7 Ways To Reduce Claim Denials For Dentists

In recent years, claim denials have threatened to strip dentists of their hard-earned money, and place an additional administrative burden on their shoulders. More than just a nuisance, claim denials drain revenue and take a significant toll on productivity, neither of which are conducive to a successful dental practice. The good news? The majority of claim denials are totally avoidable, especially if you work with accounting services for dentists, and here are 7 effective ways for dentists to reduce denied claims:

1. Get insurance confirmation from patients before every appointment

Take the time to verify active coverage on the day of the appointment, check annual maximums, waiting times and deductibles, and use payer portals online as well as same-day checks for eligibility. Remember that even patients who have been visiting your practice for many months or years, may have insurance plans that have changed.

• Enhance the level of accuracy for all data entered for claims

Make sure that before a claim is submitted, you double-check the demographic information for patients. You can also use intake forms that are electronic and which complete data automatically to avoid human error, as well as train your staff in the risks involved with inaccurate data. All it takes is one digit entered wrongly on a claim, and a denial can take forever to rectify.

• Stay updated with annual updates to coding and compliance

Keep a close eye on when updates are issued to coding and compliance, and put them into place immediately. You should also avoid upcoding and downcoding to reduce compliance issues. Errors with coding are among the most common and avoidable reasons for a claim to be denied.

• Always attach necessary documentation to support medical necessity

Leaving out such things as treatment notes, diagnostic images and narratives for patient services rendered, is almost always a guarantee that a claim will be challenged, and ultimately, denied. If a patient has made a claim for a certain procedure that isn’t backed up with the appropriate evidence, in most instances, it will likely be rejected.

• Ensure that claims are filed promptly

Make sure there is an internal policy in place mandating that all claims are submitted within 24-48 hours following treatment. For quicker delivery, you can use real-time electronic data interchange (EDI) or batch submission systems for a swifter delivery. Remember that the quicker you submit a claim, the lower the risk of missing a deadline for filing, and the quicker you’ll get your payment.

• Be prompt when tracking and appealing denials

A denial log is a great way to keep track of trends and problems that consistently recur, and quickly appealing valid claims that have been denied with all necessary documentation, can help greatly. You can also keep a close, daily eye on Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA). When submitted early and with all necessary documentation, denial appeals are likely to be far more effective.

• Use claim scrubbing tools powered by AI

By reducing manual reviews, speeding up the turnaround of claims, and providing you with notifications of claims predicted to be high-risk as a result of payer-specific rules, billing software powered by AI can identify and flag up potential issues before a claim is submitted. Working with dental accounting experts to devise a strategy for preventing claim denials, as opposed to dealing with them once they’ve occurred, is the best solution for dental practices in 2025. Once a strategy has been formulated that takes into account the 7 points outlined here, your practice can start enjoying a reduction in the rate of denials, enhanced cashflow, and a practice that’s financially sound.