Dual Dental Insurance Write-Offs Done Correctly
Dual dental insurance write-offs are a topic for consideration. And this is an area that can cost the dental practice some serious money. If you are a dentist or practice manager, here are some words of advice. Know how to do this right. And audit patient accounts frequently. Look at your adjustment reports carefully. And randomly choose an account each day to audit. Know how to read and understand the patient ledgers. Because if you don’t, you will suffer financially.
Now, I’m not saying it will happen intentionally. There are well meaning administrators and team members who just don’t know. And they may be afraid to ask for direction or training. Partly because they fear you might say no. And a team member also wants to shine in their employer’s eyes. So, many people just absolutely “wing it” with their best intentions. And truly hope for the best. Perhaps no one will ever notice! Would you?
Here’s The Scoop!
Dual dental insurance write-offs are simpler than you might think. No, there are not two write-offs when a patient has dual insurance. Big mistake! And one that I see more often than I care to say. There is only one write-off, no matter how many insurances a patient has. And it’s super easy. The only write-off is the largest write off. Whichever contracted plan provides the greatest discount to our patient is the one we give. That’s it. But wait until both insurances pay to do any kind of write off. And keep the explanation of benefits. Scan them, file them, or whatever you must, but keep them.
But what if one insurance pays nothing? Do we still need to honor the contracted rate with that plan? Great question! And it depends on the plan and why the claim was not paid. Did the patient reach their maximum? Is this a non-covered service? In most cases, the dental provider does not need to honor the contracted rate once the maximum has been reached. And a non-covered service does not have a contracted rate. It’s a non-covered service. But always, check the particulars on the contract and state regulations.
Dual Dental Insurance Write-Offs With Downgrades
Here’s another great question! What if there are downgrades and dual dental insurance? It gets a little sticky! Right? Not really. But, there are some things to remember. How do we calculate the downgrade? We always look at the write-off as the difference between the dentist’s office fee – UCR – for whatever the procedure is and that same exact procedure code’s contracted rate with insurance. Remember, the patient pays the difference. Not the dentist!
What’s the difference I am talking about? When an insurance downgrades a procedure, they cover a different procedure code entirely! For example, a patient has a composite restoration on a posterior molar. The insurance company says they will agree to cover an amalgam filling on the posterior molar. That’s their choice. However, we do not subtract the amount of the contracted rate of the amalgam from the dentist’s fee for the composite. We stick with the actual procedure code and the dentist’s fee minus the insurance rate for that procedure code. That alone is the right off!
Train The Team Well!
It’s so much better to put in the time and the training before a problem arises. Leave no room for question or doubt. Provide all the tools and resources the entire team needs today! There is so much available for you right here. And that’s why it’s here. Schedule weekly team meetings and spend a few minutes training each week. Pick a topic of the month, like receivables, or phones. And just make it part of the agenda and part of the routine.
Let me know if I can help in any way. I’m truly, just an email away!