- A short, concise description of the treatment performed
- Supporting images or documentation
- The original claim identification number if an appeal
You may be tempted to send as much documentation as possible, including copies of charts and multiple copies of radiographs. Rest assured that you do not need to send large amounts of information to the insurance company. They really don't want to read through pages and pages of notes to justify a crown. Nor do they want to see our photocopied checklists of what could possibly be wrong with the tooth. These are not efficient or effective in having our claims paid.
Avoid layman's terms
A well-written narrative can move your claim along successfully in the insurance process. We speak to our patients in layman's terms, but avoid this in your narrative. You are writing this to be read by another dental professional. Instead of writing "lots of decay -- loose filling," be more specific, as in the following example:
Teresa Duncan is an international speaker who focuses on revenue, dental insurance, and management issues.
"Tooth #30 had open margins around existing amalgam filling. Recurrent decay was present upon removal of filling."
This narrative is short enough to fit into box #35 (Remarks). However, I highly recommend sending your attachments electronically to reduce the time needed for claim approval. Information sent by postal mail will then be scanned into electronic format anyway. And it may not be as high quality as if you were to scan or capture the image yourself.
It is also important to be sure your staff is familiar with the terms used to describe dental conditions. One of the easiest ways to do this is to work with them when they begin to write narratives. You can help them with the terms needed, such as mesiobuccal, distolingual, bruxism, retention, and missing cusps. Once they get used to writing in this language, it will become second nature.
Be sure what is being submitted on your behalf is accurate. I recommend reviewing the narratives to make sure it most accurately represents the patient's condition. This is also a good time to also compare notes on the images being sent with the claim. As an exercise, have your staff pick out images that they think most accurately represent the tooth's condition. Your staff will quickly become more confident as they see the clinical condition of the tooth and better understand why you are performing the treatment. A good narrative writer does not need to be in a clinical position but must know clinical terms and procedures.
When it comes to writing fantastic narratives, it takes a team effort between the staff and the doctor. Take a deep breath and approach the job differently -- in this case, practice does make perfect!
Teresa Duncan is an international speaker who focuses on revenue, dental insurance, and management issues. For more information or to contact her, visit her Odyssey Management website.
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