Technology is rapidly evolving, and the dental industry is evolving rapidly too. While tools and techniques for rendering services and procedures have advanced, the practice must also automate the billing and claims process with dental billing software solutions.
It needs to transition from traditional systems to modern and technologically advanced solutions that can streamline the billing process. It can now embrace tech-based solutions to automate the billing and claim submissions process. This ensures greater accuracy and negligible claim rejections.
Some ways in which technology and dental billing software solutions can play a role in billing and claims are as follows:
AI is exponentially growing and making its presence in all facets of the dental care industry. Some ways in which AI is making an impact are as follows.
As mentioned, technology is advancing and must be embraced by the dental healthcare sector at the earliest. Advanced technology solutions are easily available, and the dental practice must initially automate the scheduling and registration process. The advantage that these solutions offer is the ability to integrate with the existing practice management software, thereby considerably enhancing the daily routine operations.
AI-based solutions transform the process of dental billing and claims by easier and quicker formatting, storage, and retrieval of reports and patient data. They are designed to understand and respond based on the patient’s requirements. Routine interaction with the integrated practice management software or electronic health records simulates the software to gauge individual patient requirements and function accordingly.
Today, a large majority of dental claims can go through the auto-adjudication process. Claims with major services need reviews by professionals or dental claims consultants. These experts review all claims that include a narrative in the remarks portion of the claim form or if the submissions have been sent as electronic attachments.
The role of AI can be significant for a significant component of a dental practice. AI can accelerate the billing and coding activities qualitatively and quantitatively. Advancements in AI usage can help the practice navigate the critical billing and coding function through continuously evolving regulatory guidelines and compliance norms. This can have a considerable impact on the cash flows of the practice.
AI can also help the team avoid coding errors such as under-coding or over-coding. Consider the example of a patient with heavy calculus buildup, inflammation, and bleeding when probed. The dental practice might recommend scaling and root planing to rectify the inflammation. It might not be possible to confirm if calculus is located on the enamel or the root surface. Using AI, an analysis can reveal no noteworthy bone loss, while all calculus deposits are shown on the enamel. In such a situation, scaling with an inflammation code can be used to ensure that the claim is accepted by the insurance company.
There can also be a case of under-coding. There could be a young patient with healthy bone levels who has a periodontal assessment that showcases normal probing depths. There might be an appearance of calculus buildup and minimal plaque. A dental practice may opt for a code of prophylaxis. However, there might also be more than 35% bleeding recorded during the probe. Using AI-enabled diagnosis and data analysis, a recommendation of therapeutic gingivitis treatment may be suitable for the patient.
The primary benefit of AI is the creation of perfect claims at the first instance. This results in acceptance of claims and no rejections or requests for additional data. AI can evaluate and decipher multiple codes, insurance plans, and terms for any procedure to get reimbursement from the insurance company. It can also provide optional ways to enhance the claim document so that claims get accepted the first time. As an example, it can prompt the team to add a narrative for certain procedures. It can even suggest a sample narrative
to the team.
All insurance organizations are wary of fraud, even if it is not very common. While recording details, there might be simple user errors. AI can help to augment accuracy and avoid errors that can be interpreted as fraud. The main benefit of AI is that there is no eye fatigue, lack of focus, or boredom. AI can process claims with complete accuracy as compared to dependency on human resources alone.
Hence, the team at the practice must familiarize itself with multiple dental AI programs that can prove useful to them in many ways.
Auto-Adjudication is the process in which an insurance organization’s computer software processes and manages claims without the need for human intervention. This process uses advanced AI tools and algorithms to scan the data for errors. It then approves, denies, or changes insurance claims.
From an operational perspective, this works out cheaper for the insurance company as it does not have to pay for human resources. This process is prevalent across most insurance companies. A dental practice needs to take advantage of such a process.
Auto-adjudication benefits a dental practice as it gets the claims processed faster and hence gets paid faster. Other additional benefits include a reduction in the need for human review and lower claim rejections
A dental practice can get claims paid faster by using auto-adjudication in cases where it does not get preventive and basic claims paid with EFTs in the bank account or cheques within four to ten working days. This happens when the practice is not sending claims properly.
Dental practices can consider opting for various AI-based and automation tools for reducing administrative jobs and enhancing claim workflows. Some of these tools can collate x-ray data, credentialing, claims management, payment tracking, and eligibility checks in one place. An example can be AI-powered X-ray analysis with a revenue platform. This enables a practice to pick and attach a patient’s X-ray within the claim process. This lowers the time needed to prepare and send claims drastically.
Some tech-based products offer a platform that combines claims management, credentialing, eligibility checks, and real-time claim tracking. This means that the practice does not have to invest in several systems while also cutting down on manual work. These products can let the dental team manage credentials and eligibility on their own. This eliminates the need for support requests and costs. It can also send claims and documents electronically, thereby reducing paper mail costs and data entry errors.
To implement claims automation, a dental practice must successfully integrate several elements. This includes an assessment of the present RCM process. This helps to identify bottlenecks that need automation. The team can then look for a solution that integrates with the prevalent practice management software and provides specific features for the dental practice. Once integrated, the team needs to understand how to use these solutions and regularly review performance metrics.
The dental practice needs to adopt innovative tech-based solutions that are vital for handling billing and the claims submission process. Exceptional patient care can also be realized through technology by altering the dental billing and claims submission process.
