Stop Claim Denials Before They Start
Following the overwhelming response to our Why Dental Claims Fail webinar, Jennifer Steadman and Jill Nesbitt returned for a special Q&A follow-up session to address the questions dental teams were still asking. In this discussion, they take a deeper dive into the real-world challenges that impact reimbursement success. If your practice is looking to reduce claim denials, accelerate payments, and create more consistent workflows, this webinar offers practical strategies you can put to work immediately.
Below is the video transcript.
Jennifer Steadman
Hi, everyone. Thank you so much for joining us again. I am Jennifer Steadman, and I'm super happy to have Jill Nesbitt here with me. We were recently on a why dental claims fail webinar, and there was a ton of follow-up questions.
Wasn't there, Jill? There was so much interaction. It was I've never seen anything like it. It was amazing.
Never ever. Yeah. It was super fun.
Yeah. So based on that, you know, we kinda put our brains together and said, we need to give you guys a little bit more. So on that note, we have compiled some of the question all of the questions into different themes to make sure that we were able to get as much information to you guys as possible. So, Jill, what we're gonna do is kinda go through some of these themes and kinda just go back and forth together.
Sound like a plan? Sounds like a great idea. Perfect. Okay. So the first theme is documentations that drive claim approval.
So specifically, what documentation makes the biggest difference in getting claims approved?
Jill Nesbitt
having as you and I were discussing right before we jumped on this call, I just came back from a on-site visit with a potential client who's making a big change with software.
And frankly, we talked a lot about getting claims paid and how can we get paid more and faster. And the documentation issues and what I'm finding is it's all about attachments and narratives, at least from my perspective right now. And so the conversation really became how easily can I get the x-ray from my imaging? And I watched some real challenges just happen.
So I think when teams are looking at how am I going to manage my documentation, really observe how quickly and easily can you grab the image, the intraoral camera, the whatever image you're needing, or the perio chart, you know, the primary client, things like that. What do you need from an attachment's perspective? How quick is it? How easy is it?
And when you're working in a DSO space, whose responsibility is it, and are those getting done in a timely manner? You know, I think that's that's my kind of first stab at the conversation.
Jennifer Steadman
Yeah. Absolutely. Because I think sometimes we forget about, you know, the ease of use and the time that it takes, like, after the patient leaves to make sure that everything is attached and that the admin team has everything that they need. So on that note, we need to make sure clinically that everything is acquired, I'll say, right, to be able to get the diagnosis. So then the admin team, it's one less hurdle that they have to jump through.
So on that front, I know you've mentioned we need radiographs. We need comprehensive, like, full perio charting with, you know, not just probing depths. We need bleeding, furcation, clinical attachment loss, the whole bit.
Intraoral photos, goodness. We can't say that enough. Right? Pre and post op, if you have those.
Your narratives, your chart notes, everything and anything, even, you know, past dates of service is so important too. Right? If someone had scaling and root planning before, you're gonna need that original data service in there as well. So I think that's kind of a from the admin perspective, like a full team approach and what specific documentation do we need in there too.
Jill Nesbitt
Totally agree. One one comment to add to the clinical notes or to the narratives is build it into your clinical note templates. We talked about that in the full webinar. But if you let your insurance team find out what are the things they're chasing on narratives, go back and build that into your clinical note template. Now when you catch it the first time, that allows you to submit accurately with the right information on the first go round and avoid the denial that just simply adds delays and begins the gamesmanship that happens with carriers.
Jennifer Steadman
Yeah. And it's kind of like you knew what the next theme was because that was a great segue into the next one.
So the next theme here is denials, rejections, and stuck claims. So when claims keep getting denied or stuck, what should we do and where should we look first? And I think, you know, you had mentioned there too, like, talking to the team about it. I think some of the biggest challenges come up when, you know, the admin team is processing those claims.
Right? They're putting everything in there. They're getting the denials, but maybe they're not communicating with the clinical team what the denials are. Right?
Why they were denied in the first place? So really making sure that you have that conversation with your team to understand, are there themes? Right? Do you have do you find when you're looking through and you're getting rejections, things aren't attached or maybe you don't have the radiographs in the first place, right, that you that are needed.
So really making sure it's open communication so you have everything and things are corrected before you submit.
Jill Nesbitt
I think on my end, when I'm thinking about how am I gonna really manage denials, some of it is putting the denials first in your day. It's the quickest thing when you put that as alright. That's the very first thing. And as soon as you catch them, and I know, for example, in Ascend, it's, you know, the very top box, you can select only to view your denials.
If you're seeing them and you can get those fixed and adjusted quickly and resubmitted, now you have the fastest cash flow. So I think part of addressing denials is actually having a workflow that prioritizes those and doesn't wait until thirty, sixty, ninety days. Right? So that's one thing I've seen.
I think the other part is the actual denial. So many of these are due to what we kinda you know, just almost like fat finger errors. We don't have the subscriber ID. Right?
We don't have the insurance carrier. Right? We just have some basic things, which actually then backs up the train.
Okay. Did you get your insurance verification done properly? Is the plan built properly? You know, if you're trying to manage a downstream problem like denials, take just like you were talking about, go and talk to your team, take a look at how is the darn thing set up, and do we have a good insurance estimate in the first place?
Friend, let me give you an example. I was literally just in a practice just last week, and I'm watching a team, and I know their software will do this for them. But they went in, they were doing calculator math on every single treatment plan because the system did not calculate the deductible properly. So imagine, everyone, we have everything beautifully digitized.
We print this beautiful treatment plan. We then take the white out and go over. We get our calculator out. We push all the buttons.
We do a fixed calculation, pen in hand. We write on top of it, and that's what we present to the patient. And then they're looking at you like, how much do you really think I'm gonna have to pay? So I think when you again, when you're looking at why am I not getting why am I getting denials or what's happening with this whole process?
That is so incredibly painful If someone takes the time, which we intend to do, of course, you know, to set up your software properly, this actually is a win for you down the road.
Jennifer Steadman
Yeah. And I think that's a a huge point. Right? Because we were also talking about AI and everything recently too when we did the webinar and how important it is that there's so many different tools that are at your disposal, but you still have to do some work on the front end to make sure that you're getting the correct output.
Right? And, you know, a team cares so much. They wanna do everything that they can for the patient. So they're gonna make sure that it's right.
But goodness, if all of that information is in there correctly at the beginning, if we just pause and do that at the beginning, think about how much time they're actually gonna save in the long run.
Amen.
Significant. Significant. Love it. Love it. Okay. Now let's talk about pre collections and handling any treatment changes in the op.
So what is the best way that we can handle prepayment when treatment plans change? What are your thoughts on that, Jill?
Jill Nesbitt
I would say let's just pause and acknowledge this is hard. Like, treatment changes a lot. And depending on the practice you're in, depending on how how challenging the cases are or what's going on.
So I think, you know, my recommendation, if you're trying to say, wait, we hear that we should collect in advance so that we can make sure patients don't walk out with without paying us. I think, frankly, it gets to relationship and communication, which doesn't feel like anything to do with payment or RCM, but it's kinda the foundation for all of it. So, you know, what I'm a huge fan of is, frankly, have a conversation with your patient when you're scheduling them around what is the treatment you're having, what is the plan, how much is their portion, you know, the whole financial arrangement that we always do, how do they wanna take care of that. Right? You can then say, we'd like some down to schedule or whatever your financial arrangements are.
I think it's lovely if there's a way that you can, hey, motivate them to pay in order to reserve time because it's gonna be an hour an appointment. I think it's lovely if we can give a cash discount. I think it's if there's any of these motivators, I also do not have a problem if, hey. We've collected in full and then treatment changes. When that appointment is over or even if we have to go back in the treatment room I was just talking to, a team member that was saying, we love having our little, you know, wireless credit card terminal. We just go back in the room and we have a little bit of flexibility. But it's really then having an updated treatment plan, sitting down and just taking it from an informed consent.
Hi, Susie, I wanted to sit down. As you know, doctor wanted to pause because we originally had this plan. It looks like this has happened. And now instead of doing, you know, instead of doing the root canal, we are looking at doing extraction and potentially an implant.
Here's what that would look like. It's if you wanted to go ahead and take that first step since you're already numb, we could do x y z, but you still have control about how your finances are going to run. This is not a pressure cooker, you know, sort of situation. But, so I think part of that is just acknowledging that it's hard and giving that patient a minute to actually think about, wait.
Okay. What's happening? Let them absorb that. And then working out, you know, how how how if we do this much down or do we have a new plan that feels comfortable?
Then we can always take, you know, write that out and make it more clear for them a little bit later. But it is hard. There's not a perfect situation. And I think the more you're talking to your patients, it's sort of like just the repetition of it.
I think that'll be really helpful.
Jennifer Steadman
Yeah. I agree. And I think, you know, the other thing too when you were saying, like, sometimes you just have to pause and say, you know what?
Doctors say something different. I think that's when it's also important. I'm gonna important. I'm gonna, like, pull something else in here too.
It's like we were talking about ambient noise. Right? And being able to have the ambient noise, listen in to what's going on clinically in the operatory to then help to support you with your notes. It's also amazing for the patient to hear that.
So if you're, you know, going through and say you're doing a crown prep and you're like, oh, actually, now I need to do a buildup. And it's like, hey. You know what?
Missus Jones, this is what I'm seeing right now. I'm gonna need to do a buildup. I need to support this tooth. Like, so many different things, right, that you can build into that conversation.
And then not only are you informing the patient, but because you're saying it out loud, it's also gonna pull into your notes, which is then gonna help your narrative, and it's gonna be able to help the whole process from start to finish. So really making sure that you are informing the patient, like you were saying, right, like, that conversation. I think one of the biggest things in dental or the dental industry in general is I think some people think like, oh, you know, my hands are gonna be in their mouth. Like, I don't really have to talk too much.
And I've been you know, have observed in lots of different practices and have heard or not heard hygienists, like, saying anything. I'm like, they don't talk. Like, you don't need to talk about the weather. You don't need to talk about anything else.
Just talk about what you see and use that time to your advantage.
So being able to have those conversations, I think the biggest thing that any dental professional can do is take some communication courses, get really comfortable with communicating and being uncomfortable, and just use your voice I love be able to support that.
Jill Nesbitt
I love that. I think people forget we're also patients. Like, I was just I just was at the dentist a couple of weeks ago, and I'm chatting. I'm like, of course, and, you know, oh, maybe I can get a new one.
She was telling me about some new cool cleaner on Amazon. I'm like, tell me all about it, sister. I wanna know what's happening and what the easiest way is and what the best product is. And with our new cool text it's not new anymore.
Everyone we've been texting for what feels like forever. But I kid you not, she texted me through the office and said, hey, Jill, I found the thing. Here's the link or whatever. I was like, this is amazing.
So you can you can really make that even more part of your expertise sharing that with your patients. So I love I think you are spot on with that. Just talk. Just talk.
The more you talk to us, we love it and appreciate it. And we'll talk about money and we'll talk about dentistry and us. Heck, you're talking about my face, my smile, my appearance, my eating, like, all the things that I'm kind of interested in.
Jennifer Steadman
Yep. Absolutely. Absolutely. Awesome. Okay. Let's move on to the next one. Yep. We have Dentrix Ascend, And there was lots of different questions about workflows.
So what are the common insurance workflow issues that teams run into?
Jill Nesbitt
What do you see? Oh, goodness.
I am a huge fan of the visibility that that home overview page brings.
And, you know, the common insurance workflow issues are the same things. Do we actually get claims created on time? Do we get the darn attachments added? Do we get the things sent out?
And then are we following up on the outstanding? And those are literally those three things I just mentioned are the top three boxes that everyone in practice sees when you log in to Ascend. So it makes it really clear. Did we create the claims?
Did we send the claims? And how are we doing on following up on outstanding? I think one thing that I would strongly encourage actually, I can't resist two things.
First is I just had a meeting with a, with a, like, fifty some location RCM leader who's, like, dying because she's got a fantastic team, and the operations are fantastic. But, man, we do not have enough connection and communication with our practices on those two topics. So anyway, the one is how is how do you make sure that you're collecting the co pay? Because, obviously, the co pay follows, did I get the actual insurance estimate right?
And that is use your workflow compliance report. So there's your homework. If you're an ascend user, go in, hunt down, find this workflow compliance report. If you're a regional manager, side note, you can run it for multiple locations now.
So the workflow compliance report will let you know per patient, did you in fact collect a co pay? And there's more things to it, but I'll let you find that. The only other idea that I'm such a huge fan of, and I'm hearing more and more really good stories about, is the fact that Ascend allows you to set up what's called clinical decision support where when you set it up, you can automatically pull in and connect the ICD ten codes that match your your CDT or your dental codes. And if you did that just on the top codes that you generally are seeing on the treatment that you generally are doing, I heard of, I had a friend of mine who runs a practice, out in Utah, a matter of fact, and she said when she started and switched over using quick exam, connecting and setting up that clinical decision support just by adding those ICD ten codes, which side note automatically add on the claim, you don't have to do anything.
There's no notes. There's no nothing. It just absolutely just automatically happens. She started getting paid two weeks faster.
Didn't change a thing. So I think those are probably my a couple of really big workflow ideas that I would recommend to any of our send teams.
Jennifer Steadman
Love it. It. Love it. Okay. Last theme here was all about different tools at AI and templates.
And really, one of the biggest questions was, like, what do we do next? Right? So what resources or tools should practices start with and where to improve claim outcomes? Think the biggest thing that I would say is every practice is different.
So what is good for one practice might not be what's best for the other. So really, think the biggest thing today is, like, communication. You need to be able to communicate with your team and ask them what is their biggest challenge, where do they see, you know, the most rejections or the challenges that they're facing in the practice, and start there first.
When you start with the challenges that your team is having, they're gonna have better buy in on any AI tools that you're gonna implement that's gonna help with those, and they're gonna have better buy in on future AI tools too knowing that they're going to support them because they've had a good experience and they've gone through everything. So I think, you know, AI isn't just the bright shiny object. It is what is important to your team. I would suggest to start there first. That would be my biggest suggestion.
Jill Nesbitt
All I can say is I completely agree one hundred percent. Plus, if you solve the biggest problem, you will unlock some time savings that now can be used perhaps in some other downstream projects. So I'll just echo, yes. Hundred percent agree.
Jennifer Steadman
Yeah. I think just like beating eating the biggest frog first. Right? Like, AI, with anything like that, with the claim rejections.
Right? Like how you said, start that at the beginning of your day. That's usually the things that we kinda procrast inate on because you're like, oh my gosh. This is gonna take me forever or it's a pain in the caboose.
But just start somewhere, eat the biggest frog first, and just have a conversation with your team and see what different tools you can utilize to help to support them and to support the patients ultimately at the end of the day. So any any closing remarks, Jill, before we before we end this for today?
Jill Nesbitt
I do. I'm gonna steal from an from this from another friend of mine who was talking to me when we were talking about denials and this follow-up conversation. And she said, you know, I sort of feel like it's this game. It's me versus the insurance company.
And she said, I know that they're gonna find a reason to deny and to delay and to cause some different things. And so she said, it is really up to me to think of what are the different scenarios that get my claims denied, and how can I make sure that I'm submitting everything, that I have processes in place, attachments, and narratives, and clinic like, all the things that we just talked about? She said, because as soon as I get a denial, I feel like now there's they get the second claim and it's a duplicate, or there's just other sort of gamesmanship that happens. And so she said it's me versus them, and my goal is to win this game by providing the right information at the right time so my claims get paid in a timely manner.
Jennifer Steadman
I love it. I love it. Love it. Love it. So on that amazing note, we will say we hope that this was really helpful for everyone.
We're gonna continue to use your questions to shape further webinars and just to provide other resources for you. So make sure that you stay involved and that you keep them coming. If you've missed anything from this session from this session that Jill and I did originally, we'll make sure that it's included in the recording is included in the follow-up. So hope you guys have a wonderful day, and you got this.
Want to learn more? Check out the full webinar.