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When to Hire an Insurance Coordinator

As your dental practice grows, you may find that you need to grow your team. Amol Nirgudkar, CEO of Patient Prism, asks dental insurance expert Teresa Duncan to share her insight into when the time is right to hire a dental insurance coordinator.

“For years the pushback was I don't want to pay somebody to handle insurance when I'm already taking a write off,” says Duncan. “What I see in many practices is a busy receptionist performing many tasks, including insurance coordination. It's too much, and we wonder why we get burnout. So, I think in today's day and age, if you have a decent number of plans (whether you're participating or not), you need someone to handle the claims, the appeals, checking on benefits, and talking to the patients. There's a whole list of things that an insurance coordinator can do."

All too often, someone becomes the insurance coordinator by accident. They are not usually trained for it. In fact, Duncan reports that one of the most popular courses she provides at dental association meetings is called “The Accidental Insurance Coordinator.”

Duncan recommends dentists look at their front desk team. If the dental receptionists are spending a lot of their time on the phone with insurance companies, it's time to hire someone who can dedicate their time to insurance. Receptionists should be speaking with patients and potential patients, not speaking or on hold with insurance companies. “If somebody is going to be talking to the insurance company, have them sit in a different location (than the front desk), or maybe outsource it, but it has to be somebody who is dedicated and can handle it all day long instead of being interrupted.”

An insurance coordinator might be combined with the role of treatment plan coordinator. “I think it’s a good idea,” says Duncan, “because they are the most familiar with the benefits. In a large group, that might not make sense, but if it’s a typical solo practitioner, that's actually the perfect role--a combined insurance and treatment coordinator.

Nirgudkar has witnessed a lot of dentists pushing back on the idea, fearing the overhead.  “They aren’t measuring their collection and the number of denials they are getting. If you really measure that cost, the insurance coordinator more than pays for herself or himself.”

Dental practice owners frequently ask Duncan, “Why am I writing so many refund checks? Why do I have so many adjustments?” Duncan said the main reason is because they don't have one person dedicated to the process, “double checking on things.”

Both Nirgudkar and Dunca agree that hiring an insurance coordinator more than pays for itself. Not only are there too many write-offs and patient complaints, but compliance comes into play. Without training and annual updates, a practice can bill incorrectly.

“Many pick a code they know is covered by the plan,” says Duncan, “even though they are submitting for a totally different procedure. When I audit offices and point out they cannot do this, I hear, ‘Nobody told me I couldn’t do this.’ In the past, I’ve seen offices where everybody gets upgraded on a crown. Everybody gets a buildup. It’s important to stay in compliance.”

Staying up-to-date and well-trained in how to comply, how to optimize, how to collect and how to appeal is a full-time job. Staying up-to-date is a tough task in itself because insurance plans can change every year. “When I was doing this 20 years ago, it was pretty much the same for five to six years,” says Duncan. “Nowadays, it's almost like taking yearly OSHA CE. You've got to take an insurance class, whether it's me or any of the other experts out there. You have to take a yearly class and stay on top of it.”

Having been a business advisor to hundreds of practices and growing DSOs, Nirgudkar asserts that dental offices should hire ahead of their growth and make sure the right team is in place. Becoming an insurance coordinator shouldn’t be by accident.

About this Industry Leader:

Teresa Duncan, M.S. - Profile Pic

Teresa Duncan, M.S.

Dental Insurance Expert

Teresa is founder of Odyssey Management, author of Moving Your Patients to Yes: Easy Insurance Conversations, and a contributing author to the ADA's CDT 2017 Companion Guide. Teresa is a frequent contributor to The Observer, The Progressive Dentist, and Dr. Bicuspid publications. She served as a founding Trustee for the auxiliary-learning focused DALE Foundation. Teresa is a member of the Academy of Dental Management Consultants and the National Speakers Association. She has been named one of the Top 25 Women in Dentistry by Dental Products Report Magazine and is recognized as a Leader in Consulting by Dentistry Today. Most recently she provided consulting assistance in the development of the American Dental Association's Guidelines for Practice Success™. Teresa received her master's degree in Healthcare Management from Marymount University.

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