Increasing Dental Insurance Documentation Demands

Here at Dental Didactics CE we receive tons of emails as a dental continuing education provider expressing various concerns about the dental profession industry standards, especially related to insurance issues. Recently we have been flooded with emails regarding increasing difficulties with practices being reimbursed for services by dental insurance companies. Treatment documentation demands have been rising year over year, especially for crown and bridge, dental implant, and anterior composite services. Claims are being regularly rejected for a variety of reasons linked to "inadequate documentation". The phrase "a picture is worth a thousand words" is becoming more and more frequently voiced in dental offices throughout the country. Besides the historically customary (now mandatory) periapical x-ray and extensive narrative regarding each tooth treated, it is becoming necessary to attach a clinical photograph to various claims to further document the need for services. The most common complaint we hear is the failure to accept narratives for cervical Class V composites which are not (as is usually the case) distinctly observable on bitewing, periapical, or panoramic x-rays. Many offices are now forced to routinely take a digital photo with either intraoral camera or cell phone to fully document and display the pathology to satisfy claims reviewers. Unfortunately, most insurers are not covering payment for those photos (submitted as dental code D0350) and the cost is shouldered by the patients, who often bitterly complain about the additional charge. This is an instance where excellent communication skills are needed by staff to patiently explain the increasing difficulty of obtaining dental insurance payments, and emphasizing to the patient that the practice is going out of its way to maximize their dental benefits. Most offices report that after hearing the full story the patients are angered by the insurer's lack of trust in the dentist reporting the treatment, and are sympathetic with the dentist jumping through increasingly demanding hoops to obtain payment on behalf of the patient. This can actually turn into a great opportunity to bond with your patients over everyone's increasing frustration with corporate insurance policies getting in the way of care.