Why insurance coordinators need to be flexible in today's dental world

Flexibility is the name of the game in today’s dental insurance world. Administrative roles have shifted greatly in recent years to include the growing, evolving role of insurance in the dental office.

My classes are attended by both newer and more veteran team members – both groups equally confused by the changing "rules of thumb." The most dangerous phrases uttered in the administrative area are assumptive ones made out of habit, such as "insurance policies always cover…" or "your deductible won’t apply to your cleaning."

Offices (both participating and non-participating) feel increasing pressure to know a patient’s benefit plan inside and out. Is it unreasonable? Yes, absolutely. But is it expected? Yes, absolutely. And this is where reality meets theory. If I could wave a magic wand, I’d love for all offices to be able to estimate co-payments accurately and quickly. We can do one or the other, but, often, both are hard to find in one total package. The industry is moving in that direction, but, for most offices, the reality is full of long hold times, websites and faxes with less-than-complete information and patients who are clueless about how their benefits work.

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Today’s insurance coordinators benefit from on-the-job training every day – because plans change just that quickly. What was once an assumption (i.e. all radiographs paid at the preventive percentage) can prove to be a costly mistake when communicating with patients. The main insurance coordinator in the office is typically an administrative person who expressed an interest in handling patient benefits. Ten years ago, this person could also pull double duty as receptionist or office manager. As benefit plans and networks become more complex, it becomes very plain that insurance management has become its own position. To ask a full-time receptionist to "just add these couple tasks" to his or her day is a recipe for burnout.

However, in many offices, the doctor or manager does not want to hire a full-time coordinator because this position is seen as a non-revenue-producing position. Many owners simply have no idea how much time is involved in managing this vital system. The typical day involves the following tasks for an insurance coordinator:

• Verifying eligibility for the next two days’ worth of patients

• Obtaining benefits for plans not entered into the practice management system

• Filing claims as procedures are posted (claims should be sent daily)

• Gathering information for narratives required for certain procedures

• Processing incoming insurance checks and sending statements to patients with residual balances (this includes paper checks and/or logging into the insurance companies’ web portals)

• Appealing claim denials or answering requests for more information

• Reviewing claim submission reports from the clearinghouse

• Reviewing treatment plans slated for presentation to ensure benefit estimations are accurate

• Answering patient phone inquiries regarding balances and benefits

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In addition to these daily tasks, there are other duties that need to be completed at regular intervals. These tasks can be bi-monthly or monthly depending on your volume:

• Running regular reports to track aging claims and pre-treatment estimates

• Calling to check on the status of unpaid claims

• Running a report to identify procedures not claimed

There are also reports that should be run quarterly and yearly that show how much production is tied to your carriers, but these are often performed by either the insurance coordinator or the office manager. Don’t forget about tracking when you can negotiate your fees and remembering re-credentialing deadlines. When I meet with seminar attendees I often hear that dealing with insurance is the most aggravating and least-liked task in the office. As a result, it is often the last system addressed, when, in reality, it should be handled efficiently on a daily basis.

Almost all offices I talk with could use a full-time insurance coordinator; however, there is great reluctance to assign one person to handle the insurance process. Don’t think of it as a cost center of your office. You stand to lose more revenue due to patient dissatisfaction, inaccurate co-payments and higher accounts receivables if you don’t streamline this system. A well trained and knowledgeable insurance coordinator can save your practice from losing revenue. With today’s tight dental office margins, it is a position you can’t afford to do without.

Related reading: 5 facts you should know about dental insurance coverage