eligible.

So if you submit to insurance a panoramic x-ray any other combination of x-rays, an alternate benefit may be given and could possibly be given the most comprehensive benefit (FMX) and no benefit will be paid, depending if the patient has reached their frequency limit on the FMX.


February 2017, Medicaid sent out letters to providers across the nation requesting refunds of money paid to billing companies that charge a % of collection for their services. Medicaid has determined that paying a % of collections is illegal fee-splitting. They are also charging 9% interest. Dental Claims Cleanup has always charged flat rate monthly fees for our services. READ THE ENTIRE ARTICLE located on our home page under pricing.

Dental Insurance Credentialing & RetroActive Credentialing

Posted on April 25, 2017 at 10:45 AM Comments comments (6141)

As the landscape of the Dental Industry changes, and we engage in increased insurance contracts, it is difficult for providers to repeat the credentialing process annually and remember the dates to re-credential. As a result, many providers found themselves receiving an out-of-network status notification and were dropped by the insurance. Recently, Delta Dental did a nationwide sweep of dropping providers and sending out-of-network status notices. This can be a devastating and costly mistake to the practice. When this happens, the insurance payments start going to the patient and the patients owe more money for treatment, therefore start leaving your office. You can outsource the credentialing process if

1. you want to ensure that you are in good in-network status, and

2. you would like to take the credentialing burden off of your team or yourself, or

3. you are hiring a new provider and need to enroll them in the insurances you are contracted with

4. you are interested in signing up for a new insurance, or

5. you purchased an office that you are not credentialed with the insurances the new office is in-network with

Our credentialing department uses specialized software that submits the information to the insurance companies in a professional, legible, accurate manner, ensuring the credentialing goes through fast without problems. The software communicates with the insurance companies to alert us when the re-credentialing process needs to be done. We specialize in RetroActive Re-credentialing. A most common credentialing issue is during practice transitions. The owner purchases a practice and the owner is not credentialed with the insurances the office is in-network with. Another scenario is when you hire an associate. The associate starts working but is not credentialed with the insurances. Insurances pay based on the in/out-of-network status of the Dentist provider that actually did the treatment. Therefore, if the associate is not credentialed, claims are paid to the owner, on an out-of-network status. Many owners enter themselves as the providers for the treatment performed (since they are credentialed in-network), but, as we know, that is illegal. Since the process takes up to 3 months, claims are paid on an out-of-network status. If your claims did not pay due to credentialing, we will appeal the case to push for a retroactive re-credentialing. We helped many clients with retroactive re-credentialing and re-submitted claims resulting in payment.  

visit our website for more information:

Solution to a Problem in Every Dental Office

Posted on December 10, 2016 at 8:10 AM Comments comments (4869)

The health and wealth of a dental practice is highly dependent on accurate, efficient, and consistent dental billing. With the changing landscape of the Dental Industry, increased dependence on dental insurance, the increased debt of the young Dentists, and the gobbling up of practices by Dental Service Organizations, the private practice needs help. There is a reason why DSOs are so successful. It is because they provide a solution to the dental business management and the dental billing headache. However, not all of us private practice practitioners want to be a DSO Dentist. So what can we do in this changing Industry that will solve the headache of administration but not change our practice philosophy. Did you know that outsourcing dental billing is available to practices, without the ties of a DSOs? Dental Claims Cleanup has solved this dental billing problem with our services and we provide an alternative to a DSOs.




Here is what happens. When the office losses an employee to disability, medical leave or pregnancy leave, or does not have the manpower to plow through the dental billing workload, or if the team is lacking skills, or the Dentist does not have the ability to supervise the dental billing and accounting, the Dentist is left vulnerable. They are at the mercy of local talent to hire, train, and hope that the new employee will honest, self-motivated, and skilled to run the financial aspect of the practice. After a few hires and fires, and a progression into increased accounts receivable, the Dentist realizes that business management and dental billing is a huge headache and they start investigating options. The first one that comes to mind is partnering with a DSO. All of us are getting notices from Heartland, Aspen, and Pacific. They are successful organizations and employ many happy Dentists. The offers are very tempting, but we went into private practice for a reason, right? So if we don't want to sell the practice, don't want to partner with DSO, and do not want to pay for consultants, what options do we have?




What if you can keep all as is, but outsource the part that is a keeps you up at night?


What if, instead of you paying and supervising the employee performing the job, someone else will have that headache?


What if, instead of you paying the employee benefits, you get bothered about raises and time-off, someone else will deal with that burden for similar or lesser price?


What if you had all the help you need to take the headache away, without changing your practice philosophy or have any ties to other business organizations?


What if, in exchange, you and your team has more quality time with your patients and has more time to focus on the schedule and treatment acceptance?




Answer these questions to see how effective is your office in dental billing and business administration:


1. Claims Management (claim submission, claim follow-up, claim correction) is a job that needs to be performed every day.


a) Are your claims submitted at the end of every business day?


b) Does your team have at least 2 solid hours to follow-up on unresolved claims per day?


2. Account Receivable volume aging over 30 days: AR reports need to be run weekly. Industry standard is no more than $5,000 in over 30 days total unresolved claims and $3,000 in unpaid patient balances over 30 days for every 80,000 of monthly production. Carve out 1 hour per week to meet with the person doing your dental billing. Your team should have reports for you: a) status on ALL unresolved claims over 30 days, b) amount of unresolved claims over 30 days, c) amount of unpaid patient balances over 30 days. Keep the reports from week to week. Expect insurance payments in 3 weeks. Expect patient payments in 1 month.


a) Is your total accounts receivable over 30 days less than $10,000 for every $80,000 gross production?


3. Patient Balances: Patient co-pays MUST be collected at time of service or NO service is performed


a) Does your team collect the patient’s portion at time of service?


b) Are your total overdue patients’ balances, over 30 days, less than $10,000?


4. Insurance Verification is done 3 days prior for ALL hygiene patients. All new patients and emergency patients are verified and setup as they make the appointments. Use a benefits verification sheet to obtain plan specific clauses that match your frequent procedures. Correct plan setup is a must and the team should be trained in this area. Use an eletronic verification service that, with a click of a button, verifies patients from the schedule. It will not necessarily tell you plan breakdown, but it will tell you they have active coverage.


a) Does your team perform benefits verifications and draft treatment estimates based on verifications so they can collect the correct amount at time of service?


5. Accounting: When EOBs are entered and there is a remaining balance, call the patient after you enter the insurance check payment, and ask to resolve the balance over the phone with a credit card. If you do not reach the patient send a statement. Statements should be going out daily and at least once per week.


a) Does your office enter ALL the EOBs and ETFs, for that day, same day?


b) Does your office send statements at least once per week?


6. Financial Agreements and Treatment Estimates: Sound financial agreements must be drafted, signed by patients, and retained so that clear patient responsibility that was discussed prior to procedure is documented. The amounts to be collected, at time of service, should be reviewed with the team in the morning huddle and reviewed the following day to make sure it was actually collected. Review with the team reasons why the money was not collected. This accountability help keep employees motivated to collect at itme of service.


a) Do all of your patients, regardless of amount, have a signed financial agreement, and are they clear what their portion is at time of service?


7. Hygiene Reactivation: A full hygiene schedule ensures a full doctor’s schedule. Hygiene reactivation is a daily task. The goal is to call at least 30 patients per day, speak to at least 4, and schedule at least 4 for a single provider operation. The schedule is dynamic and must be worked every day to fill last minute openings. Unfilled appointments is money that can never be recovered.


a) Does your team work on hygiene reactivation daily?


b) Does your team track their efforts?


c) Does your team fill last minute openings successfully?




YOUR SCORE-write the number of “Yes”



#YES_________/12 x 100%=_______%



10-50% Need Help: systems not in place or lack of knowledge or man power


50%-60% Lack of Supervision or Consistency: make sure there is clearly defined system for the team to follow and get involved by reviewing reports and set accountability


60-75% Average: systems are most likely in place, motivated team, most likely time management is an issue, re-define tasks and schedule time for execution


75-85% Above Average: focus on the task the team is not executing, find out why, or define the system and expectations


85-100% Healthy Practices: owner/manager supervising and holding team accountable, reviewing weekly reports and resolving problems as they arise




Today, the entire dental billing position, and other business tasks like hygiene reactivation, can be outsourced.


Dental Claims Cleanup provides the dental billing services via a remote, HIPPA secure access connection to the dental office workstation. We seamlessly work in the background without disrupting the clinical operations. We provide the clinical team more quality time for patient care. We work with all dental practice management softwares. Our services include:


1. daily claims submission, unresolved claims research, follow-up and claim correction and re-submission with narratives or start of an appeal process


2. patient balances research, statements, phone calls to collect the balances


3. EOB, ETF entry in the dental software


4. benefits verification eligibility, full plan breakdown for new patients, emergency patients, existing patients with insurance changes, and new insurance account setup or correction as needed


5. medical billing for dental procedures


6. hygiene reactivation program: we manage all your unscheduled recalls and fill your schedule.


Dental Claims Cleanup works the accounts efficiently, producing results, and we do this for a fraction of the cost of an employees with benefits, raises, payroll taxes, and time off. We report weekly on our progress and we are the watchdog of the practice’s health and wealth. Our weekly reports inform the Dentist of trends and team’s productivity so the Dentist can make informed business decisions. We provide the resources without compromising your practice. The medical industry has been outsourcing medical billing for years because they understand that it is cost effective, efficient, and more productive. Now we have the same service available to the Dental Industry.



Most Valuable Asset in Your practice

Posted on December 10, 2016 at 8:10 AM Comments comments (7802)

Believe it or not, Doctors, it is not you. It is your front office person/team. These are the magic people who project the image of your office to new and existing patients. These are the people who can make or break your practice without you even knowing. This team needs to have above average abilities in communication, with your patients, vendors, clinical staff, and of course, you.


Anyone can answer a phone, but it is difficult to find someone who will represent you and your practice in the best light. How do you want others to see your practice; Guarded by a fierce dragon who they have to bypass to get to the treasure (your amazing dental skill), or directed by a welcoming guide who will be able to take them from start to finish with the smoothest experience possible? I choose option two.


Before hiring just anyone to “answer the phone”, think about your experience with customer service in your life. What are the best experiences you’ve had, or the worst experiences, and why. The best experience will help in finding someone who can offer that same great feeling to your patients. The bad experience will remind you what traits you want to steer away from.


Once you find that perfect person, be sure they are fully trained before releasing them into your practice. A lot of damage can be done in a short period of time by someone who thinks they know more than they do. Be sure they have the tools needed to complete their job effectively; forms to gather the correct information from new and existing patients, or insurance companies, and where and how to use this information in your dental software and within the office. Have them SMILE when answering the phone, and for the duration of the call. Make sure they welcome each and every patient like family, on the phone or in person, because these patients are your family. If done right, you can retain your patients for years, seeing them through all phases of their lives.


With the proper person representing your office, your day will be smoother, your team will be happier, and your patients will not hesitate to return. Your practice can and will grow at a steady rate, and your patient retention will be off the charts. Too many dentists spend thousands in marketing to new patients, while the patient retention is what needs to improve in their practices. Internal operations must be reviewed to see where the gaps are.


Top 10 Reasons the Front Office Creates Happy Patients


1. Answer the phone by 3rd Ring: New patients get annoyed when they call an office and no-one answers the phone or it rings and rings. The result is that the new patient hangs up and calls the next office in line. It is imperative that the front office answers the phone SMILING and by the 3rd ring.


2. Greeting on arrival: There is nothing more disrespectful than when a patient enters the office and the front desk has her head down with her nose in papers not acknowledging the patient. The elephant is in the room and everyone knows that the front desk saw and heard the patient walk in. Without excuses, the front desk MUST look up and great the patient. Rudeness in inexcusable and will leave a negative impression on patients.


3. Don’t be all business: Very often the front office is overwhelmed with the daily tasks, and tries to rush patients through their experience and interaction with the front office. Friendliness and a few minutes of pleasant conversation is necessary to keep patients feeling like they are welcome and not an interruption. Spend a few minutes with each patient and make small talk before you throw a financial agreement in front of them or ask them to pay for today’s visit. People hate paying for rudeness and will find another office that they feel welcome spending their money with.


4. Keep Smiling: A smile says a thousand words. Here is what a smile will tell your patients: I am happy with my job. My boss is good to me. I love working here. My teammates are amazing. My doctor is awesome. I am a friendly person, come talk to me. A frown or seriousness has just the opposite effect and poorly represents the operation.


5. Be Helpful: Think to yourself how you can elevate your patient’s experience at the office. Offer yourself to help patients. If they can’t fill out a form, ask to help. If they don’t understand something, clarify it. If they need to make special arrangements, whether it is scheduling or financial, be understanding, but be professional. Do not take things personally, or be sensitive to patient’s objection, since most of the time it has nothing to do with you personally.


6. Negative Attitude: Get rid of a negative attitude. It usually takes much more effort to be grumpy all day and complain than to roll with the punches and be happy-go-lucky. Negative attitude breeds resentment and leaves a negative impression with patients.


7. Follow-up: There is nothing more annoying than to be promised to be contacted and the calls never comes. We recommend that the practice creates a “follow-up” column in their appointment book. That column serves for appointing patients to be called and followed-up on, and for messages reminders about patient contacts. Anyone that leaves the office without an appointment, or tells you to call them, is scheduled in this follow-up column. On the day of that appointment, the front office is reminded to clear their messages from the follow-up column by contacting all the patients.


8. Systematic approach: Do things the same way if it works. Provide the same positive, welcoming, friendly, experience to all patients. This is important when patients refer other patients for the great experience. There is nothing worse than a patient awaiting a certain experience that was told to them by the referring patient and finds themselves to be disappointed. At the same time, if you are providing a consistent negative experience, it will kill the practice.


9. Brag on The Office: It takes years to gain patient’s trust and build a long lasting relationship. But there is one thing that will accelerate this process. The team MUST believe in the office philosophy, the Doctor’s skills, and be happy at their work place. There is nothing more powerful than a testimonial from the front office about the Doctor’s skills or the team’s professionalism. Confidence in the practice can be facilitated by the front office communication with the patients about positive differences between other offices and your practice. The patient wants to be reassured they have chosen well and have come to the right place for their care.


10. Love Your Job: It amazes me how many people stay in a position they are not happy working every day. If the front desk employee does not like her position, it will shine right through and leave a negative, long lasting impression. There are many jobs out there, so if you do not enjoy a front office position, I say “Move on”. At the same time, when an employee loves what they do, they do it with pride, enthusiasm, and charisma. They create a positive experience for patients, and keep patients coming back. Those employees are true keepers and are the most valuable asset to your dental office.


If the 10 items are not followed, by the time the patient is seen by the Doctor, they already have had a negative experience and are in a bad mood. The Doctor then tells the patient more bad news, that they need dental treatment. Most people are afraid of getting dental work done, so a bad experience with bad news throws them over the edge, and the result is lack of treatment plan acceptance. Furthermore, the patient usually decides to just stay away from dentistry all together, or leaves the practice to look for another provider. Remember that patients have a choice of Dentists. Give your patients a reason to return, otherwise the patient will chose to spend their money on dental treatment at a friendly office where they feel welcome and are treated well.


In closing, when you hire, hire for personality and train the skills.

Anti-Theft Protection Safeguards in a Dental Office

Posted on July 31, 2016 at 6:00 PM Comments comments (4895)

I am compelled to write this article due to the number of clients that started our service this month as a result of theft in their dental office.


The subject of theft stirs something in my core. Dentists, as a group, are good, honest, people, trying to make a living. They are also the MOST vulnerable profession exposed to the potential of theft. Let me tell you why.


1. lack of training in business management leaves the owner at the mercy of others to run their accounting


2. the dental business structure does not allow for cost effective tasks distribution to prevent "one hand in all pots" which leaves one person doing all the financial aspects of the business.


3. busyness of the business leaves the owner exhausted and non-motivated to deal with the business part of the practice


As a result, the situation provides a great, tempting opportunity for theft that goes un-noticed for years and maybe never discovered. The purpose of this article is to reveal the methods of theft, set safeguards, and provide guidelines to prevent creation of an environment where theft proliferates.


Here is some examples of ways theft can occur:


1. front office asks patients to allow her to fill out/write checks for patients and instead of writing the check out to the practice, writes her name on the checks then cashes them


2. front office sets up a checking account with her name as authorized signee for check deposits. Uses this account for personal expenses


3. Front office takes cash payments for procedures and does not record transactions in the dental software


4. front office records huge discounts for cash procedures, paid in full by the patients, in the dental software and pockets the discounted amount out of the cash from daily deposits


5. front office submits lower fees than UCR and records adjustment to collection, then takes out cash from deposit to cover the overpaid amount


6. team uses business credit card for personal expenses


Here is a list of bare minimal involvement in the financial aspect of the practice by the owner Dentist, without exceptions! Starting the day after you read this article you will do the following.


a. reconcile the monthly bank statement. Bank reconciliation is a balance check for discrepancies between the daily deposits (what should have ended up in the bank) compared to your report from the practice management system. The other items that will be verified is the expenses paid with checks to vendors, as well as, any unusual transactions. For this task you will need to obtain/run the monthly deposit report from your dental software and have your bank statement available. In your Quickbooks, Quicken, or any other financial management software, you go to the reconciliation section, put in your starting and ending balances, and you check off things that were recorded throughout the month against the bank statement. This takes 5 minutes and is an easy task that even the computer illiterate can perform. The financial management software should be closed out monthly, and password protected, after your reconciliation of the bank statement.


b. review of all discounts and adjustments made throughout the month. This is another report from your dental software. The software will break out the insurance adjustments, patient discounts, and refunds. No one is authorized to provide discounts to patients other than current promotions or discounts at Doctor's discretion. All discounts must be reported on claims submitted to insurance companies, since the insurance benefit is calculated based on the fee after the discount is given. Lack of reporting of discounts is considered insurance fraud.


c. review collections report. There should be no adjustments to collections here. Any adjustments to collections should be refunds to insurance companies, refunds to financing companies, or refunds to patients. If there are adjustments to collections other than those mentioned you need to research why. A common fraud that occurs, is that the fee submitted to the insurance companies are lower than the UCR. As a result the insurance overpays. Since your dental software is waiting on payment that is lower than the insurance payment sent to you, if you record that the expected payment was received but the over-payment is adjusted (adjustment to collection), the money can be moved out of the daily cash deposit and can go unnoticed.The patient's ledger will be reconciled as $0 balance, but the over-payment can be moved via cash outside of the dental software accounting system. We have also seen this, for instance, as deceit in associate Dentist under-compensation and it is directly related to not having the updated insurance fees in the dental software. The over-payment was adjusted to collection from the Associate and credited to the owner.


d. Prevent setup of vendors in the financial management software by the same person that does the bookkeeping. Setup and editing of vendors information should be done by the Administrator/Owner or someone other than the main bookkeeper. Fraud can occur when vendors are setup with fraudulent information so that expense checks can go to that address and can be cashed by the perpetrator.


e. Review what's expected to be collected (patient's portion) in the morning and track what was actually collected to be review in the am huddle next day. This is good to track the practice collection rate, promotes the team to collect at time of service, allows for open monitoring of cash flow, is good for the health of the practice and an incentive program. Along with collection rates, production efficiency (what was booked and what showed up) and acceptance rates (what was planned and what scheduled next visit) should be tracked. The collection rate at time of service should be 97% or higher, the production efficiency should be 98% or higher, the treatment plan acceptance in hygiene should be 35% or higher, and assistants acceptance rate (treatment scheduled out of Doctors rooms) should be 45% or higher.


f. Person preparing/reviewing deposit should not be the same person who collected money all day. There should be one other person in the office that checks off on the actual deposit with their signature. If you report what should be collected at time of service in am huddle, and then a team member will review what was or was not actually collected by the front office, this will deter possible fraud. It is less likely that there will be 2 accomplices.


g. review production in the morning huddle of the previous day. Review anticipated production and actual production. Run daily reports and ask team to bring to morning huddles. This ensures that all procedures are recorded in the dental software. Fraudulent activity will be prevented if the team knows you reviewed in the huddle what you were booked to produce and review again what you actually produced. We have our providers sign off on their production. This also prevents inaccurate billing or lack of procedures that need to be billed. Many times the appointment card does not contain procedures that need to be checked out, as a result those procedures are not billed and are difficult to catch that they were not billed since the only record of the actual procedure is in the progress notes. If your office does not put procedures in the appointment card of what is scheduled you MUST start that today. Also ALL discounts to be given MUST be reflected in the appointment card. This serves as an official, authorized discount by the owner. The dental software is designed to enter the treatment plan, schedule procedures from the treatment plan (which also removes them form the treatment plan as they are scheduled), and then billed/checked out from the appointment card. Things are missed and fraud occurs when this is not followed. Something always gets omitted and it results in errors and ultimately in lack of money for the practice.


h. close out your day daily. After all transactions are entered and the deposit is balanced against production and the schedule, the day needs to be closed so no changes can be made thereafter. This is important if you are reviewing the production/collection results the next day, so you want to make sure no one can change what you just reviewed. For instance, if you review daily production procedures and now remember transactions that were part of the production, the team is less likely to remove any transactions after you reviewed and they are less likely to pocket money paid on those procedures. The day is already closed so they can not make changes to the system, so all production and collections are recorded. Too many offices do not close out the day and the team can go back and make changes to accounts. If your office does not close out the day daily you MUST start this immediately. To open up the day after it was closed, it should require a password, and needs to be done by the owner. Don't forget, the financial management software should be closed out monthly after your reconciliation of the bank statement.


i. deposits MUST be deposited in the bank daily. Once you close out the day, the money collected should be given to the bank that night in a nightly deposit envelope and dropped in a night deposit box. If you signed up for electronic transfer of funds (ETF) by the insurances, your team has to enter the EOBs same day you get a notice of ETF deposit, or the reconciliation of your bank statement will be a nightmare. Daily deposits of your money ensures:


1. easier reconciliation of deposits against your dental software since the dates will be accurate


2. prevents money laying around the office and possibly disappearing. If the team knows you will be reviewing the production and collection in the morning, fraudulent activity will most likely happen after your review. If the day is closed out, and the money is in the bank, fraud is less likely.


j. sign/review all checks to vendors. The team can prepare the checks. Al checks to be signed should have an invoice or bill paper-clipped to the check to be signed. If they enter the bill to be paid in the financial management software they need to scan the invoice or bill as an attachment to the software bill to be paid. The owner Dentist reviews the bills to be paid, signs the checks, or reviews the bills in the software, and then the OWNER pays them online through online banking. Online banking is an excellent method to handle your finances. There is a record of all checks and addresses where the checks went, you have control who has the ability to write checks and pay bills, and control who can setup new vendors. The other method of paying bills is through credit card payment. With a credit card, there is a record where the money went and ability to attach invoices or bills to each credit card payment.


k. credit card charges alert to your phone. Log into your online credit card and setup alerts (as an email or text) to go to your phone every time your credit card is used.


l. review the credit card monthly statement. Just look at it please!


In closing, your involvement in the financial aspect of the practice is crucial to prevent the opportunity of theft.


If you suspect fraud in your office or want to prevent fraud with safeguards, please reach out to us and we can assist you. The situation can be managed in several ways. We can be hired for an initial investigation or we can setup safe guards. Also, we can be the mediator with the team as the professionals instructing the practice to have the Doctor's involvement in the financial aspect (this is a good method if you are afraid the team will feel uneasy if you start asking for reports or you are doing more than you used to). Or you can outsource your billing with us. Please reach out if you need our assistance. In addition, if you were a victim of fraud, we would love to hear your story so we can see what safeguards would have prevented that from happening and learn from your unfortunate experience. Email us at [email protected]



Insurance Benefits Verification-a dreaded task by the Dental Front Office

Posted on July 19, 2016 at 4:05 PM Comments comments (3070)

One dreaded task for the dental front office is insurance benefits verification. Here are some of the issues that the front office has to deal with:


Length of time on the phone keeping front office away from live operations due to waiting for insurance reps to answer the phone and the length of the actual phone call. On average, there are 6 new full benefits verifications (new patients, emergency patients, existing patients with new insurance) that need to be obtained with an average 15 minute call time. That is 1.5 hrs on the phone.

Increased number of phone calls that have to be made to obtain full benefits breakdowns due to more frequent insurance plan changes by employers

Insurance misinformation, many insurance reps do not give the correct information causing estimation errors or wrong plan setup

Uninterrupted length of time and expertise required to enter new plans for new patients, emergency patients, or existing patients with new insurances. Once you obtain the insurance benefits verification now it takes on average another 10-15 minutes to setup the new plan in the system.

Plan clauses (exclusions and frequencies) are not considered in the practice management system. There are no fields and no provisions for this information, but the information effects correct patient portion estimation. During treatment planning, plan specific information must be applied manually and many times it is overlooked resulting in an incorrect estimation.

Plans that pay on UCR are difficult to obtain a correct estimation

Insurance fees have to be updated annually to allow for the estimation (based on the benefits verification) to accurately be computed. Updating the fee schedules for several plans takes many hours and the team has to remember to contact the insurances individually for the most updated fee schedule. We have come across insurances which refuse or make it difficult to release to the providers their updated fee schedules.

Why do we bother with this task? Because it is our obligation and it is essential to inform the patient of their treatment cost involved BEFORE they proceed with treatment. Furthermore, for the health and wealth of the practice, we should:


collect at least the patient’s portion at time of service to keep a constant cash flow into our business

not surprise the patient with a higher balance due to lack of coverage on plan exclusions or frequency limitations during our treatment estimation

know if the patient has active coverage, otherwise, the patient will be surprised with a higher unexpected balance

Financial Conflicts between patients result in 3 main issues:


the loss of a patient from the practice

an angry patient with the office or the Doctor

dissatisfaction with work performed and an excuse for the patient to refuse to pay for something they are not pleased with

Here is a protocol that is effective for dental insurance benefits verification:


All hygiene patients are verified with electronic services and phone calls if there is no e-services linked with the insurance company. We like ClaimX insurance verification software from Extradent. It is fast, accurate, cheap, and draws directly ALL patients for the day from your schedule. All new patients & existing patients with new insurance are verified by phone call and a new benefits verification sheet is filled out. The information is entered in the practice management system and the benefits verification sheet is scanned to the patient's chart. All emergency patients are verified with electronic services, if they came in for hygiene within 6 months, and with a phone call, if they did not come in for hygiene within 6 months or if their insurance is not linked with e-services verification. The verification for hygiene patients is 3 business days prior to appointment. New patients and emergency patients are verified same day the appointment was made. The insurance fee schedules are obtained in January for every insurance in contract and the system is updated. Do not proceed with treatment without a signed financial agreement and treatment plan estimation. Clear instruction is given to the patient that the patient's portion will be collected at the time of service.

Out of Control Overdue Patient Balances in Dental Billing

Posted on March 19, 2016 at 8:45 PM Comments comments (3470)

Out of Control Overdue Patient Balances Working with practices across the nation provides us with trends and common struggles in dental offices. One denominator is that many offices have the patient balances over 30 days are out of control. It is our job to clean those up, but if we do not help the practice change their protocols there will be more balances rolling over as fast as we clean them up. Here is what must happen in the to make sure that your cashflow in healthy and the accounts receivable growth is minimized. 1. Correct estimate of treatment plan with a clear financial agreement. For this to happen 2 things are pre-requisites:you must have the insurance fees update and the plan breakdown in correctly, you must verify insurance coverage and call on plan breakdown once per year. This agreement needs have the following components to specify the following: A) your total price is… B) the in-network discount for the patient is… C) the estimated insurance is…. D) the patient’s portion that needs to be collected at time of service is… E) must tell the patient that once the claim resolves, there might be more that the patient owes….. F) the insurnace estimate is not a guarantee and is base don prior hisotry of payment, the insurnace will determine what the patient willowe and what the insurnace will pay…. The agreement is signed by the patient, patient gets a copy, and scan a copy to the patient. 2. You must collect whatever the financial agreement stated at time of service. We try to collect the copay before the procedure is done. We print the scanned financial agreements and have them ready for the am huddle so we can review with the Doctors what is expected to be done today and collected today. Someone is responsible to report on prior account balances to be collected at time of service. 3. Review in the am huddle balances to collect for each patient. This should include the prior account balance and todays copay. Review the next day what was anticipated to collect yesterday and what the team actually collected. If they did not collect what was expected, the Doctor needs to know why. You might find out that you have a weak link managing your money. 4. As soon as the EOB resolves, call the patient stating that the claim resolved and the insurance determined that the patient owes______ and you are calling to collect the balance over the phone to settle the account and avoid billing. 5. Follow this collection process: a) call patient after EOB was entered to collect balances, if you don’t reach the patient b) send out balance due letter with 10 days response demand c) if you don’t hear from the patient, send 1st notice overdue balance 14 days from balance due letter. d) if you don’t hear from the patient, send final notice with a 10 day response demand 14 days after 1st notice letter. e) if you don’t hear form the patient, call the patient: You will tell them that you are calling to interfere with an automatice collection agency process. The collection agency automatically takes over overdue accounts unless they settle the balance right now with you on the phone. You certainly don’t want this matter to interfere with the patient’s dental care or relationship with the office. So you are calling as a courtesy to a long standing good patient of the office. If they don’t settle over the phone tell them to mail the check in within 3 business days. f) if you don’t hear form the patient send to collection agency and allow collection agency to follow through with their collection protocol 6. run your AR reports weekly. Review with your team responsible for billing the outstanding patient balancing over 30 days and unresolved dental claims over 30 days. This is your supervision checks and balances that the team is resolving money owed to you and that your current systems are executed and effective. Obviously if you can not supervise, then you need to outsource dental billing.

Benefits of outsourcing dental billing

Posted on November 23, 2015 at 9:55 AM Comments comments (2725)

Outsourcing dental billing is a novel concept in the Dental Industry. The fact is, that medical billing has been common practice for decades. The reason why is that medical offices have a high volume of insurance claims and need dedicated people with expertise to handle this job efficiently and effectively. It is expensive to have that team on site. As the landscape of Dentistry has changed, and the private practices increased their provider participation, the insurance claims volume increased respectively. However, there is still lack of formal education in the dental coding and billing field, since the didactic arena has not kept up with the changing trend of increased insurance providers. As a result, the dental billing remains an "on-the-job" training position. Therefore, good, but also bad, as well as lack of skills are passed on. Outsourcing dental billing has the following benefits:


1. expertise of the dental billing company gets you paid fast


2. lack of mistakes prevents angry patients


3. lack of payroll taxes and benefits saves you money


4. dental billing company does not call in sick or takes a day off of working your accounts, so you have constant flow of cash


5. professional routine reporting allows you to stay informed on health and wealth of the practice, but also provides barometers for improvement of intra- office mistakes, therefore allows for improvement. (you don't know what you don't know-with reporting on each and every claim you will know)


6. cash tied up in unresolved dental claims can have a detrimental effect on the survival of practices


7. New Dentists now have the option to be in a private practice without the knowledge of accounts management. The increasing trend of working in Corporate Dentistry is attractive to new graduates who do not have knowledge in the financial aspect of the practice. If this continues the private practice in Dentistry as we know it will cease.


Please visit our website for more information

Appointment Pre-Booking Interview

Posted on October 19, 2015 at 11:30 AM Comments comments (5044)

So here is a concept that might be new to you- "Appointment Pre-Booking Interview". This is a series of questions from your scheduling coordinator to our patients to discover if they truly should be given an appointment. What we have found is that the no shows kill practices and the financial burden that they place on the practice is unacceptable. So we researched what are the top 4 reasons that effect a patient showing up for their appointment. Research showed that they sequence from highest frequency as follows:

1. Value

2. Time

3. Fear and

4. Financial.

In response to this we developed a series of questions that the team can ask. If, and only if, the patient answers YES to all do they go into the appointment book. As the team learns this concept the sheet goes away and they can make a decision whether or not the patient should be given an appointment. Here is the link from our website

In addition remember that we recommend 1/3 down of patient's portion for large procedures to be placed in the appointment book and 3% or 5% discount for total pre-payment.

Accomplish Your Goals!

Posted on October 17, 2015 at 9:50 PM Comments comments (2915)

Based on "The 4 Disciplines of Execution by Chris McChesney & Sean Covey" 

Gives you a guide how to achieve a goal successfully with results in the office and track results. Take this example: if you want to decrease no shows in the office

1. focus: widely important goal must be set (decrease no shows)

2. leverage (find out 2 to 3 things that effect people showing up to their appointments) for example value of the procedure, time availability by the patient, price and affordability, fear of dentistry are all leverages that effect people showing up for the appointment. effecting any one of those will result in a person showing up or not. meaning if the person values the procedure he will show up if he does not he will not. So spending more time on education and taking/showing intra-oral picture on every patient while treatment planning should leverage that the patient will value the procedure and show up. Effecting the price...making procedure affordable by proposing care credit, 5% discount for prepayment of procedure can leverage if the person will show up or not. etc. Then you systematically tell the team to educate, propose payment options, etc.

3. engagement (meet every week to discuss progress and keep team motivation and focus on the project)

4. accountability (set up a tracking system visible to everyone to keep score on progress and success or failure). you track how many people you offered payment options and educated with intra-oral picture on the procedure and they actually showed up. The more systematic you are the more successful you should be. You can build a whole incentive program and set goals from there.


This applies to anything you want to change successfully int he office. Love that book.