Cash Management Services
Health Management Solutions, Inc. will assist the healthcare or dental provider with cash flow optimization through various methods. Our Cash Management Services are revered in the industry for empowering dental practices to achieve success Contact us today to get started.
Improving cash-flow is the single most important goal of any business, and in the health care industry, this becomes a challenge with non-existent or outdated financial policies, unfair insurance tactics, inflexible fee schedules, new coding requirements and an ever increasing bureaucratic system that incorporates delaying tactics by insurance providers.
Improving cash-flow can best be achieved in a cost-effective manner through the outsourcing of services to an independent expert Cash Management Organization.
Health Management Solutions, Inc., will assist the practice in obtaining a suitable arrangement for the business’ present and future cash management services that will be needed, depending on the practice’s goals and priorities.
Some of the advantages of out-sourcing Billing and Collection services to an expert organization are:
- Improves average money turnaround, claims get paid in approximately 14 days;
- Increases office productivity and improves patient care by increasing staff availability to dedicate time to internal marketing and address patients’ needs;
- practice will know of billing rejections within 24 hours;
significantly reduce Administrative cost;
- Expert optimization of billing claims will increase practice’s revenues over time;
- Improves practice’s analysis, accountability and control of Administrative procedures;
DENTAL INSURANCE BILLING
- At the end of the work day at the practice, someone from our office will retrieve the reports and the list of patients who were treated with insurances.
- All claims will be sent appropriately with any kind of required documentation attachments.
- Our professional expert billing team will ensure that the Dental Practice receives payments on time.
- Reports will be sent to the Dental Practice of all the claims which are submitted on a daily basis.
Dental Ins Claims Processing and Follow Ups
Dental Insurance Credentialing
New Credentialing: Any new dentists who are independent contractors, need to be accredited by the different dental insurance companies they desire to be a participating provider of.
Re-credentialing: Once a dentist is contracted, those accreditations need to be validated and renewed annually. We can help dentist with their renewal credentialing insurance agreements.
We will collect the enrollment forms from the respective Dental Insurances and complete the details and the Authorized Signatures as instructed by the dental insurance, and we will submit the same to the dental insurances via email or fax. Further, we will follow up periodically with dental insurances to inquire on the status of the enrollment, the results will be shared with the Dental Practice Manager in a documented spreadsheet report.
Eligibility and Dental Insurance Verification
- Same Day verification: Our Subcontractors will work on the verification of the same day appointments which are scheduled on the same day or on an emergency basis. We would need the dental practice to send the insurance verification requests via email to our group’s email address, we would need 2 hours to accomplish the verification process since there would be an expected “holding time” on the phone, from dental insurance companies while processing the dental benefits eligibility, and some insurance would provide dental benefits verifications via fax, which may take additional time. Nevertheless, we need to further verify the availability of dental benefits by phone once we have received the fax, to go over omissions and exclusions the dental insurance company may have overlooked on the fax, and we would be subjected to the “holding time”, and the turnaround time (TAT) of the fax from the insurance companies. When this happens, we would make sure to inform the dental practice the reason for the delay, on a timely manner. Once the verification is completed, the status will be shared with the respective dental practice via email.
- Next Day Verification: 2. Our Subcontractors, will work on the verification for the next day (Next working day) 1 day prior to the appointment, and we will generate the report for the next day’s appointments from the Practice Management Software (PMS) and accomplish the verification on the same day. This will help the dental practice to get the verification completed, 1 day prior to the date of service (DOS). Once the Next Day verification is completed, we will share with the respective dental practice, in a spreadsheet report, via email by the end of the business day. By using this reporting style, all the appointments which are added to the PMS for the next day, will be included in the verification report, the dental practice would not need to send any extra email.
- Future Verification: 3. Our Subcontractors, will verify appointments of future dates which are scheduled in advance by retrieving future dates’ appointments (maximum next 5 working days) and verifying those according to date of service First-in First-out (FIFO). The dental practice will receive future reports 2 days prior to the appointment, allowing the dental practice to prepare the Treatment Plan for patients. The practice will have sufficient time to communicate with patients in cases such as: the laboratory case is not completed; certain dental materials are in back-order and not available for the date of the appointment; or the patient’s dental policy is not active; or we need additional information from the patient to complete the dental insurance verification process.
Plan Creation or Evaluation (Group dental benefits administration in the PMS): Our Subcontractors, will have the responsibility to create the new employers’ or group plan corresponding to the dental benefits obtained from the insurance, following the dental practice’s instructions. If the plan is already available in the PMS, we will update the plan as per the instructions provided by the dental practice.
Breakdown Forms: Our Subcontractors, will process the insurance eligibility verification on the Customized Breakdown forms selected by the dental practice.
- Full Form: (For the PPO and Indemnity policies and the New Patients)
- Short Form: (For the existing patients with the PPO and Indemnity policies)
- HMO/ DMO Form: (For the patients with the HMO/ DMO policies)
- Specialty Forms: (For the patients who will be seeing the specialist; Endodontic, Periodontics, Oral Surgery, Orthodontic, etc.)
Source of Verification: We will use various sources to obtain the dental insurance eligibility benefits of the patients. Those are:
- Verification over the phone
- Verification from insurance Website (the dental practice will provide the Website credentials)
- Verification from fax received from insurance
- Verification from the insurance IVRU (Interactive Voice Response Unit)
- Same Day Verification: The status will be shared with the dental practice instantly.
- If the “Family File” has not been created, our subcontractors will create the plan on a “test account” in the PMS and they will share the same with the dental practice. Once this has been created, the dental practice will have the instant plan to attach to the respective patient’s “Family File.”
- If the “Document Center” or the “Case Note” (the module in PMS where the patient’s breakdown is posted) is not available, the breakdown will be share via email with the dental practice. Once the same is created, the dental practice will be able to post the instant breakdown to the module.
- The status will be shared with the dental practice at the end of the day, for all the appointments of the following day. For example:
- On Monday: The report of Tuesday will be shared at the end of the day.
- On Tuesday: The report of Wednesday will be shared at the end of the day.
- On Wednesday: The report of Thursday will be shared at the end of the day.
- On Thursday: The report of Friday will be shared at the end of the day.
- On Friday: The report of Monday will be shared at the end of the day.
- Future Verification: The status will be shared with the dental practice at the end of the day, for all the appointments of the +2 days. For example:
- On Monday: The report of Wednesday will be shared at the end of the day.
- On Tuesday: The report of Thursday will be shared at the end of the day.
- On Wednesday: The report of Friday will be shared at the end of the day.
- On Thursday: The report of Monday will be shared at the end of the day.
- On Friday: The report of Tuesday will be shared at the end of the day.
Fee Schedule Negotiations Maintenance
New Year fee schedule maintenance: We will obtain up-to-date fee schedules from various dental insurance providers during the month of January, since most of them revise the fee annually, especially in January.
Our subcontractors, will create the fee table in the PMS against the Procedure Codes as per the calculation of the dental insurance allowable amount. The specialists fees will be updated separately since the insurance allowable is different from the general practitioners.
We will update the following fees:
- PPO fee
- UCR fee
- HMO/ DMO fee
- Specialty fee
- FEE SCHEDULE NEGOTIATIONS, Insurance plans, for the most part, will occasionally grant dental providers a percentage increase “at their discretion” when you request an increase, or when you hire a consulting company to do a one-time negotiation increase. However, not all plans will be willing to negotiate. Nevertheless, DENTAL PROVIDERS ARE ENTITLED TO TWO FEE SCHEDULE INCREASES ANNUALLY; and when you allow OUR TEAM to negotiate your fee schedules BIANNUALLY, HMS’s subcontractors, will do a thorough demographic analyses, per fee schedule, and Health Management Solutions Inc. and it’s collaborating partners, WILL NEGOTIATE a fair percentage per UCRF. ” HMS will go to bat for you biannually,” this will provide CONTINUOUS gradual increase revenues for your dental practice; over time, your dental practice will be able to keep up with inflation and it will allow you to remain competitive.
- Pricing structure TO BE NEGOTIATED PER PRACTICE VOLUME AND NEEDS.
Account Receivable Insurance Claims Aging Report
By the end of the week, the worked claims report will be shared with the Account Receivable (AR) Manager of the respective Dental Practice. The report will contain the following details which were obtained from the different dental insurances: (the following list, is subject to change as per the need of the dental practices and the AR Manager’s specific requests).
- Payment date
- Mailing address where the check is sent
- Amount on the check
- Single or Bulk Check
- Any adjustment done for the excess payment made for the previous claims (Off-Set)
- Check status (Cashed or not)
- EFT (Electronic Fund Transfer) payment detail
- Denial reason
- Denial date
- Pending reason
- Pending date
- Deductible adjustment detail
- Co-Pay detail
- Primary insurance settlement detail (COB and EOB information)
- Claim number (from the insurance database)
For denied claims, we will re-submit claims which are expected to be paid with some additional documentation. However, in order to do so, we will need specific access of the PMS from the dental practice in order to obtain additional requested documentation. Our hours of operation are very flexible and we can set up a specific time, at a mutually agreed time frame, to access the PMS in order not to disrupt the practice access to their PMS, we always respect the client’s need.
Fee Schedule Negotiations
Insurance Payment Posting
- Lock Box
- SFTP (Secure File Transfer Protocol)
- Insurance Website
- Scanned EOBs and Checks mailed by the dental practice
As per the guideline defined by the AR Manager, we will write-off the payment in the Ledger.
Timeline: We will follow the timeline defined by the AR Manager, to post payments because it is necessary to have a crystal clear understanding of the DOD (Date of Deposit) and the Closer time-table (usually happens at the end or beginning of the month).
Reporting: On a daily basis, we will share with the Account Receivable’s (AR) Manager the Run-Tape (spreadsheet which contains the summary report of payments). In the same report, we will also highlight payments, which were not posted due to certain discrepancies, or they require the AR manager’s immediate attention and clarification. As per the indicated time-table, we will share the Monthly Report with the AR Manager.
Credit Card payment: Following the instructions of the AR Manager, we will also post Credit Card payments which were made by patients. In order to prevent fraud and misuse of the financial data, we follow strict confidentiality and security practices, and we abide by HIPAA’s Privacy Act requirements.
We will make sure that all the patients’ documents are kept in their respective patient’s account, in the Document Center of the PMS. Such as:
1) EOB (Explanation of Dental benefits),
3) Driving License,
4) HIPAA form,
5) Other Contract Agreement,
6) Dental Benefits Breakdown
- These documents usually come in bulk, especially from the dental insurance end. Hence, we will split these in various manners such as by-Date, by-Patient Name, by-Insurance, etc., and will upload them in the directory of the patients’ document.
Medical Billing for Dental Procedures
- Is there an overlap of what procedures should be billed for medical or dental insurance?
- A “dental practice” can bill to the “Medical Insurance Provider”, but to get paid for the claim, you must first understand the nuances of “Medical Billing For Dental Procedures”.
- When billing to medical insurance, it is important to remember that “Medical Insurances” do not focus on what the patient needs, they need to know “why the patient needs the treatment!” This entails changing the clinician’s thought process to consider not just what needs to be fixed, but how did the patient get that way? (“The Medical Necessity.”)
The following are some of the medical reasons for dental treatment:
- Inflammation and infections not treatable by entry through the tooth;
- Hard and soft tissue pathology such as biopsy or excision of hard or soft tissue lesions or surgical placement of implants;
- Certain types of dysfunction such as skeletal dysplasia, sleep apnea, oral dysfunction;
- Anything and everything related to traumatic injury. This can include implant placements, removable and fixed prosthodontic, restorative treatment, endodontic, and surgical treatment. Periodontal treatments can include sinus elevation and osseous surgery. Orthodontists can consider night guards and palatal expanders for skeletal anomalies as medical treatments.
HMS’s Medical Insurance expert billers will help dental practices obtain maximum reimbursements from patients’ Medical Insurance. Important points in Medical billing:
- 1. The Dentist must include in addition to the SOAP Clinical Evaluation and all other diagnostic procedures, the following notes:
- Proper treatment explanation;
- Length of the treatment;
- Specific area of the mouth where treatment will be done ( eg. Gum, tooth, upper jaw );
- Primary care physician information of the patient medical insurance;
- When was the last time patient visited his or her Primary Care Physician; since we need a referral letter from the PCP provider of the patient to obtain approval;
- Clear x-rays of the patient current condition and other supportive documents from Medical History.
- Medical billing requires diagnostic codes to support medical necessity of procedure codes to be submitted with the claim;
- 3. Insurance coverage depends on an exact match of plan coverage and diagnostic codes for procedure codes;
- 4. All information should be correct to get paid by the Medical Insurance, e.g. patient, provider, and insurance demographics, diagnostic codes and procedure codes, modifiers, narrative submission, etc.
- 5. The Dental practice has to call up the Medical Insurance of the patient to find out whether they will cover Dental Benefits. In other words, if they cover Dental procedure which are medically necessary.
- 6. Pre-Authorization is mandatory before billing to Medical insurance.
- 7. Medical claim submission has 90 days from date of service prior to expiration.
- 8. Almost every time, Medical Insurances reimbursements are significantly more than Dental Insurance payments.
HMS can assist your dental practice in getting paid from Medical Insurance Providers:
- HMS will provide the Dental Practice with the list of services that are covered by Medical Insurances, so that Dental Providers become aware about them, before the patient’s visit;
- Our team will call up the Medical Insurance company to find out if they cover Dental Benefits, and make sure they will accept the claim;
- Based on the practice’s notes from the Dentist, our team will prepare a pre-authorization, and we will submit it to the Medical Insurance for approval;
- Once we receive the pre-authorization number from the Medical insurance, we will bill the “Medical” insurance with the appropriate “diagnostic codes” and CPT codes to have the claim paid.
- Out team will follow-up with the patient’s Medical insurance, after 10 days of the claim having been submitted, to find out how much the Medical Insurance Company has paid.
- Once the practice receives payments, the dental practice or we can post the EOB information in the Practice’s Management Software.
- Reimbursement from Medical insurances is a minimum $1000 in most of the cases, based on the treatment.
Medical and dental billing shares the following:
- Patient and insurance information has to be obtained, verified, and correctly set-up in the Practice Management System;
- Procedures must be coded and fees established;
- A claim form is submitted;
- Payment is received with and explanation of benefits (EOB) that needs to be broken down in the Practice Management System;
- Claims need to be followed until payment are received and re-submission and appeals are performed until payment are obtained;
- Patient’s portion must be collected after the insurance claims are resolved, or must be collected prior to the procedure (if an estimate of patient’s portion is possible).
Differences between Medical Billing and Dental Billing:
- Medical billing requires diagnostic codes to support medical necessity of procedure codes to be submitted with the claim; there are no requirements yet for diagnostic codes in dental billing, however, diagnostic reasons for dental procedures are provided upon request by the Medical Insurance, during narrative submission with claims, and during claims appeal process, and must be documented in the patient’s chart.
- Insurance coverage depends on an exact match of plan coverage and diagnostic codes for procedure codes. Claim denial is more likely with medical claims, due to the requirements necessary for a “clean” claim submission; therefore, it is important to find out information requirements for certain procedures, during the coverage verification process (pre-certification and pre-authorization) before the claim is submitted.
- Sending “clean” claims in Medical Billing is crucial to obtaining coverage and payment. All information must be accurate including patient, provider, and insurance demographics, diagnostic codes and procedure codes, modifiers, narrative submission, etc..
- Pre-certifications (“pre-certs”) for treatment are important prior to proceeding with treatment. Decisions are made, once pre-certs or denials are obtained from the Medical Insurance, to submit to “dental insurance” instead. The patient can make a decision whether or not to proceed with treatment, based on the information received from the pre-certs. Other pertinent information is discovered during the pre-cert step that aids in claim submission and claim coverage based on the information disclosed in the pre-cert. The insurance company will determine whether the procedure needs to be pre-certified or pre-authorized.
- Pre-certifications establish that the procedure “MAY BE” medically necessary and needs a review prior to payment.
- Pre-authorizations establish that the procedure “will be covered”, but the insurance company does not disclose any fees.
- ADA codes for dental treatment encompass many procedures that are not coded, but are part of the fee (ex: lab materials, lab fee, temporary crown fabrication, visit for insert of the crown, x-ray when crown was seated etc.) Those parts of the treatment are included in one crown fee. In medical billing there is a service CPT (reports medical, surgical, & diagnostic procedures and services) or HCPCS code (products, supplies, & services not included in the CPT codes) for all the parts of treatment or a procedure which would add up to the analogous one fee in dental coding. The fee for medical treatment is obtained from coding all parts of the treatment. Dental billing bills for a “product” provided and this product has one fee that is coded. In Medical Billing, we bill for treatment of a “condition” provided (includes services performed based on time and complexity, products/devices, materials used and amounts, and diagnostics procedures, the procedure can be broken into technical service and professional service provided).
- >Medical claims submission has 90 days from day of service prior to expiration, while dental insurances allow up to 6 months, or even up to 1 year, for claim submission from date of service. Therefore, if the “Medical Insurance” does not pay for the dental procedure, there is time to submit the claim to the Dental Insurance provider. The claim cannot, ethically, be submitted simultaneously to the Dental and Medical Insurance. If you submit $500 to the Medical Insurance for a procedure, that gets denied, you have to submit $500 to Dental Insurance for the same procedure. This is why, the price for the procedure, billed to Dental or Medical Insurance, has to be the same. Several medical codes (which will include services, products/devices, materials, and diagnostic procedures) may need to be used for the analogous ADA code, but the price for the treatment should be the same. Many ADA codes include procedures that in medical coding are billed separately. Ex: x-rays in dental billing include the diagnosis and reporting, while x-rays in medical can be billed as a service fee (technical component) and the reporting fee (professional component) with a modifier 26.
- Narratives/letters to support “Medical Necessity” are crucial to obtaining medical claim coverage; in dental billing, letters of medical necessity are only necessary for ADA codes that ask for narratives by report or during the appeal process, or as a follow-up to referring provider.
- Medical reimbursement for exams/practice visits/consultations depends on time spent with the patient’s encounters, complexity of the encounter/exam, and reimbursements for each encounter for previously diagnosed condition, in dental follow-up visits and visits for previously diagnosed condition are considered part of the dental procedure.
- Medical insurances do not provide fees for treatment during the benefits verification process, or pre-certification process, but rather, informs if treatment is eligible for medical billing after claim examiner review. The Pre-authorization will tell you if it will be covered by the Medical Insurance plan but the insurance company will not disclose the fees. The reimbursement depends on the medical plan’s reimbursement schedule, covered benefit, and if it is a medically billable procedure. It is not possible to do a sound pre-estimate and figure out the patient’s responsibility for the treatment. Therefore, the Dental Provider or Dental Administrator must decide how much will be collected from the patient at time of service. If the Medical Insurance reports that the dental services will be covered (pre-authorized) and can be submitted, it is recommended that a minimum of 1/3 should be collected from the patient, as a down payment at the time of service. Some Medical Insurances are known to take a long time to pay out. Therefore, some dental providers might consider to collect the total amount from the patient, at time services are rendered, and then send insurance payment to the patient directly when the payment is received.
- Most Medical insurance have higher reimbursements for dental services, than dental insurances resulting in a lower patient balance, and therefore, it increases the ability for patients to obtain recommended dental services. This happens because several parts of one dental code are billable to Medical insurances resulting in payments for several more codes yielding higher insurance reimbursement. In addition, Medical insurances do not have clear provisions or historical payments on dental procedures; consequently, often Medical insurance companies, pays well on those codes resulting in higher reimbursements.
- Dental insurance allows to charge out indirect procedures, involving a laboratory, on the day of impressions, while indirect procedures can only be billed out to Medical insurance providers, the day you insert the prosthesis.
- How to get started? The Dentist must decide which procedures they will perform, be eligible for medical billing.
1. Traumatic injury
2. Inflammation or infection
3. Surgery required
4. Diagnosing/diagnosed medical condition
5. Suffering from loss of function
6. Referral from Medical Doctor
- The Dentist has to make a Medical connection based on the Medical history to the dental treatment that needs to be provided. A letter of “Medical Necessity” needs to be written and submitted with the claim. (HMS has provided the Medical form for Dental Providers to use.)
- 3. Next, we suggest the Dentist runs a report of those medically-billable procedures that were already treatment-planned, from the practice management software. Call the patients and obtain their Medical insurance information. Inform the patients that you will attempt to check with their Medical insurance for assistance with their dental treatment plan reimbursement. You only schedule the patient when there is pre-certification, pre-authorization. When calling the patient to schedule, make sure that at least 1/3 of the fee is discussed to be collected at time of service towards the treatment plan before pre-authorizations. Also, discuss the full fee for the total treatment plan, before it is submitted for pre-certifications, in the event that the Medical insurance does not pay at all. Have a “back-up plan” to submit to the Dental insurance and quote the patient the Dental insurance breakdown based on dental insurance coverage history; in this case make sure to disclose the patients’ portion, deductibles, co-payments and/or credit lending arrangements.
Let Health Management Solutions, Inc., assist you to implement Medical Billing for Dental Procedures in your dental practice, please give us a call.
- Why only us?
- 1. HMS has teamed up with an Associate Billing Provider who has a Certified Team of Experienced Medical Coders; they will ensure that your dental practice will get paid on every approved pre-authorization.
- 2. HMS has teamed up with an Associate Provider who has an experienced billing team and know how to communicate with Medical Insurances Providers to verify dental benefits, and also collect payment and submit additional information if required by the Medical insurance carriers.
- 3. HMS takes this cumbersome and tedious process of dealing with Medical insurances providers, and our experience professional billing team will get your practice reimbursed within approximately 20 days of a claim that has been submitted for payment to the Medical insurance company.
Medical Insurance Credentialing
Based on the dental practice location, we will ask you to provide us with the list of most commonly used Medical Insurances. You can accomplish this, by asking your office staff to request patients’ their Medical Insurance cards in addition to the Dental Insurance information when they are coming to the dental practice. By implementing this practice, you will get an approximate list of the most common Medical Insurances from your patient base.
Once we receive the list of Medical insurances, our Medical billing experts will start the credentialing documentation process for the Dentist/s and we will fill out and complete all of the required documentation for the dental providers from our end. We will update the dentist(s) with a periodic status report, and we will ensure that the dental provider gets in-network with the Medical insurance companies within 30 to 90 days.
In order to proceed with the process we would need a list of the following documents:
- Dental License copy
- DEA Copy
- Insurance Liability copy
- Specialist certificate if any and or Dental School Certificate
- W9 form