Resources

How to Decide Between Prep Date and Seat Date for Claims Submission

Filing claims on either prep date or seat date is legitimate. Which one to choose depends on selecting the set of pros and cons that works best for your office. The main concern arises when treatment spans two policy years, and offices should take steps to prevent these issues.

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The Most Common Challenges: Understanding the Insurance Challenge

The prior article discussed how to gather great information—through verifications and breakdowns—to use when creating treatment estimates for patients. The next step is learning how to process that information correctly. Insurance can be extremely complex, but thankfully, it’s also highly predictable. It only seems unpredictable when it’s not well understood, which is quite common.

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The Most Common Challenges: Verification and Breakdown Challenge

Getting information from an insurance company can be tedious, difficult, time-consuming, and just an overall pain in the rear. Because of this, most offices tend to try to bypass or skip this step, which leads to many other issues: poor collections, inaccurate estimates, unhappy patients, negative atmosphere, and more.

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The Most Common Challenges: The Estimating Challenge

Most offices routinely use the term “estimate” when presenting treatment plans. However, the way we, as dental professionals, understand the term is often very different from how patients perceive it. So when they receive a surprise bill later, it can feel like a betrayal. Patients typically work within a fixed monthly budget, and an unexpected bill can throw that off entirely.

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The Most Common Challenges: Collecting Payment Owed

I answer questions daily from dentists and team members needing help on anything from insurance to practice management. Most tend to have similar queries, so in this series, I plan to address the most common questions that plague dental offices.

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Periodontal Documentation: Eliminate Denials and Get Paid for the Care You Provide

Periodontal treatment remains one of the most commonly underdiagnosed and under-reimbursed areas in dentistry. Most denials I see can be traced back to incomplete or inconsistent charting, unclear narratives, or incorrect coding.

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Are You Using the Right Exam Code?

Mixing up D0150 and D0180 could be costing your practice. One reflects a healthy mouth, the other signals periodontal concerns—and comes with significantly higher reimbursement. Learn the simple switch that can boost revenue without extra documentation.

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Responding to Insurance Refund Demands After Patient Complaints

Insurance refund demand after a patient complaint? Don’t rush to pay. These requests are often based on misunderstanding and can usually be challenged with the right documentation and strategy. Learn how to push back effectively, prevent future complaints with smarter post-SRP follow-ups and protect both your revenue and reputation.

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Breakdowns and Estimates: Are You Using the Correct Fee Schedule? (INN, UCR, MAC)

Insurance can be complex and highly detailed on a good day, and therefore easy to get tripped up even for the most experienced dental insurance coordinators. A pitfall we have seen of late occurs when offices are compiling their breakdowns and estimates and inadvertently use an incorrect “fee schedule.”

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Make Sure Coding Matches Lab Cases and Fees

Here are some common mis-coding scenarios where you’ll want to always “double-check.

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Navigating Year End Considerations in Dental Offices

As the year draws to a close, dental offices must consider a range of factors to ensure their practice operates efficiently and effectively. This article delves into key aspects, including insurance, patient scheduling, equipment management, and the use of marketing letters, offering valuable insights and guidance. 

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Top 10 Ways to Improve Savings and Profitability in Your Dental Office

With the current economic market, it has never been more imperative to assess our business practices and find ways to counter the rising costs of overhead expenses as well as stagnant insurance fees.  A review of your expenses should be done more than once a year to make sure you aren’t overspending.

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Insurance Forms

Hygienist Training Guide

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Denture Timelines - Levels 1-3

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Treatment Plan Template

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Crown Narrative Form

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Insurance Overpayment Letter

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Insurance Letter Deny Refund

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Patient Forms

Do Not Bill to Insurance - Patient HIPAA Restriction Request Form

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1) Patient Form - Getting To Know You As Our Patient

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2) Patient Form - Financial and Insurance Form

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3) Patient Form - Medical History

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4) Patient Form - Dental History

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5) Patient Form - Informed Consent for Services

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Consent for Use and Disclosure of Health Information

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Dental History Form

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Secondary Insurance

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Update Medical History

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Consent Forms

Consent for Use and Disclosure of Health Information

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In Office Bleaching Consent Form

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Informational Informed Consent: Oral Sedation

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Oral Sedation Informed Consent

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Perio Informed Refusal

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Employment Forms

Reference Letter Sample

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I-9 Form

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W-4 Form

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Employee Key Agreement Form

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General Team Expectations

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Team Dental Benefits Option 2

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Practice Management

Hygienist Training Guide

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End of Year Letters

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Bleaching Syringe Log

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Bleaching Trays Tracking Sheet

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Lab Case Tracking

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Lab Cases

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Limited Exam Checklist

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Limited Warranty

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Medical Consult Request

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Refund - Liability Release

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School/Work Excuse

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X-Ray Protocol

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XRay Training- Anterior PAs

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Sample Hygiene Clinical Note for SRP

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Non-Covered Services by State

Laws preventing insurance companies from dictating fees for non-covered services.

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Interpreting Non-Covered Services Laws - Cheat Sheets

(Member Benefit) Breakdown interpretation of how to understand Non-Covered Service laws in each state.

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Assignment of Benefit Laws

State laws requiring insurance companies to send AOB to OON providers when requested.

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Unclaimed Property

When patient credits must be reported to the state.

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Insurance Recoupment Laws

Insurance recoupment laws encompass several key concepts. It is essential for stakeholders to be aware of these nuances to ensure compliance within the complex landscape of insurance recoupment.

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Insurance Commissioner Contacts by State

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Internal Coding Examples

Many procedures and visits are not covered by ADA codes, hence the need for offices to create a good set of internal codes for both tracking and patient billing purposes. Here is a basic list to help you think about what codes you may need to create for your office's function.

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How to Handle an Appeal Chart

Let´s face it, insurance claims get denied. When it happens, it´s important to understand what recourse you have. This chart lists the most common EOB denial language, whether an appeal can potentially change the outcome, and what specific action is recommended.

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Secondary Insurance Calculator

This calculator is designed to assist teams with correctly inputting reimbursements from multiple insurance companies. It will help you determine the correct input and write offs for accounts and claims that involve secondary insurance.

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Buy the Book! Understanding Dental Insurance: A Guide For Dentists and Their Teams

This book, written by Dr. Travis Campbell, serves as an additional training tool offering in-depth information for the more experienced, as well as a quick “look up” to have in your office for anyone with questions about dental insurance. Packed with information, illustrations, examples, tips and case studies, this guide covers every aspect of dental insurance from claims for simple fillings to complex hybrid denture and implant cases in real life situations.

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Old habits die hard. If your current dental insurance claims process hasn’t been updated, it’s likely outdated.

Up-to-date, ongoing billing education isn’t just helpful, it’s essential for your practice to thrive.

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