Document, Document, Document!

On one hand electronic claim disbursements are a very good thing.  Dental practices get paid much faster.  On the other hand the quick turnaround can make you think the insurance claim was approved and all is well.  Think again.

Dentists and their teams are often surprised when insurance companies follow up after claims have been paid, requesting documentation to substantiate the services provided.  If your documentation is inadequate and the reasons for treatment are unclear, you can expect the insurance company to issue a post-payment refund request.  Or in some cases the insurance company may pull the refund out of a future disbursement.

To prepare for unexpected insurance inquiries, make sure you thoroughly document from the start.  This will require you and your entire dental team to understand what is needed for every diagnosis.  Here are some points to consider.

First, insurance reviewers want to see what you see via x-rays and intra-oral photos.  Intra-oral photos are especially helpful when x-rays do not clearly show the issue.

Secondly, reviewers want to know why treatment was rendered.  This means your chart notes need to substantiate everything from recall intervals to the need for a crown.  Some insurance companies are even questioning the frequency of x-rays.

Finally, you will often need to provide a narrative with the claim.  The current issue of Insurance Solutions Newsletter provides excellent examples of sample narratives, which can also help fine-tune your charting.

When the entire team understands what constitutes effective documentation, everyone can help put the chart in order for each diagnosis.  And you can work together to streamline your system, making the process as efficient as possible.

In the end there is no substitute for documentation, especially since insurance companies are closely watching the claims that they pay.

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