NEA also identifies the three most troublesome claims that are most often rejected by payers after the first submission.
ATLANTA – Feb. 1, 2018 — NEA Powered by Vyne, the leading provider of solutions for electronic submission of supporting documentation and claim attachments to dental practices in the United States, today announces the results of a recent study it conducted to determine dental practice pain points and the most pressing issues practices face with claims management. Among key data points surveyed, the study revealed the most troublesome CDT procedure codes for practices – those requiring the most supporting documentation for adjudication and those most often rejected at first pass.
According to the August 2017 survey of its clients, NEA identified D4341, D2740 and D2950 as the top three claim procedure codes requiring the most supporting documentation for adjudication, and the claims most often rejected by payers after first submission.
Descriptions of the codes include:
- D4341: Periodontal scaling and root planing, per quadrant, is described as involving “instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces
- D2740: Crown-porcelain/ceramic substrate
- D2950: Core buildup, including any pins when required
Specifically code D4341 is causing trouble for practices because more dentists and hygienists are using periodontal scaling and root planing as treatments to help patients control their periodontal disease. Unfortunately, according to survey respondents, many practices also are experiencing insurance-benefit issues relating to the claim number. While most indemnity carriers cover D4341, restrictions and requirements for payment are abundant.
Supporting claims documentation
More than 40 percent of respondents said that, on average, 10 percent to 25 percent of their claims require supporting documentation or attachments, while 36 percent said that between 26 percent and 50 percent of their claims require additional documentation.
Practice pain points
NEA asked practice leaders what their practice’s greatest pain points were in regard to dealing with insurance. While the responses varied, there was significant feedback suggesting there are more than a few issues troubling even the best of practices. Culling through the data, 10 most commonly reported issues emerged, however. In no particular order of importance, they include:
- Claims processing delays
- Following up on claims not paid/rejected claims; rejections causing slower turn around payments
- Verifying eligibility; verifying coverages prior to procedures then being told the procedure is not covered after the practice received verification that it is
- Payers claiming they did not receive documents that were sent
- Reimbursement levels – lower than originally expected
- Rejections/requests for additional information
- Long hold times/not getting a person on the phone/payer’s automated customer support systems
- Coordination of benefits
- Dental insurance downgrades
- Medical billing for dental – challenges of CDT vs CPT coding; what gets billed medical versus dental?
One area of immense encouragement from the dental community is in regard to data security efforts taken by practice administrators. Fifty (50) percent of respondents said they use secure email in their practices to communicate with referring or other dental specialists. This is especially important given the enormous security concerns regarding potential for breach of health information in electronic communications.
An area of concern did arise, however. About 20 percent of respondents said that they still use standard (non-secure) email for communications, which is an obvious compliance risk for their practice and the data they manage.
“The insurance pain points and claim-related issues faced by dental practices can seem overwhelming to even the most tech-savvy and experienced practices, said Robert Patrick, Vyne’s president of dental operations. “Even those using technology to alleviate the burdens of claim processing are not immune to the challenges of dealing with insurance. Persistence is key when it comes to managing A/R and insurance claims. Tools like FastAttach from NEA help alleviate the supporting documentation headaches for more than 55,000 dental practice offices nationwide.”
An established brand for more than 20 years, NEA continues to lead the dental market with its FastAttach solution for secure electronic document submission, having exchanged hundreds of millions of claim attachments between dental practices and payers since the product’s inception.
NEA also ensures that payers are able to request additional information, and dental care givers can immediately respond to the request by providing additional patient information by using a suite of capture methods, including virtual print, screen import, scanned images, file import and patented mobile device image capture — the most complete array of tools available for secure electronic attachments in dental care.
View the NEA Client Survey infographic for a visual representation of the results.
Vyne™ is the industry leader in secure health information exchange and electronic healthcare communication management. The company’s robust technology platform facilitates the electronic capture, storage and submission of healthcare data in any form – voice, fax, image, data or electronic document. Vyne’s proven solutions connect disconnected data to close gaps in documentation and improve the continuum of care through a more complete and fully accessible patient record. Outcomes include improved financial strength, operational performance and patient experience for medical and dental providers and payers. For more information, visit vynecorp.com.