Tackling Dental Claim Denials: Key Stats and Strategies

Dental claim denials are a big problem. They can cost a lot and are hard to manage. Let’s look at some numbers and find ways to deal with them better.

Denial Statistics in Dentistry:

• General Trend: About 1 in 7 healthcare claims get denied. This trend affects dental practices too.

• Dental-Specific Data: A study of a big dental insurer showed 8% of dental claims get denied[3].

• Financial Impact: Denied claims in healthcare cost $262 billion a year[1]. This means lost money for dentists too.

• Cost of Reworking Claims: It costs $25 to fix a denied claim[1]. This adds up fast for a dental office.

• Un-resubmitted Claims: About 65% of denied claims are never fixed and resubmitted[1]. This is lost income for dentists.

Reasons for Denials:

• Coding Mistakes: Wrong or incomplete codes cause 32% of healthcare claim denials[1].

• Documentation Issues: Not having enough documentation is a common problem[1].

• Patient Information Errors: Mistakes in patient data or insurance eligibility cause 27% of denials[1].

How to Reduce Denials:

• Focus on Coding: Use the right codes. This is key to getting claims paid.

• Document Well: Make sure all details and paperwork are correct and complete.

• Check Patient Data: Always verify patient insurance information before treatment.

• Educate Your Team: Keep your staff trained on the latest billing practices and insurance changes[1].

The world 'Dental' was, is and never will be a good enough reason to deny or skip considering the mouth, and the rest of the medical needs of the living patient first" - Eric Chong

Dental Denials Don't Need to be Difficult

Dental claim denials are tough but manageable. Paying attention to coding, documentation, and patient data can make a big difference. Staying informed and training your team are also important.

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Citations:

[1] https://www.agd.org/constituent/news/2023/05/08/dental-insurance-a-time-for-disruption

[2] https://www.dentalclaimsupport.com/blog/dental-insurance-claims-reimbursed-2023

[3] https://pubmed.ncbi.nlm.nih.gov/25715040/

[4] https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/

[5] https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/practice/dental-insurance/ada_dental_insurance_reform_retroactive_denials.pdf

[6] https://therapybrands.com/blog/top-5-dental-procedures-denied-by-payers-and-why/