“We’ve already followed up on these claims. Why is the money still outstanding?”
The practice owner refers to a few similar balances in the accounts receivable aging report. The office manager also knows them by sight and checks the claim notes to determine what’s delaying the paycheck.
Initially, it seems like follow-up is now being carried out. However, further checking shows the issue one requires an attachment, one needs a payer reference without a follow-up date, and a number of them simply read “insurance contacted.”
The next step is not so clear in those notes, so that if someone else takes it up, he or she must go back and investigate it again. Meanwhile, patient calls and checkout questions are intruding on that work. The team reviews claims, but the same “banks” are still on the report.
Recognizing that pattern, the owner asks an important question: “How do we advance these claims with the team we have?”
This question is the starting point by which dental AR can be reduced within 90 days. The office should determine what each of these claims is waiting on, which individual will be making some of these follow-up calls, and when they will make these follow-up calls before taking any additional calls.
Why Were These Dental Insurance Claims Still Unpaid?
Here is an example of a failed practice (first review) in the following practice exercise. The team has been reaching out to insurers, but the notes do not contain details consistently enough of what’s required for a claim to proceed.
To determine the issue, the office manager takes each response from a payer and checks it against what they do following the response. That comparison shows where work has “stalled.”
Contact Was Recorded, but the Next Action Was Missing
According to one note, the insurer demanded documentation to support this claim. There is no indication in the record when it was sent or when it was received, however.
If there had been no such confirmation, another employee might call for a status update until the payer had received the attachment. The call would take a while without helping to clear up the cause of the delay.
It is thus decided that the claim has a specific next step: an examination of whether the document was submitted, which, if it was, is sent by the office manager, and confirmation of whether the document was received.
Ownership Became Unclear Between Staff Members
The review also reveals that claims involving a number of employees have been touched. In the absence of someone being in charge of the next step, every person needs to guess where the person before them stopped and take it from there.
In this type of situation, it becomes more difficult to make time for a follow-up report on insurance. Rather than using a clear handoff, staff repeat aspects of the investigation.
In response to this, a manager will designate an “owner” for the unresolved claim and schedule a follow-up date. The owner may request assistance from fellow team members, but should ensure the next step is accomplished.
Different Problems Were Sitting in the Same Queue
Finally, the manager knows that the oldest balances require a different response. Some may need documentation, others may need denial review, and others need clarification on the coverage of the health care plan that would be covering the healthcare service.
Most people wouldn’t want to go through them all to see them respond the same way, as that’s not treating them as individuals; treating them as one general call list would overlook that difference. She does this by listing the statements and arranging them into categories of what each group needs to do in order to provide an account for each statement.
To date, the review has not recovered any money but has given them the direction of where they need to go in order to recommence. Using that information, the office could then focus its dental AR efforts on the claims that have been reopened more often than they should be, instead of opening the very same claims repeatedly.
Which Dental AR Over 90 Days Should the Team Work First?
The reasons for delay noted will enable the office manager to prioritize claims for action. In this illustrative practice, she sheds the approach of impending deadlines before first seeking out claims which offer a clear action the team can take.
This makes it easier for her to generate an effective sequence to work through instead of she just walking from the top of the balance down.
Check Deadlines Before Choosing the Next Claim
She reviews the appropriate payer rules prior to work assignment for timely filing, copies of claims, and appeals. She writes the date that these requirements apply, as well as where they are coming from for each account.
If there are no deadlines, then double-checking it is the next task. This will avoid the team accruing the belief that each claim that has been outstanding more than 90 days has had offset equal to 90 days.
Once those checks are recorded, claims requiring immediate action are put in the holding line to the front of the queue.
Move Claims With Clear Next Steps Into a Work List
Then the manager sorts claims referring to an out-of-place item from those which must be investigated further. For instance, if a child asks the team to attach to a certain toy, they will have something specific for the team to address – as long as that is relevant today.
She appoints somebody to ensure the required document is submitted, ensure it follows the right path, and record the confirmation. The completion of that does not automatically mean that the claim will be paid; however, it remedies the known reason the claim has halted moving.
Claims submitted that have non-specific payer responses are placed on an investigation list separate from the cases that have been submitted on the payer’s form. This helps not to bog down unrelated work that is part of a complex account.
Match Each Account With the Right Action
To make the priorities easy to follow, the manager creates a short dental AR recovery work list:
| Claim situation | Next action | What to record |
| Filing or appeal deadline may be approaching | Verify the deadline and submission requirements | Source, due date, and assigned owner |
| Payer has requested documentation | Check the request and submit the required material | Submission confirmation and follow-up date |
| Denial reason needs review | Compare the response with the claim and applicable plan information | Findings and proposed next step |
| Payment is reported, but the balance remains open | Check the remittance, deposit, and account posting | Any mismatch and action needed |
Each account now is ‘for something more’ than “call insurance.” Staff is able to see what they have to do and what evidence to leave for the next review.
The other one is to figure out how to accommodate that work without the addition of staff. Once that is done, an insured focus follow-up needs to be incorporated into the team’s schedule.
How Can the Team Handle Insurance Follow-Up Without Extra Staff?
The office manager begins by carving out space in the current workload. For this illustrative practice, she walks through what tasks can be consolidated or shifted to another named person to be responsible for the queue and then dedicates some time to a specific follow-up exercise.
This makes the plan a realistic exercise: is it possible to work through something, but maintain the safety of patient-facing tasks?
Give Follow-Up a Place in the Schedule
Previously, staff who had claims were returning to unpaid claims when there was less work done. However, all the time saved was hard to save because of incoming phone calls, check-out questions, and insurance estimates.
The manager agrees with the team to schedule one member of the team to concentrate on dental AR recovery, and the person who will handle routine questions will be determined. Additionally, she reviews the schedule to see if other lower priority tasks can shift, so the arrangement doesn’t rely on the individual packing more into an overfull schedule.
Every time that requires a patient to interrupt those times, she looks at that setup. Schedule should align with the team’s capacity.
Prepare the Account Before Making the Call
When the time comes, the next aim is to make the best use of it. The assigned employee pre-visits the claim before calling the payer, checking previous feedback, documents or attachments, and question(s) awaiting a reply.
If a claim is expecting an attachment, for instance, a general status check is not enough. An employee should be prepared to document whether the document has been forwarded to the payer and if there is anything outstanding.
That preparation provides direction and focus to the conversation. The employee then documents the response, reference/ability number, next action, and follow-up date.
Group Similar Tasks, Then Leave a Clear Handoff
The manager bundles work together by the action necessary and not repeated, to avoid repeating the set-up. Documents can be blended together except for accounts that require clinical clarification, which are assigned to the proper reviewer.
But, an impending timeline always supersedes convenient categorization. The work list retains those exceptions so that they don’t get lost in the common work.
Before the completion of the follow-up period, the employee will update each account worked. In case of continuing by someone else, the notes indicate clearly where to start.
Once that’s done, the owner can ask a more relevant question than: How many calls did we make? The next review should identify any claims that advanced, balances still in play, and whether any money was collected.
How Does the Office Track Progress on Dental AR Over 90 Days?
Payments collected and outstanding claims are kept in a different section, and balance adjustments are done in that section. This is to let the owner know if follow-up is attracting collections or just shuffling material around the “top of the report.
Here, in this illustrative practice example, the manager records the starting accounts receivable aging report and the selection of the claims for a review. Next, she then reads the same stories so the team can tell what happened to each balance.
Separate Collected Payments From Other Balance Changes
If the balance is reduced, the manager asks the question “Why was the balance reduced?”. She keeps records of the various payment outcomes, including money received, an approved adjustment, and a transfer to patient responsibility.
For instance, if the balance is shifted from insurance to the patient ledger, this can decrease insurance AR without the practice collecting the money. Having that distinction clearly in evidence will prevent the report from overestimating dental AR recovery.
The team therefore uses a simple tracking table:
| Outcome | What the team records |
| Payment received | Amount received and matched to the account |
| Adjustment or write-off | Amount, reason, and approval |
| Transfer to patient responsibility | Amount and documented basis for the transfer |
| Claim still unresolved | Remaining balance, next action, owner, and follow-up date |
Follow the Starting Claims and New Aging Balances
An original claim list indicates if the recovery work is occurring or not. It doesn’t capture all changes in the practice’s age report, however, as there can be other unpaid balances that will be over 90 days in the review period.
Therefore, the manager refers to both perspectives. She monitors results for the starting claims as well as balances newly making it into dental AR in the following 90 days separately.
This will help her to differentiate between the two: the older claim that is not addressed and the newer claim which should be addressed first. Known as the “whole child” approach, the team can then examine one at a time, rather than focusing on the overall balance.
Use Unresolved Claims to Guide the Next Review
If a claim is open, the manager details whether the promised next step has taken place. She checks in for an attachment, and then assigns the next follow-up if no payer response is provided by the original overdue attachment.
If the same difficulty is mentioned in multiple accounts, she takes it to the person who can solve this difficulty. It may involve rereading a documentation prompt and/or discussing a payer instruction or posting error.
There is no actual documentation of collection products from the story, although there is documentation from the measurement plan providing the office with a solid method to assess their work. It also illustrates the locations of the existing team where they need more billing assistance.
How Can Virtual Dental Billing Support Your AR Follow-Up?
Virtual Dental Billing offers dental accounts receivable recovery services for practices that need help following up on unpaid claims. For an office like the one in this illustrative story, the next step would be identifying which unresolved accounts need that support.
The manager already has a useful starting point: a claim list showing the outstanding balance, previous actions, and current obstacle. Sharing that information gives the billing team context without requiring office staff to explain every account from the beginning.
If your dental practice is struggling to follow up on past-due claims, then Virtual Dental Billing is your answer to dental accounts receivable recovery. The next step for an office like this illustrative story’s office would be to determine which unpaid accounts require such support.
Noting that they have a useful starting point: the claim list with the outstanding balance, previous actions, and current obstacle, as shown by the manager. Providing that information confers context on the billing team without them having to explain every account from the get-go.
Agree on Who Handles the Next Action
When giving over follow-up, outline the tasks the billing team will be able to do and the questions that need to be answered by the practice. For instance, payers might follow up and find that clinical documentation is needed to observe the treating provider’s behavior.
That will keep work moving and help the questions all have a clear path to follow. Ensure a joint agreement is set on how claim updates and document requests will be communicated, along with any issues that have not been resolved, in order to keep everyone visible.
Keep Reporting Focused on Collections
The same reporting procedures to be followed when the office does it should also apply when supporting externally. Separate out payments received from adjustments, write-offs, and transfers to allow the owner to evaluate the production of the recovery work.
This helps to avoid any confusion about “without extra staff”: while outsourcing can help increase capacities for follow-up, it will involve service costs and coordination, so it’s not “without extra staff”.
Once the role and the reporting relationship are agreed, the practice will be able to determine if additional support makes sense as it relates to their workloads.
