Tips for Dental PPO Fee Negotiation & Credentialing

The post Tips for Dental PPO Fee Negotiation & Credentialing appeared first on Apex Reimbursement Specialists.

Special Message For The Dental Community

The post Special Message For The Dental Community appeared first on Apex Reimbursement Specialists.

COVID-19 and Your Dental Practice

If your dental practice is located in the United States, there is a high probability that “business as usual” is anything but “usual” right now. We wanted to share with you how APEX Reimbursement Specialists is working tirelessly to help support all of our dentist clients and ensure that revenue is maximized and uninterrupted during this difficult time. 

COVID-19 and Your Dental Practice 

Most recently, the American Dental Association suggested that dentists postpone all elective procedures for three weeks and instead leave schedules open for emergency dental care. This will allow dentists to see emergency patients that otherwise might go to the hospital emergency departments and provide the most pressing care. This will also help to limit the spread of COVID-19 in your community and in your dental practice. The ADA also created an informative FAQ guide for dental providers struggling to determine the best way to serve patients while staying healthy for the duration of the pandemic. 

Additionally, the American Academy of Periodontology has created COVID-19 resources that can be utilized by general dentists and specialists alike. Their tips include ways to protect your workforce, including screening patients for symptoms of acute respiratory illness before entering your practice, using the proper personal protection equipment (PPE), encouraging sick employees to remain at home and adjusting your hours to include telephone triage and follow-up with patients before and after they visit.

How We Are Helping

As always, APEX Reimbursement Specialists is working hard to generate as much revenue as possible for your dental practice. From optimizing your coding, negotiating with insurance providers on your behalf, completing credentialing paperwork, and addressing accounts receivables to make sure all insurance revenue is collected during this time, we want to ensure you get the revenue that you rely on to keep your bottom line healthy. 

We know that you are probably dealing with numerous complex patient situations now, as some offices are moving to only work with emergency and complicated dental patients. Let us communicate with insurance carriers on your behalf to keep all contact as seamless as possible so that you can focus on your patients. From following up on your credentialing paperwork to negotiating reimbursement rates, our team can support yours as we all work together during this trying time. 

APEX Reimbursement Specialists Can Help Your Dental Practice During COVID-19

Whether you’re preparing for the recredentialing process or looking for assistance credentialing with a new provider, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

The post COVID-19 and Your Dental Practice appeared first on Apex Reimbursement Specialists.

How to Optimize Your Dental Insurance Credentialing Process

The credentialing process is never enjoyable for dentists, and unfortunately, it’s something that needs to be completed for every insurance company (and again when it is time to complete the recredentialing process). Thankfully, there are ways to make the process easier, including working with APEX Reimbursement Specialists.

Dental Credentialing 101

Dental credentialing is the process of verifying a dentist, their licensing and professional record before allowing them to be part of an insurance network. The credentialing process includes things like verifying career history, training history, education, malpractice history and licensing. The credentialing process will need to be completed for every insurance company that you become an in-network provider for.

Why Is Credentialing Important?

Credentialing is no longer optional for many dentists, as many patients will start planning the dental treatment process by first checking which dentists are in network. When you credential, you will increase the chances that patients in your area will become patients of your practice. The insurance companies that you are in network for will also give you publicity as a result through listing you in their guides online and in print. When you attract more patients, it can increase your revenue and help your practice to grow exponentially.

How Can You Make It Easier?

While the credentialing process is critical to the success of many practices, it is not easy or straightforward. Because it is so complex and time-consuming, many dental practices choose to work with a partner like APEX Reimbursement Specialists. We can take all of the necessary documents, like your malpractice insurance, licensing, certifications and other information, and ensure that your application is completed correctly. Then, we will complete the hardest part of the process for you—follow up. Many insurance companies will leave you completely in the dark during the process and you will not know if something was missing or not received. That’s why someone following up on a regular basis to ensure the application was received and processed is so important. We will work with you through every part of the credentialing process to save you time.

APEX Reimbursement Specialists Can Help With Your Credentialing

Whether you’re preparing for the recredentialing process or looking for assistance credentialing with a new provider, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

The post How to Optimize Your Dental Insurance Credentialing Process appeared first on Apex Reimbursement Specialists.

Could Your Practice Benefit from a Third-Party Audit?

Every year, your dental practice faces the threat of an audit from an insurance provider. Do you think that you would pass? Many dental practices fail to adequately self-audit their businesses, which can lead to serious consequences if a formal audit occurs. Whether you think you have nothing to worry about or have concerns about the accuracy of your coding, here are some of the signs that your dental practice could benefit from a third-party audit.

What Is a Third-Party Audit?

During a third-party audit, a professional company can complete a review of your office’s practices and procedures, from your charting methods to your insurance claims. When you work with an insurance carrier, your dental practice is always at risk for an audit. These audits are designed to ensure that providers are properly documenting treatment and that the treatment paid for was appropriate for the situation. During an audit, the insurance carrier will request copies of patient records from your dental practice to confirm the necessity of the treatment. A third-party audit can ensure you are maintaining compliance and, in the process, you may even find out that there is revenue opportunity! 

Could Your Dental Practice Benefit from a Third-Party Audit?

1. Medicaid Compliance: Any dental practice that participates in Medicaid should schedule an annual third-party audit to ensure compliance. Medicaid standards are very strict, complex and change from year to year. Dentists can face civil or criminal charges in the aftermath of a Medicaid audit under the False Claims Act, so what seems like a small error could turn into a big deal.
2. Chart Irregularities: Are all of your dentists and coders doing a consistent job writing down what procedures were completed and supplying documentation? A third-party audit can complete a random charting review to check for everything that an insurance company would when completing an audit and identify any necessary areas for improvement.
3. Changes to Your Processes: If you recently made significant changes to how your practice workflow operates, switched coding software or had other alterations to your practice that could affect the accuracy of your claims, a third-party audit can ensure everything is going according to plan.

Benefit from a Third-Party Audit from APEX Reimbursement Specialists

Whether you’re concerned about the potential for receiving an insurance provider audit in the new year or looking for assistance in raising your overall revenue with skilled PPO fee negotiation, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

The post Could Your Practice Benefit from a Third-Party Audit? appeared first on Apex Reimbursement Specialists.

What to Look for in a PPO Fee Negotiator

As you close out your books for 2019, are you leaving money on the table? Every year, dental practices leave behind thousands of dollars in potential reimbursement fees due to not negotiating with their insurance provider partners. If you are ready to take charge of your revenue in 2020 and not leave any money behind, you need to work with a PPO fee negotiator. They work on your behalf to increase reimbursement rates for every insurance provider and boost your bottom line. What should you look for in a PPO fee negotiator?

4 Characteristics of a High-Quality Negotiator

1. Knowledge: Working with insurance providers requires a great deal of knowledge, and there’s a reason why reimbursement negotiation is so difficult for a dentist to complete on their own—it’s hard! A PPO fee negotiator has all of the background knowledge necessary to identify your areas for improvement and work with insurance providers to get more beneficial rates.
2. Persistence: Many dental practices struggle with PPO fee negotiation because they get told “no” one time and give up. Negotiation takes hard work and persistence. A professional PPO fee negotiator knows the effort required to follow up with each provider, ensure that all paperwork was processed, update your fee schedules and re-negotiate again the next time that credentialing takes place.
3. Reputation: Reputation matters when negotiating with insurers and when choosing a negotiator. You want your practice to be professionally represented when speaking and working with insurance providers, so you should choose a highly professional PPO fee negotiator that understands it represents both itself and you. Reputation also stems from experience, and an experienced negotiator understands how to package alterations to reimbursement in a way that benefits your practice without isolating the insurance provider.
4. Strategy: Do you think that PPO fee negotiation is just a matter of asking every code to be increased? Nope! There is a great deal of strategy and data computation behind the best way to get results, and that is what quality PPO fee negotiators specialize in.

Partner with the PPO Fee Negotiator Specialists at APEX Reimbursement Specialists

Whether you’re preparing for the recredentialing process or looking for assistance in raising your overall revenue with skilled PPO fee negotiation, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

The post What to Look for in a PPO Fee Negotiator appeared first on Apex Reimbursement Specialists.

3 Common Coding Mistakes for Dental Practices in 2019

Your dental practice relies on accurate coding to quickly and efficiently bill insurance providers and receive reimbursement for the services you perform. Common coding mistakes can lead to denied claims or issues with receiving your reimbursement as quickly as possible. What were some of the most common coding mistakes for dental practices in 2019?

3 Common Coding Mistakes

1. Using the Wrong Codes: It probably goes without saying that the most common code mistakes are using the wrong code. This often occurs when the new year begins and codes that were valid last year have been replaced or refined with something else. This can also happen when there is a new, more specific code for the procedure that you performed. Always make sure that your staff and all of those who participate in the coding and billing processes take relevant trainings to prevent errors.
2. Not Running Your Reports: What is one of the best ways to catch common coding mistakes? Running your practice analysis reports on a regular basis. If your practice does not offer certain services, you can also proactively deactivate the codes associated with them to prevent them from being accidentally used. When you update your charting and coding systems with the new codes for 2020, only add the codes that are for procedures that your practice provides. In many cases, having too many codes makes it easy to mistype or misidentify a procedure. By eliminating codes that you do not offer or that are no longer acceptable to insurance providers, you can increase accuracy without asking your dentists or billing professionals to do anything at all!
3. Improper Communication: One of the other causes of using the wrong code is not charting and communicating correctly. If the person who is completing procedures is not the person who is doing the billing, it is up to them to clearly communicate and chart what procedures were performed and provide back-up documentation. Make sure that you have a defined system for charting, coding and billing that everyone in your practice understands.

Avoid Common Coding Mistakes with APEX Reimbursement Specialists

Whether you’re preparing for the recredentialing process or looking for assistance making sure that your office coding practices are up to snuff, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.

The post 3 Common Coding Mistakes for Dental Practices in 2019 appeared first on Apex Reimbursement Specialists.