Put together a solid insurance credentialing process if you want to stay on top of communications with the insurance companies. As a dental care provider, it is vital to get credentialed to avoid possible payment delays.
What is a Dental Credentialing Process?
Dental credentialing involves verifying a dentist's background and entering into a contract with the insurance company. Insurance companies vetting process includes verifying information like training, professional history, and education during the credentialing process as per the guidelines to be an in-network provider.
Many patients prefer in-network providers with their insurance due to costs. The process requires regular follow-ups to get the paperwork done on time.
Important Points Regarding Dental Credentialing
Which Insurance Company to Credential with and How to Decide?
Contracting and Credentialing Checklist
Dental Insurance Credentialing Tips for Providers
The number of dental practices is increasing, and you are probably worried about the competitors when picking a location. Thereby, conducting a competitive analysis gives a bigger picture inside and out. Most importantly, it can provide dental practices an edge in the marketplace.
Describing Competitive Analysis
A competitive analysis is a way to gain insight and review who your competitors are and how this wealth of information gets used to optimize your course of action to make the most of your dollars. The key to success is understanding the competitor's marketing plans, website, social presence, and how they promote their products and services.
Plus, competitor analysis helps you understand changing customer needs and areas of opportunity in the business. Before we get started with how to conduct a competitor's exploration for your dental practice, let's look at a few benefits of the same:
How to conduct the competitive analysis?
Step 1: Maximum use of the digital competitor analysis tools
The new online tools, such as Practice Management Software, Google Alerts, Moz, Semrush, Ahrefs, etc., can help the dental office to analyze emerging service trends. It is also helpful to compare the KPIs of your competitors to know where your clinic stands in the market. All these free tools heightened focus on the information from the competitors and get continual updates on the things that interest you.
Step 2: Identify the competitors
This step prepares you to pick between 5-8 competing practices that offer similar services and products. In this way, you can understand the direct and indirect competitors, meaning your exact alternative and dental practice that offers something similar but cannot replace you. You and your direct competitors are fidgeting for a similar audience and are a threat. You and your indirect competitor have a common tiny segment but not the biggest threat.
Step 3: Competitors' areas of marketing
Study your competitor's types of marketing you want to evaluate, such as SEO, email marketing, content, and social media, to understand their engagement level and online presence. SEO strategy can help you with more online visibility and ends up with more patients in your dental chair. Top SERPs (Search Engine Results Pages) means you drive more traffic in your area to other offices.
Similarly, marketing via email is a critical component in understanding the online presence of competing dentists. Keep tabs on what type of emails the competitors send to patients to understand the discounts and other compelling tactics to pull traffic away from your office. Study your competitor's website and compare your content to determine the actionable advice and headlines you are missing.
Step 4: How your dental practice growth pushes away the competitors
Once you have all the data, now is the time to organize the information and bring new and refreshing ideas that should get repurposed in the marketing strategy. With the comparison, you can define the story the competitor is telling, what value they bring to their customer base, do they have a voice and mission. To answer all these questions, you can focus on your marketing strategy and build customer personas.
Step 5: SWOT analysis
To get an understanding, conduct a swot analysis for your dental practice. Identify your office's strength- any features that boost your industry standing and make you valuable. As you evaluate the practice's strengths, now analyze the weak points- what needs fixing, are their dissatisfied patients, outdated equipment, and areas your practice struggles with than your competitors.
Once you have scrapped enough data, use dental engagement strategies to brainstorm and expand your practice with novel marketing strategies. Finally, evaluate the unaddressed weaknesses that arise in the field of dental practice, like supply chain delays, patient expectations about oral healthcare service, regulatory changes, and new dental tech.
Being ready for what you do not expect is a part of the dental business, and following the above processes can empower you with impactful insights and help to expand your strategy to include a larger region.
As a dentist, the dentistry business can be challenging for the career and leave many practices struggling to improve the profit margin and make the money the provider's skill deserves.
Here are the guidelines that increase the revenue that practice has plateaued and needed a boost to improve the financial health of the dental practice.
Be strategic in creating a marketing plan:
Every business has a marketing plan, but the question arises, how often the team follows the marketing plan to achieve the financial goals? A proper dental marketing plan organizes in a way that addresses advertising needs and matches the financial goals from beginning to end. That means united efforts by the team where they are on board with the set goals, mapping out targeted campaigns, offering insights, and incorporating organizational incentives to have the entire team motivated to do better.
Educate with better dental practices:
This includes reviewing and updating the best practice that the dental practitioner follows. It will create high-value customer satisfaction, and the patient will not leave the office just with a beautiful smile but also with a positive feeling about their oral care.
As a dentist, your team members should feel invested in patient care and success, helping you make the practice profitable. Understanding superior business principles will have an impact that rectifies wastes of effort, time, and resources.
Timely review of operational habits:
This approach is necessary to re-evaluate the current processes that do and do not benefit the practice without compromising customer satisfaction. The team gets invested in productivity time and streamlining the processes with automation that can boost the revenue, and the workflow happens efficiently. This same approach can improve the morale of your staff regarding their role in the office.
Automation:
Streamlining dental operations with automation is a way to increase revenue quickly. For instance, the practice still processes intake through paperwork or electronic forms. That means the paperwork will consume more time in data entry, filing, and navigation through the additional document.
Automation, on the other hand, centralizes the documentation, communication, and collection processes more efficiently. Adding new management tools in the toolbox, such as automated appointment reminders and phone systems that automatically retrieve caller profiles, can improve profitability in no time.
Manage collection for existing patients through dental practice software, which makes it easier for the team and the patient to reconcile their outstanding balance.
Create financial goals:
Setting milestones than aimless endeavors is a way to achieve better revenues. Challenging goals such as reducing overhead costs or increasing elective procedures performed will make each team member work hard, become more productive, and ultimately succeed.
Instead of establishing generic goals, create smaller goals that get everyone invested. An invested employee works better. Your staff does not lose motivation and participate in the dental practice's success.
It's a fact with SMART goals- specific, measurable, achievable, realistic, and time-bound- approach you help to fine-tune other operational processes and improve profits across the board. For instance, attracting ten new patients a month, cutting overhead by 3%, and elective procedures performed by 15%.
Learn the value of patient experience:
Few patients think of their dental visit as a positive experience. The dental office promises a pleasant experience. What about when the patient wants to reschedule the appointment or delay paying the bill? The patient mentions that the dental office has a long wait time and takes time to get the dental records.
Everything the dental office does gets viewed through the lens of the patient experience because the happy patient is the backbone of financial success.
Always work to add specialists to the dental office:
Hygienists with specialty/specialized skills do better work and bring better results. Of course, these team members don't need to be dentists, but they are more focused on their efforts and can be good with children or patients suffering from dental anxiety.
Some hygienists are good with individual specific needs and get along better with different circumstances. By expanding the current skillset of the dental practice, you can bring in more revenue by increasing the price point of the services patient will want.
Revamp the service offerings:
Building a unique selling proposition will put you ahead of the competition in the area to provide new products and treatments. It will require time, resources, and initial investment that expand your offerings, such as crown composites and new whitening technology that makes the office unique enough.
Addressing dental patient billing issues is a challenge for many dental practices. Improving collections and dealing with patients arguing about their out-of-pocket costs require understanding and empathy toward the patient.
Here are a few scenarios of a dental patient who has a problem with their bill and is unhappy. To deal with the patient, you and your team should feel prepared and confident to handle the situation and boost income while maintaining a good relationship.
When the patient feels their paying portion is more than the insurance company and the dental practice has overcharged them.
When it comes to expensive treatment, say for a crown, the patient visiting your dental practice, and after hearing their total out-of-pocket expense, a matter of disagreement arises, and they get angry. For instance, it is $1000, and their insurance company covers 50%, which is $500. They are unhappy and feel that their insurance company should cover 80% of the cost and become more reluctant to pay and think that the dental practice is overcharging them.
Bill collecting has never been easy, and resolving the matter requires the utmost ability to listen to your patients and then calmly remind them of the payment policy that clearly states the patient payment portion, irrespective of what the insurance policy covers.
Ideally, the dental practice team already has a conversation about the payment policy with the patient before the treatment. You can remind them of this conversation and explains to the patient the limits of the insurance benefits.
The best you can offer is a payment plan if affordability is the issue, and they can pay in installments as per their need. Before performing a high-cost procedure, give patients a signed copy of the payment policy, the estimated amount due, and your fee that states the patient's financial responsibility disregarding the insurance coverage.
The patient did not know they owed money to the dental practice and received a bill in the mail.
Unexpected bills in the mail are unpleasant, and sometimes the dental practice has to send the billed more than they planned to pay. The additional cost upset the patient, and they wanted to know why their insurance did not cover it. They owed more money to the practice creating collection problems.
The inaccurate estimation can cause frustration in the patient. A kind apology can mellow down the situation. Assuming that the patient is wrong is not helpful. Try to make them understand the policy that says patients are responsible for the entire fee, irrespective of what the insurance covers.
Presenting patients with your payment options is the best strategy. Also, show them the EOB if they are still unhappy about the due balance. A prepayment policy is a proactive approach to avoid surprise bills.
The dental patient paid more, and now they owe a refund from the insurer.
The dental office calculated a higher estimation, and the patient realized that they spent more than they needed to, at the office. The dental practice is the one who should come to know that they owe the patient a refund. Let your patient know as early as possible that you found out first.
Let's say the patient found out that the out-of-pocket estimate was high after the insurance payment plus the fee and now demands a refund.
Apologizing to the patient for the inaccurate estimate and offering the option for a refund is a good part. However, the dental office should refer to the same payment method the patient used at the time of payment. Check with your accountant to offer the best refund option and also with the financial services you use for the financing.
It is also necessary to ask the patient whether they want to keep the credit on their account for the upcoming dental visit or would like to go for a refund. Document the patient's agreement to avoid any discrepancy. Keep a copy in the financial notes for the audits of unclaimed funds.
Complete understanding of a dental patient with billing issues can get challenging. Running the practice with consistent revenue is equally important while maintaining good patient relationships. To have a worry-free revenue collection system, you outsource or fully equip your dental practice and team to handle the billing issue of the patient.
Putting together a solid dental insurance credentialing management and tracking process helps a dental practice stay on top of status updates and communication with insurance companies.
When putting this process together, it is important to be aware of the common mistakes that can be made and have tips on how to avoid them.
1. Spreading thin over multiple dental carriers
This is one of the most common mistakes made especially by new practices. While the urge to get started with a bang is compelling, this generally works against the practice.
One of the drawbacks is not having an optimized fee schedule due to tying up with networks that have lesser-known insurance organizations. This move could acquire more footfalls than can be managed which then affects quality and care.
This could add more strain on the staff to rectify downgraded or withheld payments. This could lead to attrition of staff while a slip in collections could have an impact on profitability.
Identifying leading insurance brands and enrolling with five to six of them is a good bet. This could balance the business from acquiring patients to managing the documentation and other processes.
2. Negotiating the fee schedule
All covered services and the specific contracted in-network rates that the insurance organization pays to the practice pertain to the fee schedule. These fees are the benchmark of the maximum amount the patient can get as well as the extent to which the patient’s plan will pay out for services rendered under the cover.
A blind acceptance of the first fee schedule is a regular error of some practices. All insurance companies may not agree to deliberate across the table but an attempt must be made in earnest. The fee schedule needs to be skillfully managed through an experienced negotiator who can maximize returns for the practice.
3. Starting the credentialing process too late
A delay in commencing the credentialing process is a costly mistake. Credentialing consumes a great deal of effort and time. One must be equipped to handle the task in its entirety or else it hinders the completion of the process within the expected timeframe. The process can take 90 days or more and can begin even before the newly hired associate dentist joins.
One must also pay attention to the re-credentialing process. Insurance companies have their own rules regarding re-credentialing and this covers the timeframe for renewals. One must not wait till the end of the term as this can lead to a disruption to the in-network status.
4. Sending claims with the wrong provider information
Submission of incorrectly filled claims that lack complete accuracy is something that must be avoided at all costs. This can cause serious repercussions including being charged with fraud.
A newly joined associate dentist who has not yet been credentialed may perform a service. Jotting down the NPI of the credentialed dentist is akin to claiming that a dentist who did not undertake the task, did do it.
The payment that is accepted by the practice on the basis of incorrect data on the insurance claim is tantamount to being deceitful. Getting credentialed at the earliest is critical and yet ethical.
5. Leaving applications incomplete
A submission that is incorrect or incomplete is a gross error on the part of the practice. As expected, applications are cumbersome and exhaustive. It is crucial that all questions are appropriately answered.
For questions not relevant to the practice, a N/A can be marked. Leaving any questions unanswered might make the insurance company assume the form to be incomplete. Many a time, a missing check mark can render the form to be returned.
It must be noted that all insurance companies have their own application requirements along with their own variations. The staff needs to consider each application with due merit.
Patients must be entitled to the care they deserve. A reason a dental practice gets selected is because of the In-Network. Hence, the need for credentialing and the processes expected to have adhered to cannot be undermined. As challenging and frustrating, being cognizant of the credentialing process is highly imperative.
One of the best indicators and outcomes of how the clinic communicates with patients is case acceptance. It is a litmus test of growing the practice while having a robust base of patients. While patients need the attention and skill of the dentist, some clinics can tend to be lackadaisical when it comes to scheduling and confirming appointments.
High case acceptance rates are pivotal for success. Yet, there are many clinics that succumb to the specter of low-case acceptance. How exactly can one get patients to act favorably without getting them edgy? How can patients be influenced to move forward and book appointments without getting too pushy?
Some unswerving steps are needed to ensure that the patient is well briefed about the course of treatment and outcomes and provided with choices to commence treatment as desired. A few tips on raising the bar for case acceptance:
A confident online and in-office experience
In most cases, opinions are formed on first impressions. Browsing through the website or a visit to the office can create opinions that might be unfavorable or otherwise.
A user-friendly site that is informative and easily navigable with a chat feature would be ideal. This could push them into making an appointment faster. A visit to the office should also beckon a warm and friendly environment coupled with a welcoming front desk.
Creating the rapport
Doing a great job and satisfying underlying needs is what every customer needs. From a clinical perspective, a patient would feel much better about the treatment and service provided when there is a warm rapport between the dentist and them.
In many cases, the patient is a bit nervous and might need some cajoling. Leaving a lasting impression is possible through conversation and interaction beyond just the dental chatter is a need that is easily possible.
Time is not a hurdle
Many patients might want to know how much time the session could take. This is a query that needs to be managed well. Giving an answer such as 60 to 90 minutes might simply make a patient reschedule the appointment.
Responses such as “can you leave the office early today” or “how long can you take time off” can clarify whether same-day treatment is possible or an option for which day and what to do.
Same day treatment
Time is of the essence to everyone, and in this demanding environment, patients often prefer immediate and effective action.
Striving towards treatment on the same day for most cases pushes the pedal for case acceptance. The operating words must have ‘today’ to bridge any hesitation that a patient might have. Some possible thoughts
Nipping unwanted fear
There is always many a patient who has a bit of fear and anxiety when entering the clinic. The use of reassuring terms throughout the conversation such as quick, simple, easy, or not-to-worry will help make the patient routine much easier and more comfortable. Emphasis on the vast experience in performing complex tasks helps make patients less apprehensive.
Relationships make the difference
Most purchase decisions are a combination of rational and emotional responses. Relationships need to be built with the entire team as this can influence how the patient feels about the dentist and the clinic as a whole.
When the entire team has built a relationship and rapport with patients, referrals are more likely to come by. Building bridges with patients can greatly enhance the acquisition and retention of patients organically.
Choice of words
The patient's tension and fears can be solved through simple and lucid explanations. Conversation must be carried out using simple terms and any technical jargon must be kept to the minimum.
Effective communication on advice and treatment plans is paramount to success. Taking a little bit of time and effort to craft effective ways on communicating treatment plans or confirming appointments will greatly help in increasing the case acceptance rate.
A vital operation at any dental office or practice is dental insurance billing. While offering patients quality care and outcomes is imperative, it can come to naught in an absence of an ethical dental billing process in place.
Sound financial management principles are a necessity and must complement the efforts made in refining the practice. The dental billing process is intricate and getting stuck on some issue or the other is often a concern.
The capacity to code and bill insurance precisely while maintaining transparency is paramount. This helps to capitalize on the reimbursement amount which makes it a win-win for everyone a few suggestions to help ensure success are as follows:
The need for pre-authorization
There are multiple occasions when patients might not be certain if there is insurance coverage on the complete plan for treatment. Pre-authorizations are critical for ascertaining the quantum of treatment coverage by the insurance company and the co-pay amount to be paid by the patient.
By ensuring pre-authorizations, one reduces the odds of a claim denial from the insurance company and the possibility of a refusal for co-payment by the customer.
Multiple methods for making payments simple
Patients can hail from multiple backgrounds and can range from technophobic to tech-savvy. Hence, a multitude of payment options that include online solutions as well as traditional methods will help to make payments smooth and timely.
Some payment mechanisms that can be offered include
Timely collection of Co-Pay Amounts
To ensure complete payment to the office, the staff needs to be adequately trained in following up with patients regarding co-payment details. Ideally, all co-payments must be done at least by the date of the appointment. This aids in preventing potential delays or non-payment at a later date. It is important to maintain transparency concerning co-payments as this will help build trust and retain patients.
Staying abreast on coding policies
Undoubtedly, dental billing is a tricky and complex proposition from an insurance and claim point of view. One has to keep track of evolving coding policies too.
A great deal of time and effort needs to be invested to precisely comprehend these procedures and sure that the dental practice stays profitable ethically. Here is where dental codes are needed for insurance verification and staying completely updated in such a dynamic environment is an absolute must.
Outsourcing such requirements as well as other needs of the practice can also be considered.
Update the billing details on the time
Any dental practice must be profitable and the dental billing process plays a key role in making this happen. Filing and organizing all documentation paperwork on time will save potential trouble later.
The process for claims takes time and needs a great level of organizing. Treatment details, receipts, clinical notes, and other mandatories need to be suitably attached.
Options for adaptable payment plans
Different patients have different payment capabilities. This warrants an offering of flexible payment modes that are based on their financial standing and can satisfy the entire patient base.
To ensure a complete outreach to all patients, it is imperative to provide multiple payment modes. Patients with restricted funds or insurance might require longer-term financing as compared to patients with comprehensive insurance coverage.
Moreover, this also helps to attract and retain patients and builds a long-term relationship and trust with them while also receiving the due payment on time.
Following the norms of insurance companies
Patients will have their dental health insured under different insurance companies. The protocols to be followed for each insurance company can be complex and varied.
One needs to adapt to these varying networks with their own guidelines and standards for receiving claims. Adapting carefully to such processes will ensure that patients also receive attention and treatment without worry.
The search for the right dental billing company is no exception. Indexing, outsourcing documentation, RCM, and billing feels like a big decision where you need a group of people you trust to get paid. Outsourcing allows the providers to focus on treatment so that nothing can get in the way of patient care. An RCM company can take over all the billing challenges, insurance denials, and errors and streamline all the data to reduce billing errors and improve collections.
Here are the following points in selecting the dental billing service for your practice:
Prioritize the need for your practice
Before beginning to research the dental billing company, consider what parameters you would like them to address and resolve for you. Some questions are worth asking, such as:
Answering the above questions not only makes you feel confident about what you are looking forward to before the initial conversation with the dental billing company. It also ensures that you are aware of your practice. The outsourcing company will not put you in the corner, and you will be able to make a conscious decision.
It is also crucial to consider how many skill-based tasks in practice you need to outsource. For instance, if you outsource specific billing tasks and have small data volumes. In that case, a small-scale or home-based billing company will do. The larger billing companies provide a lot of features and additional facilities. If your practice has large data volumes and includes a lot of specialties, then preferably opting for a professional billing company can take more burden off your shoulders.
Most dental practices prefer this type of billing company that is capable of handling all administrative tasks. They control large volumes of data.
Research about the outsourcing company
How long have they been in the business? Are they HIPAA compliant? What experience do they have in the specialty? Do the services that the dental billing company offers match your practice needs? Start assessing their website. Whether they have the price listing, and if so, you can create the budget that fits your need. Also, understand if they have any hidden or additional charges to avoid the surprise bill.
Take a thorough look at the website, like the onboarding process, contract length, how many people to interact with daily, when to expect the increased collection, reading the reviews about the company, the customer service, etc.
All these points will help you understand the compatibility with your practice and if there is any red flag that you do not want to work with them.
Plan the budget for the outsourcing
Setting a budget for the billing company will keep you away from surprises. Most billing companies offer prices on their website that are a relief for the practices that plan the budget. If it is substantially low, it is a red flag, meaning either they have hidden charges or the quality of work is not efficient.
Mostly, dental billing companies offer different services, and thereby, prices differ. Consider outsourcing as an investment where you and your team can focus on excellent patient care, and the billing company focuses on the tasks that will bring timely reimbursement.
Communication matters a lot
You have completed the research, and you have made the budget. Now is the time to connect with the company and understand how its sales team communicates with you. Pushy salespeople are unpleasant, and you can feel the energy of being overworked. If that is the case, do not sign the contract. It tells a lot about what service you will get.
You want a company that is transparent and communicates clearly. If they are running around and bombarding you with emails and calls or completely ghosting you, consider twice before getting into business with them.
Every dental practice, in the end, wants to be successful, and outsourcing can help you achieve that goal if you choose the right dental billing company.
As we all know, dental billing has some complex steps. Even the errors like outdated billing practices and submitting claims without training can lead to cash flow disruptions, and insurance companies thrive on the incidence of billing errors. Managing the billing process is time-consuming and costly when the dental practice has to correct the mistakes and resubmit the claim.
The billing errors mentioned below help you be aware and ensure efficient claim submission.
Patient demographic information
Clean data can prevent losses and avoid to an extent to have a smooth billing process. The staff at the time of the service verifies the patient's details like name, date of birth, sex, social security number, employment status, the provider's details like name, address, contact information, and insurance provider information like policy number, address, phone number, etc.
Even trivial errors like a spelling mistake or transpose of any data can affect the overall revenue of the dental practice. A cost-effective billing process is a huge benefit, and data entry has the power to reduce it. Double-check all the information and ask for details from the patient upfront, even if they are reoccurring patients.
Ensure your team verifies the eligibility for all the patients before the scheduled office visit and reduces the workload later.
Insurance Verification Process
Every patient's coverage is different and gets checked without failure. Not verifying insurance eligibility is a costly mistake.
The verification process includes
Staying informed about coding updation
Dental coding changes happen constantly and can lead to denied claims, delayed payments, and low collections if the dental office is not keeping up with the changes. It is one of the complex parts of billing and contributes to errors. CDT procedure codes change every year as new materials and procedures arise. It is annually updated, and if the team gets this right, your chances of getting timely reimbursement increase.
To stay up with the CDT codes, ensure that your team gets the training and knowledge as much as possible to create a more optimized dental practice. Correct coding is mandatory but avoids up-coding or down-coding to prevent errors. Codes often change for clarity, and experts ensure that every procedure gets billed correctly using the correct version of codes that cause denials.
Bundling handling
As per ADA, bundling is a process the payer combines the different dental procedures into one procedure and keeps providers into contracts to pay less. Any misunderstanding of how payers bundle procedures make it hard for the dental practice to collect the payment for the rendered service. For example, a panoramic radiograph gets combined with bitewings as a full mouth radiographic examination (FMX) for reimbursement.
The problem arises when the payer bundles the two procedures that the dental office billed separately and loses money without an explanation. For instance, a panoramic x-ray costs $100 & bitewings x-ray $50, and the dental office gets the reimbursement for $150. However, the payer bundles, and you get paid $125, and for the $25, you will have to write off to the payer if you are an in-network provider.
Deadlines
For reimbursement, the dental practice has to file the claim on time as provided by the payer. Usually, it is 90 days after the date of service for the participating provider and 180 days after the service for the out-of-network provider. Each insurer has its rules, and timely filing expedites the payment of the submitted claim.
Running a successful dental practice means handling the insurance claim process responsibly. There are many moving parts to fixing revenue problems for the dental practice to be successful. Today, more than ever, dental offices are outsourcing dental billing because it is complex and requires dental billing expertise.
No doubt that all skill-based tasks can get outsourced. The purpose of outsourcing is to alleviate unnecessary stress on the practice owner and free up the staff from burnout. It can affect the revenue cycle management of the dental practice. The services any outsourced dental billing company offer:
How many of these tasks do you outsource depending upon what fits better for your dental practice? As per the statistics, nearly 50% of the U.S. adult population utilizes dental insurance, where dental billing is the main component of the RCM. Approximately 9% of the collectible revenue gets missed annually because of the dental billing process.
Importance of Dental Billing
Pros of Outsourcing Dental Billing
Here are a few benefits of the outsourced dental billing process.
Ways to make it work
