May 21, 2019
There are several causes of incomplete treatment. The most frequent reason of incomplete treatment is financial issues. Usually the issue is that the patient could not pay their part when the treatment was started, meaning that the patient might choose not to complete their treatment. One of the most fundamental steps of resolving his issue is to collect the patient’s portion during the first appointment to raise the chances that they will return for their completion of treatment.
One of the biggest financial losses of a dental office is the inability to deliver a prosthesis to a patient. In this event, it may be possible to receive reimbursement by using proper documentation. Documentation of necessity for the service, evidence of attempts to complete the treatment, records of phone conversations with the patient or payer, failed appointments, cancelled appointments, lab prescriptions, and lab bills can all aid you in achieving partial reimbursement.
To submit a claim for partial reimbursement, list the CDT codes, write the full feel listed in the fee column on the claim form, and then write the start date in box 24. Be sure to stat that the services listed have in fact been started but were never completed and request special consideration for partial reimbursement. Make sure to also add a copy of the patient’s clinical record which contains cancelled and missed appointments.
Sometimes the payer will acknowledge the lack of the patient’s compliance and will allow for partial reimbursement for the incomplete services although it is important to keep in mind that the amount reimbursed and policies differ from payer to payer. It is also possible that some payers will not reimburse the procedures at all due to their policy. Despite this fact, it is still recommended to request reimbursement in the case of incomplete treatment as the process will only work to aid the dental office by allowing it to refund some of the lost expenditure in cases of incomplete treatment.