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There’s nothing more frustrating for the team of people working at a dental practice than to see denials from insurance companies. It means more work for the financial coordinators handling the accounts receivable process, and — crucially — it means the practice isn’t getting paid anytime soon (or potentially ever).
That’s why reducing the number of denials received is such a concern for dentists and their staff. In this article, we’ll review common denial types, the impact they have on a practice, and the ways in which Wieldy, an AI-powered revenue management software, can significantly reduce denials — which in turn increases revenue.
There are an astounding array of reasons that an insurance company might deny a claim from a dental practice — but there are a few types of denials that rise to the top in terms of frequency.
One common reason that a claim might be denied is because the insurance information is incorrect or certain details are missing. This could be because a patient incorrectly input the information when filling out the intake form at the dentist’s office — or equally possible, the office manager might have misread or mistyped the information on that form. Whatever the reason, the inability to quickly verify insurance information before submitting a claim can add unnecessary time to the claims process.
When submitting a claim, the financial coordinator (FC) needs to tie the procedure to the associated claim code. Unfortunately, this isn’t as straightforward as you might think: the claim codes can change year-over-year, or it might be a simple case of a typo on the part of the FC. Whatever the reason, a claim will be denied and sent back if the wrong insurance code is used.
A claim might be denied if the dental practice didn’t receive authorization from the insurance company prior to the procedure taking place. In that case, the practice or the patient might be on the hook for full payment, since the insurance company never reviewed, approved, and agreed to cover the cost of the procedure.
In some cases, a patient can only receive a dental service once every 90 days. Getting a cavity filled, for instance, might be a procedure that needs to be spaced out between visits. Ideally, the dental office would be aware of this and would schedule the next procedure after enough time has elapsed. If not, the insurance company could deny the claim.
Depending on a patient’s insurance plan, there is a limit to how much an insurance company will payout over the patient’s lifetime. Once that limit has been reached, any claim submitted will be denied, and the patient will need to pay out-of-pocket.
There’s a time clock that starts running as soon as a procedure takes place, and a claim must be submitted and accepted before that clock runs out. A financial coordinator has to stay on top of each and every claim, ensuring that it gets submitted in a timely manner — or, as is often the case, resubmitted after being denied. Because of how manual this process is, a claim could time out before an FC is able to gather all the necessary information to submit (or resubmit) a valid claim.
Put bluntly: Denials have a material impact on the amount of revenue that a practice can bring in. They slow down the payment process, and practices with a high denial rate have a much longer claim-to-cash cycle.
There’s seemingly an obvious solution to this issue: just have less claims denied. For most practices, though, that’s not actually easily accomplished. Often, there’s not an adequate denial management system in place — or if there is, it’s a very manual process. As a result, financial coordinators don’t have visibility into why claims are frequently being denied. And without seeing that trend data, staff can’t proactively make changes to improve their denial rates — and bring in more revenue.
The Wieldy platform has a number of features that were built to both reduce denials before they happen, and track and analyze the denials that do happen.
As we covered above, some of the common reasons that claims are denied are because the information that was input was wrong. Insurance information, for instance, might have been written down incorrectly by the patient, or mistyped into the system by the FC. With Wieldy, all insurance information is verified before a claim is submitted — which means that this denial reason is taken off the table.
Alternatively, an FC might input an out-of-date insurance code for a particular procedure, which would lead to a denial. Wieldy, on the other hand, only surfaces the most current insurance codes, so FCs no longer have to worry about submitting a claim with an inaccurate code.
Because all claims are tracked in the Wieldy platform, the system is able to flag problem claims, identify the root cause of the denial, and provide actionable steps for the FC to take to fix the issue before resubmitting the claim. This saves the FC time, allowing them to resubmit or appeal a claim more quickly — thereby avoiding the additional issue wherein a claim might time out.
And even better, thanks to Wieldy, staff are trained to identify and eliminate repeat errors over time — further bringing down the overall denial rate for a practice.
In addition, Wieldy has a robust set of reports available to dentists and practice owners, which allows them to easily see trends and patterns around denial rates. They might be able to see, for instance, if there are more denials with a certain carrier or associated with an individual procedure code or even linked to a one location of their practice in particular. Alongside these reports, Wieldy provides actionable insights monthly on possible improvements that the practice could make — all of which contributes to a practice's ability to bring down the denial rates across the board.
If you’re interested in learning more about Wieldy, sign up for the waitlist here and a member of the team will reach out with information.