One of our clients is a general dentistry, in practice for many years in Texas. Theirs was a lean team of a few members at the office who handled all the administrative office work as well as billing and collection all by themselves, in-house. However, with increasing footfalls and a greater number of patients visiting their facility, the need for streamlining their processes and workflows became increasingly prominent as with limited financial knowledge, it had become difficult for the office staff to keep the financial parameters of the practice in-check everytime they handled billing for patients coming to them for treatments. They zeroed down their search to Capline Dental Services for a reliable billing partner to help them keep the financial parameters in check.
They were faced with a few challenges that slowed down their collections and kept most of their office staff occupied with handling the billing functions alone, making the perfect execution of routine administrative tasks difficult. Some of the major areas where they were struggling the most were:
Challenges faced by the client:
They were faced with a few challenges that slowed down their collections and kept most of their office staff occupied with handling the billing functions alone, making the perfect execution of routine administrative tasks difficult. Some of the major areas where they were struggling the most were:
- High TAT of submitting claims with insurances:They were struggling to submit their claims with insurance companies within 24-48 hours.
- Decreasing collections as a result of incorrect claim filing and high denials: Claim denials result in financial losses and the office experienced a sharp decrease in the collection for want of quality handling of billing and collection for their office.
- High claim denials as a result of quality claim processing: Due to a lack of financial acumen, their in-house billers were not able to keep the claim denials in check and as a result administrative tasks at the office were taking a backseat.
- Hard to keep a track of denied claims for a proper follow-up due to lack of proper reporting and accurate financial analysis of submitted claims: Their AR was not in good shape and needed an efficient follow-up to keep it in check.
- Availability of reliable service & support: They were looking for a billing support company that they could count on to consistently provide reliable service and responsive support. They needed a partner they could count on.
- Timely reporting with analysis of important financial parameters of the practice: Without proper financial analysis, patient billing can be extremely time-consuming and directionless. So it was extremely important for the billing partner they chose, to have an intuitive and timely financial reporting in-place that allowed them to assess the financial health of their practice efficiently.
The tasks that Capline Billing Team was handed over:
- The office used Eaglesoft as their Practice Management Software and we were asked to work on the same for handling their billing operation. Since our billers are efficient with any PMS that the provider office uses, our billers were able to smoothly maneuver through the software and align our services accordingly.
- The office had a high footfall and they were already struggling to keep up with the timely filing of each and claim so that they are paid on time. We were required to handle an average of 600 claims per month.
Capline Billing & Collection Team in Action:
We took the following measures to improve the productivity and collections for the client:
- They were provided with a dedicated team and account manager to handle their account. Every time they needed to discuss the financial health of their practice or wanted to know how their practice fared on important financial parameters, they always knew whom to call who had all the answers.
- The Calpine team assigned to the office consisted of AR experts and full-time billers with an experience of more than a decade in the billing industry.
- Capline’s AR experts were able to get the EOBs and claims status for a few state-specific BCBS and Delta Dental insurances faster wherein the client was facing a lot of issues which were affecting their ability to serve patients.
- We followed-up on all the denied claims and appealed where it was required.
“We always go to our Account Manager at Capline whenever we find difficulty in understanding any financial aspect of our office and he is always there with the answers.” - Office Manager
Results provided by the Capline Billing Team
Through our services, the office found that their staff is able to take better care of the administrative tasks while billing is efficiently handled by Capline.
- We brought down the average AR days from 141 to less than 40 days.
- Capline saved approx $80,000 annually for the practice in terms of administrative cost and lesser claim denials.
- We increased the collection percentage from 60.6% to 87% in only three months of our work. And further improvements were made to the collections down the road.
- We worked on their old AR and thereby collected money for the Client's practice.
- The office experienced a regular in-flow of insurance and patient payments after we started providing services.
- Since we conduct a qualitative analysis of the claims before submission to the insurance company, the client was able to see an increase in their cash flow.
- They are extremely happy with our streamlined process and our dedicated services.
Conclusion
All these years that the office has been with us, they have seen remarkable results for their practice. They have saved more than $80,000 yearly. There has been a remarkable increase in profits and the efficiency of the staff has had a direct impact on their bottom line. The streamlined billing process has meant less headache for the staff which has had a positive effect on their efficiency, thereby leaving them with more time than ever to provide fantastic care to their patients that they have always expected.
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One of our clients is based in Oxnard, California and owns and operates dental offices across the state of California. They are rapidly growing and as they open more and more offices, they need to hire and credential providers fast. Swiftness of the whole credentialing process was their primary concern since that enables them to open up their offices for more patients and bring in the revenue to keep afloat in the industry.
The client reached out to Capline because they were rapidly growing and expanding and needed a way to credential faster as well as have everything managed by a dedicated team of professionals who could be easily accessible and could be reached out by them whenever needed.
Challenges faced by the Client:
Credentialing is a time consuming process and it gets difficult for the office staff to take care of this cumbersome process all by themselves in addition to handling the routine administrative tasks. It takes a lot of time to get a response from insurances because the representative from the insurance company is not always quick to respond. This in-turn eats up a lot of time of the office staff. Omni Dental were looking for experts to take care of their credentialing hassles and save them time and money.
Challenges faced by Omni dental were:
- They wanted experts in the field to take care of their credentialing and get it done on time and with accuracy.
- They looked for direct and unlimited contact with their credentialing specialist so that they could be aware of the status of their applications all the time.
- Full outsourcing where they did not have to worry about anything related to credentialing and their office staff could focus on other important tasks.
- Timely reports on expiring and missing documents so that time wasted in furnishing the same could be saved.
- Fee Negotiation and verification of provider’s documents on a regular basis was a big challenge too.
- Long holds while on a call for follow ups with the insurance companies wasted a lot of time of the staff resulting in their inability to work on other important tasks.
- They wanted the highest levels of security for storing sensitive data.
How Capline helped the Client with Credentialing Services:
Capline’s credentialing team worked closely with their Office Manager to better understand the needs of the organization. After initial conversations, our team formulated a clear strategy of areas where we could save time and approach the credentialing process better for them according to their challenges.
Soon after their onboarding, we gathered necessary information and credentialing documents and they were assigned a dedicated manager and credentialing specialist to handle the day-to-day credentialing needs who continue to work with their office team directly to ensure that the whole process is smooth and efficient for them. They are also the ones from Capline whom the office can contact directly at any time of the day for direct resolution of any questions that they might have.
Earlier, the office was handling the credentialing process manually in-house. However, Capline has changed the whole process for them for good. They are now able to save valuable time and get credentialed in quick time like never before.
Areas where we helped them with our services:
- Our team helped them with keeping a track of their credentialing documentation that resulted in more free time for the office staff so they could focus more on patient care.
- Our team does regular follow-ups with the insurances during the credentialing process which results in timely submission of required documents and quick completion of the process.
- We do credentialing in advance of as many number of days as requested by the client. This gives the office enough time to coordinate and start a new practice.
- Our credentialing experts have in-depth knowledge of the process and are able to efficiently do fee negotiation on behalf of the provider to get a better fee for them.
- We keep the whole process transparent for them by providing bi-weekly reports to the office with fully detailed status of their credentialing applications.
"Capline has changed the way we earlier approached credentialing for good. We are now left with more time than ever to focus on our patients as the headache of following up on insurances for documentations and credentialing status is completely handled by the experts at Capline. They have made our job a lot easier.” - Office Manager
Results Provided by Capline:
- Reduced new provider onboarding time by more than 75%: By having a team of expert credentialing specialists taking care of the credentialing process, our team was able to get providers onboarded quickly and take the stress off the office staff. Getting credentialed in advance helped the client to start the practice on time.
- Established a formal credentialing processes: Earlier they had no formal processes or procedures in place to streamline their application process. Our team was able to make the process effective for their office which has helped them save valuable time.
- Savings on infrastructure and employee expenses: Outsourcing their credentialing services to Capline has helped their staff to work more efficiently on other core administrative tasks and has saved them the cost of hiring new employees.
- Quicker and efficient process: They are happy with the results Capline has provided them. They are now able to save time and money in the process which earlier looked impossible to them.
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One of our clients is a well established dental practice based in Crosby, Texas. With an ever increasing patient base and fewer front-end staff to handle patient service, it was an ongoing struggle for the in-house staff to manage patient eligibility verifications in real-time and coordinate with the patients at the same time.
With increasing footfalls and a greater number of patients visiting their facility, the need to outsource the insurance verification services had become increasingly prominent as with limited office staff and the need for other routine tasks to be handled, it had become difficult for the staff to correctly verify the details of every patient before their scheduled appointment.
They began their search by browsing through the internet, looking around at dental conventions and asking the fellow practitioners for recommendations for a reliable Insurance Verification support company that would fit their needs. They finally zeroed down their search to Capline Dental Services.
Challenges faced by the Client
At the time Capline took over the insurance verification services for the office, most of the claims submitted by the office were denied for patient coverage and the inability of the in-house team to verify the correct coverage details. The office staff was facing difficulty in handling the verifications for the walk-in patients. Some of the challenges faced by the client were:
- Mismanaged patient appointments
- Inability of the office staff to handle patient, appointment scheduling and verifying patient eligibility and coverage benefits simultaneously
- Increase in denials due to improper or no verification done on patient coverage and benefits
- More time of staff lost in verification instead of taking care of patients
- They wanted experts in the field to take care of their Insurance verification and get it done on time and with accuracy.
Solutions Provided by Capline
Within one month of working together, we had the insurance verification process streamlined at their office. We had to bring the receivables back on track and streamline the whole process so that loopholes are removed. Below are the ways in which we managed to provide solutions for the challenges that they were struggling with:
- A dedicated manager and a specialized team was deputed to handle the insurance verification for the office. The team worked in close coordination with the client’s front office staff for patient verifications and benefits.
- Capline developed a verification process so that all the verifications are completed prior to the scheduled appointment.
- Special attention was given to verifications of walk-in patients to avoid last minute hassles.
- The office staff were left with more time which they could devote to taking good care of patients and hence the footfalls at the office increased.
- We save IVs in the patient document center of client PMS for future references which can be reviewed in case of any discrepancy.
- Capline does IVs in advance of as many days as requested by the client. This gives the office enough time to coordinate and collect the amount from the patient.
- We also enter remaining benefits, deductible, co-pay according to the patient's plan in the client PMS.
- Our experienced team is able to get the information from insurance companies such as Blue Cross Blue Shield, United Healthcare, AETNA, and GHI, with which the client was facing a lot of issues while contacting for the verification earlier.
“Our patients are increasing more than ever and our staff has all the time now to provide care as we always wanted to. Capline has made our life easy. The people taking care of IV for our office are so good and know exactly what they are doing. For us, profits are always increasing and we are more than happy!” - Office Manager
Results Provided by Capline
Ever since they have chosen Capline Dental services, the client office is better equipped to cater to more and more patients while keeping control of the financial aspects. They found that the office staff is able to take better care of the administrative tasks while insurance verification is efficiently handled by Capline.
The client leveraged the following benefits by outsourcing their insurance verification requirements to Calpine Services:
- Getting IVs done in advance helped the client to collect the amount from the patient well in advance reducing their patient due balance and time and money wasted in patient statement work.
- Capline saved approx $80,000 annually for the practice in terms of administrative cost and lesser claim denials.
- Significant decrease in denied claims percentage as a result of increase in collection ratios.
- Since we have taken this back-office work off our client’s plate, they have more time to focus on patient satisfaction, and on growing their practice. They now concentrate on patient care and see more patients, with the availability of more time, and a stress free office staff.
- Increased operating efficiency and reduced administrative costs.
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