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Five Essential Steps to Managing Your Insurance Cycle

by Teresa Duncan

Running the insurance side of the practice effectively means systems, habits and follow-up. There’s just no other way around it. You are a piece of a larger pie that is called “revenue cycle management.” While we don’t use this term as frequently as the medical world does, it’s a perfect description of an insurance coordinator’s job.

Let’s look at the steps to put into place:

1. Verification of eligibility and benefits

  • Patients should have valid insurance information on file. You can only make this happen if you check the eligibility for all patients. 48 hours prior to the appointment is recommended.
  • Benefits should be updated if the plan differs from the previous year.
  • Use your software to make this task as automated as possible.

2. Communication among the entire team 

  • If a patient will reach their yearly benefit, then plan to discuss financial options.
  • Will a procedure not be covered? Inform the patient prior to treatment.
  • Notification of patient expense is necessary to earn and keep the patient’s trust in your practice.

3. Submit your claims daily

  • Utilize your software to send your claims on their way. The faster they’re sent, the faster they’re paid.
  • Use electronic attachments for images, narratives, primary insurance EOBs and to send in requested additional information.

4. Managing insurance payments and writeoffs 

  • Reconcile your checks and electronic payments as often as possible. This is your cash flow.
  • Manage your write-offs by verifying that the accurate in-network fee schedule was used.
  • Write-offs are a great way to lose money. Check and double-check their need.

5. Insurance receivables management 

  • Review the claims transmission report on a daily basis. Quick denials can be found here and are often easily correctable.
  • Insurance aging reports should be run and reviewed at least bi-weekly. If you are in clean-up mode then every two days is necessary until you catch up.

Does this seem like many steps to you? Honestly, it is. You have software to make it easier but there is still considerable effort and brain power needed to keep your insurance system humming along.

As these systems become habit, you’ll notice that insurance revenue will increase and become more regular. If it becomes irregular, then you have a breakdown in the process. Review the steps above to ensure that your system can go back to being efficient and profitable.

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Teresa Duncan

Teresa Duncan is an international speaker who focuses on insurance and management issues. She is the author of Moving Your Patients to Yes: Easy Insurance Conversations and has contributed to several ADA publications. Her memberships include the National Speakers Association and the National Association of Dental Plans. She holds a Master’s Degree in Healthcare Management.

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