PRACTICEmanagement In the world of medical commercial insurance, there is no standardized “error code library,” so take the time to study the Explanation of Benefits statement (EOB) in order to respond specifically to each “error or denial code”. It does take some skill to investigate each denial reason, but it’s our job to do the detective work and reap the rewards of a job well done.
Demographics. Demographics. Demographics.
There are many things that you can do to reduce the rate of errors and increase your reimbursements.
Demographics are the details on a patient’s insurance card and also provider detail such as Tax ID and NPI numbers. Demographics can be a problem area and should be checked and rechecked. When registering the patient ask these questions: • Is your name the same as on your insurance card? For instance, do you go by Jon or Jonathan? • Do you have original Medicare (the red, white and blue card) or a Medicare HMO? • Is your coverage active? (often the employer changes the insurance and you may be handed the older insurance card) • Is your address current? • Can I please see the back of your card? (so you can scour the card for group numbers and the insurance contact information).
Provider demographics – Information essentials
NPI, Tax ID, and taxonomy! All important for medical billing because the insurance carrier needs to know your specific creden-
Rose Nierman, RDH, is the Founder and CEO of Nierman Practice Management, an educational and software company (DentalWriter™ and CrossCode™ Software) for Medical Billing for Dentists, TMD and Dental Sleep Medicine advanced treatment, and co-founder of the SCOPE Institute, a non-profit educational organization dedicated to the advancement of sleep apnea, craniofacial pain treatment, and medical billing within dentistry. Rose and her team of clinical and medical billing experts can be reached at Rose@Dentalwriter.com or at 1-800-879-6468.
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tials in order to provide reimbursement. If you’re already receiving medical insurance reimbursement, the cardinal rule is to avoid making any changes in your identifiers without contacting the insurance company first. This is to ensure that you continue to be a known provider with that insurer. When in doubt, contact the insurer to inquire about your identifiers on file. Recently, some insurance companies started requiring a Type 2, organizational National Provider Identifier (NPI) for oral appliance reimbursement. And some insurers now require a number called a taxonomy code, typically placed in the billing information section of the claim. A taxonomy code defines your type of organization, such as dentist. This is the web site doctors go to register for their NPI 1 OR NPI 2. The provider will also get a taxonomy code here as well: https://nppes.cms.hhs. gov/NPPES/Welcome.do.
Timely follow up
Billing administrators get to know how to interpret the sometimes cryptic codes and messages the insurance payers provide on the EOB. The sooner you determine the reason for the delay and follow up on a claim, the more likely it is to be paid. In healthcare claims processing, time is an enemy to getting reimbursed. Most insurance payers have timely filing limits, so identifying problems and resolving them promptly is crucial. Most insurance representatives will try their best to help you connect with the right department for appeals. And again, always ask for a reference number for any phone contact.
Patients can also make waves
If other avenues fail, a letter from a patient may catch the attention of an insurance manager. Patients are more proactive and knowledgeable about their healthcare than ever before. If a patient takes the time to call or write a letter to an insurance company manager or executive, then the insurance company may take notice, especially when you have provided the patient with copies of the documentation that you had provided. Many denied claims, just through good communication and by providing more information, can be resolved. And keep in mind: Your patients need your help. It’s worth the effort!