Recovering denied and underpaid dental claims is a critical aspect of maximizing your practice’s revenue. The right dental claim recovery service can make a significant difference, but navigating the process can be daunting. Here’s a straightforward, step-by-step guide designed to help you recover those claims efficiently and effectively.
1. Assess Your Denied Claims Portfolio: 30 Minutes to Start
Begin by identifying claims that have been denied or underpaid in the past year. Look for patterns: are certain codes more frequently denied? Are there specific insurance companies that seem to deny more claims? This assessment should take no more than 30 minutes.
Mistake to Avoid: Ignoring smaller claims. Even a $50 underpayment can add up over time.
2. Review Payer Policies: 1-2 Hours of Research
Once you have your list, spend 1-2 hours reviewing the specific policies of the insurance companies that denied your claims. Each insurance provider has its own set of rules regarding coverage. Understanding these policies can highlight why claims were denied and how to appeal effectively.
Mistake to Avoid: Assuming all policies are the same. Each company’s requirements can vary significantly, which impacts your appeal strategy.
3. Prepare Your Appeal: 3-5 Days to Complete
Prepare your appeal with all necessary documentation, including chart notes, radiographs, and any correspondence you’ve had with the insurance company. This process typically takes about 3-5 days. Be sure to clearly outline the reasons for your appeal and reference the specific policy guidelines you found in your research.
Mistake to Avoid: Sending incomplete documentation. Claims are often denied due to missing information, so double-check your submission package.
4. Submit the Appeal: 10 Minutes to File
Once your appeal is prepared, submit it as per the insurance company’s guidelines. This usually takes about 10 minutes if you have everything ready. Most companies now accept electronic submissions, which can speed up the process.
Mistake to Avoid: Not tracking your submission. Always keep a record of what you submitted and when.
5. Follow Up: 15 Minutes Every Week
After submission, set aside 15 minutes each week to follow up on your appeals. Contact the insurance company to confirm receipt of your appeal and ask for an estimated timeline for a decision. Consistent follow-up can often expedite the review process.
Mistake to Avoid: Waiting too long to follow up. Many practices wait weeks or even months before checking in, which can delay resolution.
6. Track Outcomes: Daily Monitoring
Once you receive decisions on your appeals, log the outcomes daily. Understanding your success rate is crucial for refining your future appeals. Aim for at least a 70% success rate on your appeals — if you’re below this threshold, it’s time to reassess your approach.
Mistake to Avoid: Not tracking reasons for denials. Analyzing patterns in denials provides insight into areas for improvement.
7. Consider Professional Help: Evaluate Costs vs. Recovery
If the workload is too much or your success rates are low, consider partnering with a dental claim recovery service like Apex Dental Recovery. Our contingency-based model means you only pay when we successfully recover your funds, typically taking a percentage of the recovery (often around 25%).
Mistake to Avoid: Thinking you can handle everything in-house without the right tools and expertise. This can lead to lost revenue that professional services could recover for you.
Conclusion
By following these steps, you can significantly increase your practice’s revenue through effective recovery of denied and underpaid claims. If you’re ready to maximize your efforts and minimize your workload, consider reaching out to Apex Dental Recovery to see how we can assist you in streamlining your claim recovery process.
Sitting on denied or underpaid dental claims? Apex Dental Recovery will tell you what is recoverable and quote the rate, free.
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