Technology has improved many of the clinical and administrative aspects of running a dental practice, yet the manual process of verifying insurance has remained relatively static. During the past few years, I have spoken with hundreds of dental office managers and team members and found that the process in each office is virtually the same. It’s what one veteran treatment coordinator accurately described as “hand-to-hand combat.” Thankfully, innovative solutions that can help alleviate this massive administrative burden are now available.
When I finished my residency in 2013, I started practicing in an old-school dental office. It was a high-volume, insurance-heavy practice that used paper charts, wrote paper checks, and filed paper claims. Every day, the mighty front desk team verified benefits for dozens of patients—calling carriers, visiting countless websites, and waiting for faxes to come through. When the last appointment of the day was complete, we would go home, rest, and do it all over again the following day.
Related reading
Electronic claim payments: EFT via ACH or VCCs?
My assumption was that more modern dental offices did this more efficiently than we did. I thought surely other practices with 3D scanners and cloud-based systems weren’t looking up patient eligibility and insurance details one by one. I was wrong.
As technological innovation has made many aspects of running a practice easier, this particular function seems to get more challenging. Everybody is short staffed. Practices have fewer team members to make these calls, and carriers have less bandwidth to answer them. According to the American Dental Association Health Policy Institute, more than 70% of owner dentists say recruiting administrative staff is extremely or very challenging.1 In fact, last year the ADA explored solutions specifically for the systemic industry-wide problem of benefits verification, a testament to how greatly dental offices struggle with this.2
Why is this problem so challenging?
The carrier landscape is incredibly fragmented, with many companies offering a mind-boggling number of plans. Despite attempts at standardization (i.e., electronic data interchange [EDI] and X12 messaging formatting standard), the information is highly variable and often lacks important details.
For years, there was only one solution to this challenge: pay somebody else to do it. Companies such as eAssist provide outsourced services for various office functions, including insurance verification. Other versions have popped up through the years, many of which operate on overseas call centers. These services can certainly get the job done but rely on humans, and thus are costly and can be prone to error.
Technology is finally coming to the rescue. Solutions such as AirPay can automate this process for front desk teams, verifying eligibility and pulling benefits breakdowns for the entire schedule and in real time. These types of products are not limited by the abilities of humans to make phone inquiries or the capacity of carriers to accommodate them. Electronic data can seamlessly enter into practice management software and be easily filtered to provide actionable data at the right time.
Based on our interviews, it appears that for every 10 insurance patients on the schedule, it takes 45 to 60 minutes to pull the necessary benefits details to register patients. Imagine the impact that offloading this function has on practices that see 30, 50, or 100-plus patients a day. Team members can focus on assisting patients without a phone receiver glued to their ear and spend more time on growth functions such as recall.
There are certainly challenges ahead. The electronic benefits details provided can vary drastically from carrier to carrier. Also, it can be difficult to introduce new solutions into daily workflows that have been repeated for years and sometimes decades.
Between innovation from forward-thinking companies and industrywide initiatives from our professional associations, change is coming.
Editor's note: This article appeared in the May 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.References
1. Versaci MB. Understaffed and ready to hire, dentists face applicant shortages as they emerge from COVID-19 pandemic. American Dental Association. June 9, 2021. https://www.ada.org/publications/ada-news/2021/june/dentists-face-applicant-shortages-as-they-emerge-from-covid-19-pandemic
2. Burger D. Association moves to develop unified system to verify coverage, obtain cost estimates in real-time. American Dental Association. January 8, 2021. https://www.ada.org/en/publications/ada-news/2021/january/association-moves-to-develop-unified-system-to-verify-coverage
