Clinical Notes and How They Play a Part in Your Insurance Claim Success
The relationship between your clinical staff and the front office team is everything when navigating the world of insurance processing. Often, back office or clinical staff members are unaware of how vital their roles are in how an office can effectively process insurance claims in the fastest, most efficient timeframe possible.
The importance that the clinical staff member has in notating in their procedure clinical notes of all of the details…suggestions that the dental provider made to the patient, listing the options that the patient has to decide on to address the dental issue, and then detailing specifically every single procedure that was actually rendered on that date of service cannot be stressed enough in its importance.
Challenges Faced
I believe that whether you are a dental office manager that is instrumental in the processing of your practice’s claims or the insurance coordinator of the office, it is important that you are relaying to your back office team the struggles that you go through when processing insurance claims when the information you are needing to relay on an insurance claim form or items you are needing to attach to the claim are not in the patient’s chart.
Too often, front office staff members complain that the information they are needing isn’t in the chart…that they can’t find a pre-op x-ray of a certain tooth that the dentist rendered treatment on, etc., but fail to really take a breath…collect themselves…and take the time to explain all that goes into the processing of the insurance at your office for specific procedures.
More so than ever before, insurance companies are in the business of denying claims. It is vital that the entire dental team be made aware of all the details needed for an insurance claim to be processed in the quickest way possible.
I have found that a good way to explain to a clinical staff member what they need to notate and obtain during a patient’s dental appointment would be to say that I should be able to read your clinical notes, look over your pre-op x-rays taken, and know the story of that visit from beginning to the end.
Too often, staff members, whether you are working in the front or in the back office, begin to rely too much on auto-generated paragraphs that are attached to specific service codes that automatically populate the clinical note section for an appointment. They leave out vital details like “what was the reasoning behind the dentist deciding that this procedure was a necessity, “or “that a tooth was fractured into the furcation/non-restorable,” or even the notating of the dentist’s own words when talking to the patient about the treatment he recommends.
Team Meetings
A wonderful team meeting would be for a front office leader to go over, whether it be certain items that should be notated in the clinical note paragraph that are used to relay to an insurance company on why a crown, for instance, was necessary over a large, four surface filling…the requirement to have a preoperative x-ray of any tooth that may develop into needing a full-coverage crown etc.
While it is frustrating not to have the information you need in the patient’s chart, when it gets down to actually submitting the insurance claim, whether that be images or notes from the appointment, often the clinical staff has not been educated from the front office aspect on the reality of true claim denials and what was needed to process the claims, but was not obtained.
There have been countless conversations over the years that I have heard from dental team members about the purpose of team meetings, weekly or even morning huddles. The meeting sessions tend to become repetitive and really not filled with new information or an opportunity to grow together as intended.
Certainly, a fabulous topic that could be used for a successful team meeting over an extended blocked out time for lunch or a set aside couple of hours out of a practice’s schedule would be to discuss the detailed items that are so very important for a clinical staff member to obtain during a patient’s visit for treatment.
I have also found that the dentist needs to be very aware of the reality of the insurance claims world and what is required to submit with certain procedures in order for them to pay in a timely fashion or even pay at all.
Importance of Praising Your Clinical Staff
I am a very big advocate for praising my clinical staff for their clinical notes and the detail they put into them during patient appointments. Making clinical staff aware of the constant, ever-changing demands of insurance claim processing benefits the entire practice and certainly the bottom line.
Working Together
The front and clinical staff members work cohesively together to ultimately have claims sent out from the practice quickly, with all of the needed information required for the claim to process on the first submission. Attached is a huge, positive practice builder.
Your patients will be grateful for the smooth processing of their claim, and it will definitely add to the morale of the office in general when each staff member is meticulous about their role and how important it is.
About the Author
Laura Tucker, MAADOM
I am in my 32nd year as the office manager for Floyd Simon, Jr., DDS in Clinton, Oklahoma. Current board member of our DPLN group in OKC, Oklahoma. Current Practice Administrator for Brett R. Warn, DDS in Lawton, Oklahoma.
Laura is a trainer in various dental offices for clinical/front office staff members.
Laura has 3 beautiful children – Mitchell, Micah, and Manning- and is a current MAADOM distinction holder.
