David Pettigrew, D.M.D.
Recently I was wrapping up a course I teach on CDT
procedure coding when I asked how many dentists in the audience used practice
management software (PMS).
Most of the audience members—about 30 professionals representing 25 mid- to
high-end dental practices—raised their hands.
"And how many of you submit your claims electronically?" I asked.
This time five hands went up.
I was dumfounded.
"Why not?"
The answers were typical: "There's nothing in it for the dental
office," one dentist said. "The insurance companies are the only ones
that benefit," another said.
Time for a Reality check!
Well, I'm here to say that nothing could be further from the truth.
According to the 2004 Dental Products Report Technology Survey, and the
American Dental Association, more than 90 percent of dental offices use
computers in their offices; and more than 75 percent use practice management
software. Yet, insurance companies that accept electronic claims—more than 300
of them—state that only 30 percent to 40 percent of their claims are
electronically submitted.
Fact is, if your office participates in benefit plans, uses practice management
software and files claims manually, then you're missing out on major benefits
in efficiency, productivity, cost control and peace of mind. If you don't use
computers in your practice, then consider electronic filing to be one more
reason to move into the digital realm. Let's examine some good reasons to
submit your claims electronically and find out what's in it for you.
1—Quality control
How many times have you submitted a claim or pre-determination, only to have it
returned six weeks later because of an omission or error, such as an incorrect
group number or wrong procedure code? You need to correct the error, resubmit
and begin the whole process over again. Meanwhile, the patient is waiting for
his/her prosthesis.
If you submit your claims or pre-determinations electronically, they arrive at
the insurance company virtually error-free.
At various points in the filing process—from the software in your computer to
the clearinghouse(s) and ultimately the insurance company where processing
occurs—the claim is subjected to various checks, called "edits," that
monitor accuracy and completeness.
If mistakes are found, a message is sent back to your computer at the
office—usually within a day or two. You can make the correction and immediately
re-file.
These detailed reports are returned to you each time you
transmit your claims. The reports may vary, depending on your software, but generally include:
Submitter Report - generated prior to submitting your claims
Transmission Summary – confirms that the claims were
received electronically and summarizes all the information sent
Claim Status Report - a verification
report generated from an insurance company that explains
if a claim was rejected, denied or needs additional information submitted
before it can be processed (e.g., invalid provider number, social security
number verification, group number not found, etc.).
2—Loss prevention
How many times have you submitted a claim, waited for several weeks and, after
no reply, called the insurance company's customer service only to find that
they never received the claim.
Electronic claims are assigned tracking numbers that allow you to locate them
wherever they are in the process.
If a claim is overdue you can trace it using this number and determine where it
stalled. What this means, in short, is no more lost claims.
3—Quicker payment
How would you like to receive your reimbursement in two to three weeks (maybe
even quicker) instead of six to eight weeks or more?
A paper claim passes through many hands before you receive benefits.
These include: stuffing the envelope by hand and mailing it; time spent
traveling in the mail; receipt and sorting by the insurance company; manual
entry into the computer for processing; and printing of a paper check. And you
still have to deposit that check when you receive it.
Now consider that when electronic claims leave your office they are received
and usually processed without ever being touched by a human being.
There is no mis-sorting, no mistakes made by a claims processor keying an
incorrect procedure into the computer, and, most importantly, no paper to lose
or misplace.
And many companies offer EFT (Electronic Funds Transfer): rather than receiving
a paper check, arrangements can be made to have benefits electronically
deposited directly into your office checking account.
4—Less work
Electronic claim submission takes the hassle out of submitting x-rays or making
duplicate films.
Many insurance companies accept electronic attachments. This means that your
office can submit most forms of documentation (x-rays, periodontal charting,
narratives, etc.) electronically.
You have two basic options with regard to x-rays. One is to purchase a digital
radiography system.
The other is to convert your traditional films into a digital format using a
special scanner.
Some payers accept digital attachments directly while others use a repository,
such as the one managed by National Electronic Attachments Inc.
(www.nea-fast.com).
5—Increased efficiency
How much time does your office staff waste on the phone with customer service
representatives confirming patient eligibility?
A busy office often has a staff member spend as much as half a day, every day,
checking on the next day's patients. But as electronic claims processing
becomes more sophisticated, an increasing number of payers are allowing dental
offices to check patient eligibility, dental plan specifics and available
benefits online.
What about claims you have already submitted?
Offices often waste even more time trying to find out
where a previously submitted claim is in the payer’s system.
Imagine no longer calling the payer for this information – looking it up
yourself at anytime of day, when it’s convenient for you!
Emdeon Dental Services offers your practice an easy way
to accomplish these time consuming, frustrating tasks via one web portal,
accessing many different payers.
In January, 2006, Emdeon Dental is introducing their portal that will make
telephoning the payer obsolete. At www.emdeondental.com, your office can
receive eligibility and benefit information along with claim status directly
from the payer. One portal – many payers
– multiple transactions. And, coming in 2006, will be even more opportunities
to immediately handle other pieces of the revenue cycle, including electronic
remittance advices and electronic funds transfer.
What to do now
If you don't have a computer or practice management software, consider making
this intelligent investment.
Many articles have been written on implementing electronic claim submission.
It's a big step, so do your research. (You can search the vast resources of
Dental Practice Report and Dental Products Report and conduct a focused search
of dental literature and manufacturer information on the Internet by using
DentalExplorer Search at www.dentalproducts.net.)
Talk with your colleagues who have made the conversion, read everything you can
on the topic and visit the different software vendors at dental conventions.
Determine your needs and budget limitations. Let your staff assist you so they
feel involved in the process. This often reduces resistance from office staff
who might feel threatened by conversion.
If you already have a computer with practice management software and are not
submitting claims or pre-determinations electronically, dust off the training
manuals and contact your vendor representative. It should be relatively easy to
start electronic submissions.
Contact the various insurance companies you deal with. Most have staff
dedicated to assisting dental offices submit electronic claims. These people
are extremely helpful and can explain the requirements for their particular
plans and how to sign up.
The majority have portions of their Web sites dedicated to providers, and you
can obtain information as to what documentation is required for what services
and how and where it should be submitted.
Or, contact Emdeon Dental Services at www.emdeondental.com or call 888-416-0673 to speak to a
representative that can help you get started.
Emdeon Dental (formerly WebMD) connects dental practices all over the country
by partnering with over 130 practice management software systems to over 300
dental payers and processes more than 90 million dental claims annually
nationwide.
David J Pettigrew, DMD received his B.A. from Lafayette College
and his DMD from Fairleigh Dickinson School of Dentistry.
He completed a General Practice Residency at Englewood Hospital
and has been in private practice since 1977.
He is a member of the American Dental Association, New Jersey Dental
Association and its local component. He has conducted lectures
for students and graduates at the University of Medicine
and Dentistry of New Jersey, and throughout
New Jersey, New York and Pennsylvania on Electronic Claim Submission (EDI), CDT
(understanding and correct coding of dental procedures for insurance) and CHIP
(Child Identification Program). Dr Pettigrew has been Dental Director of Horizon
Blue Cross Blue Shield since 1994.
Related Links:
Electronic Claims Dental Savings Calculator
Posted by
dentalproducts.net. Originally published in the July 2005 Dental Practice Report. Copyright
1999-2005 Advanstar Dental Communications.