November 2017 Volume LIII Number 6

 
 
 
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Coding Corner: Tips for Writing Narratives

November 2017 Volume LII Number 6

Submitting dental claims correctly is crucial to gaining maximum reimbursement for the procedures you perform. A key part of the claims submission process frequently involves writing brief and informative narratives that accurately describe details of the procedure that the reported code does not explain to justify reimbursement.

Narrative writing may seem challenging and time consuming, but it does not have to be. Here are some tips for writing successful narratives without spending a lot of time on them.

DON’T WRITE TOO MUCH


The narrative writing process may be time consuming at first, but it pays off when reimbursement is received after the first submission. When a claim is rejected because there is not enough information provided with the initial submission, the time required to respond and provide additional information typically exceeds the time that would have been spent properly submitting the claim the first time.

If a narrative takes too long to write, it also takes too long to read. Narratives should always be brief and to the point. Remember, the dental benefits consultant reading the narrative is a knowledgeable dental professional who understands dental terms and common ab- breviations. A lengthy narrative explaining the need for the procedure is not necessary. You only need to provide the pertinent information in a precise manner.

KNOW WHAT TO WRITE

Writing a successful narrative begins with understanding the procedure provided and establishing the need for it. You should be able to succinctly describe the specific diagnosis or condition requiring treatment.

To determine the needed treatment, the doctor may perform a comprehensive oral evaluation, a radiographic examination, a periodontal examination, or determine the need for additional testing. With all of this information in hand and years of training, the doctor is able to readily make a clinical decision. However, not all of these pieces of information need to be submitted to the payer. Only infor- mation that is vital to the diagnosis of the patient’s condition and the reason for treatment should be included in a brief narrative. For example, if you are submitting a crown claim, the following information should be included:

• Any symptoms the patient is experiencing and the amount of time those symptoms have been present.
• The location and amount of existing decay.
• The amount of any remaining healthy tooth structure.
• If there is an existing restoration, the condition of the restoration and the surfaces involved.
• If any part of the tooth or restoration is fractured or missing a cusp.
• If a cusp is fractured or cracked off or is missing or severely undermined.
• If the tooth has cracked tooth syndrome and how it was diagnosed.

The clinical record must always include the same information provided to the payer in the narrative.

AVOID NARRATIVE CHECKLISTS


If you have the correct information, writing a successful narrative can be a simple and painless process. To make the process even easier, some practices use narrative checklists or choose from prewritten nar- ratives. However, this practice is not recommended.

Every narrative should be unique to the patient and procedure submitted. More detailed or customized information may be required to support necessity of the procedure. Submitting standard narratives often leads to requests for additional information, or worse, a denial.

Spending a little bit of extra time up front to develop a custom- ized narrative that describes the individual patient’s condition can result in more accurate and timely reimbursement. For those practices truly wishing to save time writing narratives, make sure that proper documentation and charting systems have been developed and imple- mented.

ELECTRONIC NARRATIVES

All narratives should be specific and concise; this is especially true for electronic narratives. Some practice management systems can transmit 150 to 200+ characters, but most clearinghouses and third- party payers only guarantee up to 80 characters will be transmitted to the payer. For this reason, it is best to limit electronic narratives to a total of 80 characters, including punctuation.

Electronic claims may pass through several stages before reaching their final destination, which increases the possibility that the original narrative may be truncated by the time it reaches the payer. When this happens, the payer may return the claim requesting the same information that was included with the original submission. For this reason, the longer the narrative, the higher the chance it will not be read in its entirety. If more than 80 characters are required, consider an electronic attachment.

In addition to being concise, electronic narratives must include enough detailed information to document the patient’s specific details necessary for the dental benefits consultant to approve the claim.

ADDITIONAL REVIEW


While most dental payers attempt to maximize the number of claims that are auto adjudicated, there will always be claims that require additional payer scrutiny before reimbursement is provided. Radiographs, photographs, narratives, and/or chart notes may be required to ensure that the procedure meets the plan document’s contractual requirements.

With this increase in the auto adjudication of dental claims comes an increase in the number of reimbursements provided in error. Therefore, payers perform post-payment audits to help identify unjustified reimbursements and request repayment of those claims. If clear documentation is not provided in the patient’s chart and/or radiographic images do not clearly demonstrate the need for treat- ment, payers often assume that past services were not necessary, and therefore, are not reimbursable. Regrettably, many doctors have been forced to provide large refunds to payers simply because they lacked adequate documentation proving that services were necessary.

Some payers now require chart notes instead of narratives for some claims. Therefore, the clinical chart notes must be thorough and concise. Any submitted supporting documentation should mirror what is documented in the clinical chart notes. If the facts and pertinent information are not included in the clinical chart note, it should not be submitted on a claim.

CONCLUSION

The treating doctor sees each patient one-on-one, hears the patient’s medical history and concerns, performs evaluations, and reviews first-hand any radiographic images and clinical photographs before making a diagnosis. When claims are submitted, all of this in- formation must be accurately reported to the payer using only dental codes and supporting documentation. Including a brief and descrip- tive narrative can help support the necessity of any dental procedure.

In many cases, merely documenting what service was performed is not enough; you must also document why the procedure was performed. Routinely including this information in narratives in a complete and concise way will increase the frequency of timely and maximum reimbursement from payers.

For more information, contact Dental Benefits Director Mary Essling at (312) 337-2169 or messling@aapd.org.

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