For many oral surgery practices, deciding to be out-of-network with insurance providers simply isn't an option anymore, which means most of us are dealing with the world of insurance companies and reimbursements.
From obtaining prior authorizations for specific procedure codes to following up on insurance benefits, insurance verification can be a time-consuming and frustrating process. However, it is a crucial tool for maintaining a good patient/practice relationship.
Why is insurance verification so important?
Insurance verification in an oral surgery practice helps determine the patient's eligibility for the procedures outlined in their treatment plan. It is essential for the patient to know what they will pay out of pocket – even if only an estimate – so they can make the right decision (for them) about proceeding. Typically, OMS Practices will conduct a verification of the patient’s benefits before the time of service. This information is then used to calculate the patient’s out of pocket expense once the surgeon creates their treatment plan.
Often, a pre-determined set of treatment codes will get verified with the patient’s insurance company depending on the type of procedure. Third molar extractions might be one set of codes, while an implant case might require another. ‘Verification’ involves just what it sounds like – contacting the insurance provider and verifying that specific patient’s coverage. Things like maximums, exclusions, and total allowable benefits mean that even two patients with the exact same policy might have significantly different out of pocket costs for the same oral surgery.
It’s a lot of information to collect and coordinate, and to do it right, it should be done for each and every patient, TWICE. Once before the consult appointment, to ensure an accurate treatment fee estimate is calculated, and then again just before the treatment appointment. Why verify twice? Well, in the time between those two appointments it is possible that a patient may exceed their maximum benefit, or even lose coverage. That second verification protects the practice by ensuring that they collect the right amount at time of service.
Getting these numbers right – the post-consult fee estimate and the amount owed at time of service – is vital to the financial health of your practice. Why? First, because an accurate fee estimate gives the patient realistic financial expectations. Too high and patients may decline treatment, too low and the practice looks bad when it ‘asks for more’.
Insurance verification is a complex, repetitive job that requires not only a solid understanding of the various types of oral surgeries, but the ability to navigate the labyrinth of insurance company policies and procedures.
MaxilloSoft’s insurance verification module
Insurance verification is likely one of your team’s least favorite tasks. It’s messy, it’s repetitive, and it involves a lot of moving parts. Using our insurance verification tool, your team will not only be more organized, they’ll be able to conduct verifications faster and more thoroughly.
How will your oral practice benefit from our insurance verifications?
Organize and collaborate. MaxilloSoft allows team members to sort, manage, and streamline the process of collecting insurance details for the hundreds of patients that come through your practice each month. And because the process is standardized and traceable, they’ll now be able to work together – one team member can pick up right where another left off. Verifications can now be done in ‘assembly line fashion’ rather than one by one.
Reduce the risk of undercharging. Our verification tool ensures that you are not caught off guard by an insurance provider that requires you to pass on an extra charge to your patients or write off a balance because your patients refuse to pay. This will help eliminate unwanted collections and reduce your accounts receivable, saving your team from the hassle of chasing payments.
Minimize claim rejections. The dental industry website DentistryIQ found that "At least 50% of dental claims for basic and major services are placed on pending status and sent back to the dental office." Because MaxilloSoft treatment plans are so complete, insurance companies don't often ask for additional detail, and insurance reimbursements are received much quicker.
Patients appreciate financial accuracy. Oral practices that don't run insurance beforehand usually present all of the costs of treatment upfront. Without verifying what is covered by insurance, the patient is faced with a much larger potential cost and thus may be less likely to move forward with treatment. However, if they know what is covered by their insurance upfront, the lower number may make them more likely to agree to treatment, and that’s better for everyone.
Our instant insurance verification tool was designed to save your time and minimize headaches, leaving you and your team with more of the most valuable resource we have: time. Now you just need to figure out how to spend it.