Rapidly evolving dental care relied heavily on electronic transactions such as EFT and ERA. With an understanding of managing complex billing, enhancing compliance, and elevating patient satisfaction.
Dental clinics' everyday challenge is to process a large amount of claims, which include remittance paperwork. EFT and ERA, which are known as Electronic Funds Transfer and Electronic Remittance Advice, are the end of the revenue cycle that involve payments from insurance companies. More than 22% of the payments are typed information due to constraints on providing ERA.
This time-consuming process takes a toll on providers. EOB has all the details about payments, which is very important for the service provider to update and maintain for accurate accounting. Let's discuss further about EFT and ERA. But before that, let's have a look at EOB.
A formal manual documentation by insurance companies to the service provider that includes claim approval or denial status, reimbursement amount, reimbursed claims, adjusted claims, and details such as code declined, expected copayments, and patient financial responsibility. This documentation is a tool that helps patients understand how the bill is broken down, known as an Explanation of Benefits.
The provider receives the report within 60-90days. The manual mistake affects the outcome. The survey demonstrated that 25% of each dollar expenditure is on files and office work related to dental billing.
Both are advanced technological tools that save a lot of money and time. Let's discuss in detail.
ERA (Electronic Remittance Advice) is an electronic data exchange protected by HIPAA. It contains payment information sent by the payers. Paper-based EOBs are obsolete due to ERAs.
Some of the details included in ERA:
ERA is universally adaptable and does not require manual intervention. No paper filing, manual payment posting, and no mail collecting are considered standard. With digital platforms, dental practitioners can reflect the full picture and eradicate the issues. ERA report focuses on insights from errors and claim status to reveal gaps and avoid future submissions and clearances.
The manual payment posting version costs $15,000 annually, a consistently high price that could hurt the revenue. On the other hand, ERAs make it easier with no printing, storage, or maintenance costs, and finally, no administrative costs.
In a dental care environment that demands faster results, precision, and measurable results. It takes 60-120 days to follow up on claim errors, which is not a competitive edge. The staff have to juggle between tasks and cannot concentrate on patients.
ERA's responsibility is a significant portion of the collection through monitoring and managing denial management. Separate ERA files on the same TIN(tax identification number) with additional security in handling the data.
EFT (Electronic Funds Transfer) is a method used by insurance agencies to electronically deposit claim payments into a provider bank account with robust security. EFTs get settled within 1-5 business days and protect sensitive data.
The handling time is quick with easy reference. The practitioners can manage multiple accounts and payments through online data availability. EFT controls self-user access and prevents manipulation in payment loss or deposits. More importantly, EFTs are explicit and processed through the Automatic Clearing House (ACH) network.
Strong Points of EFT and ERA
EFT and ERA fulfill the quality. The EFT notifies the deposit upon resolution of claims. An ERA is a formal document about the receipt of payments made to the service provider bank account. Both EFT and ERA simplify the payment process.
The future is a strategic partnership that optimizes revenue cycle management and elevates patient delight. Payment posting is a highly sensitive issue, and as an experienced company, we are aware of the multifaceted challenges of compliance standards.
The experts at Capline Dental Services stay ahead with technological advancements for better revenue. By sorting denials and adjustments, providers offer treatment, and we resolve ongoing issues. Team ensuring the accuracy of EFTs to respective ERAs.
Automated billing process delivers rapid results, enabling dental practices to streamline claims management and eliminate outdated processes.
Clinical workload and uncollected payments are the main issues for dental practices. In a recent study, they found that 55% of dental professionals prefer an automated billing process. Automation is recognizing its positive impact on outcomes. For example, automated eligibility checks reduce claim denials, increase collections, and support the team with patient-focused operations.
Coding Accuracy
The Current Dental Terminology (CDT) 2024 has 814 procedure codes, making it more complex for the providers to follow, which results in losses, denied claims, and administrative burdens.
Compliance
Violation of HIPAA compliance is a costly error. It can go up to USD 50,000 if the dental care specialist failed to navigate the policies.
Accounts Receivable Days
Incompetent AR follow-ups have historically led to reduced collections and excessive write-offs of patients. Automation in AR follow-ups mandates timely processing and minimal manual intervention, resulting in accurate insurance coordination.
Data Entry
The adoption of AI is a solution to avoid frequent denials, reimbursement issues, and uncalled audits, which can affect revenue. The transition facilitates reliability and reduces mistakes that would otherwise be missed.
Claim Denials
One of the reasons the practice faces denials is due to uncovered claims or out-of-network claims. A slip in patient details or incomplete information initiates rework and consumes resources. Practice did not verify the annual limitations, and missing pre-authorizations for expensive procedures can cause revenue leakage.
Automation in dental billing and revenue cycle management is widespread, which develops trust from insurance verification to claims processing, improving workflow, staffing, and organizational lapses. More importantly, it creates an operational connection.
Registrations, confirming patient coverage details, allocating slots for appointments, treatment documentation, claim submissions, EOBs, reworking denials, working on appeals, patient billing, and follow-up on AR aging are the contributing factors to overall success. Yet, many tasks are time-consuming, leading to administrative fatigue or errors.
Automation pulls real-time data from payer portals without affecting accuracy and transforms claim processing by flagging issues before submissions and avoiding discrepancies before they occur. Traditionally, what took hours now happens in seconds.
Manual RCM reveals inefficiencies, such as rejected claims, reduced collections, and uncollected revenue due to inefficient patient invoicing. Uncollected revenue and patient disappointments do not provide an advantage.
The automated billing process analyzes historical patterns for actionable insights. Therefore, automation is not optional. Consistent adaptation enhances transparency with precision. As a result, the claims are not stuck in the pending queue.
Automating repetitive tasks saves time to concentrate on patients and flag errors before final submissions. They include incorrect dental codes, missing documents, and incorrect beneficiary details. System matches dozens of details in seconds and provides coverage details by procedure. This improves patient satisfaction and effectively addresses financial transparency through plan limits and exclusions.
Payment posting automation is one of the breakthroughs in AI that stabilizes the cash flow and minimizes automation costs. No human intervention means fewer denials. With automation, the dental practice can apply payments and adjustments to correct claims. The data stated that through automation, practices improve profit by 30% in some cases.
Automation makes the system easier and reduces manual work. The proper guidance in handling tasks such as claim creation, eligibility checks, and payment posting becomes easy. The team has clear data to navigate.
The staff has provided suggestions for exceptional cases, such as denial scenarios not resolved automatically and payment posting mismatches. Instead of spending months training new hires, AI can contribute faster.
In dental RCM, the contributing variable is payer behavior, the hardest to track manually. With Capline AI, practices can analyze the payer's behavior through historical claims data to uncover patterns. Instantly, analyze which procedures are frequently denied, which insurance payer often delays reimbursements, and which missing documentation triggers rejections.
At Capline Dental Services, experts ensure the handling of tasks with HIPAA compliance and a speedy revenue cycle. Professionals are handling more claims without needing a larger team.
Scrutiny of practices requires attention as the regulations evolve. AI tools with auto-logging ensure consistent documentation across teams at multiple locations. There is an emphasis on compliance risks to pass audits and defend appeals. With AI, the practice stays aligned with state mandates.
AI accelerates revenue cycles. At clinics, digital imaging X-rays are used for diagnoses such as infections, cavities, and bone loss, and offer treatment planning accordingly. For customer service, digital assistance, and bots facilitate patient care services. They coordinate patients with scheduling appointments, claim processing queries, and answering questions related to payments.
More than 15% of practitioners are associated with Dental Service Organizations (DSOs) to turn the return on investment. The consolidation, driven by mergers and acquisitions (M&A), provides operational efficiency that results in higher revenue cycle management (RCM).
The survey clarifies that 47 percent of respondents cannot afford dental care, while 35 percent try to delay the care due to its cost. Rising consumer prices are leading to a rise in dental care, with providers passing the increased costs over to payers and patients. The number of uninsured patients is increasing, causing more skipped dental care.
The cost is increasing, and providing dental care at lower costs requires a shift from a fee-based model to a value-based model, elevating patient financial outcomes.
Patient-friendly billing can increase cash flow without increasing costs. Inadequate communication can balloon A/R. Get your unpaid patient portion. Capline Services is your dedicated partner to make the collection easy.
The entire process comes to a halt if patient fight to understand their bills. On the contrary, a patient-friendly billing application reduces rework. Otherwise, the staff is busy clarifying the EOBs. Scepticism surrounding the insurance terminology, CPT codes, or unexpected charges leads to delinquent payments. It also delays the necessary treatments and extended follow-up calls with the patients.
This rework can be minimized by how effectively the team responds to patients about costs and coverage. Here are five strategies by Capline Dental Services to manage billing conversations with confidence.
To remove confusion about costs, create a layout of the insurance amount and what the patient pays. A welcoming email with a contact number ensures that they know where they can turn in need.
Jargon is convenient but creates complications for patients. Instead, be specific and clear in language. D2740, a porcelain crown, costing $1200. Ins Adj $300, meaning insurance adjustment, Pat Resp TBD means patient responsibility to be determined post EOB, which refers to after the explanation of benefits. Well-informed patients feel more in control when they understand their financial details.
Proactive dental payment reminders reduce the unclaimed revenue. Capline Dental specialists make relevant communication through automation. The messages should be on their preferred channel of communication, along with the necessary details. Skip generic details and focus on information that requires prompt action.
For instance: Hi XXX, a gentle reminder for the upcoming appointment tomorrow at 5:00 PM. The balance due is $50. Use the secure link to pay now or during your visit.
Reminders have to go in a repeatable schedule:
An interactive platform that allows patients to communicate, confirm the appointment, or look for some assistance. There is a reduced need for staff to chase invoices. Document the details in case of discrepancies. It is likely that with consistent and easy-to-respond-to reminders, the patients will remain on time with their payment schedules.
The patient is responsible for settling the account upon completion of treatment. But the reality is more complex than this. Patients have unexpected expenses. The financial strain is making them consider repayment options.
Repayment options through digital platforms that manage payments with just a few taps have a high chance.
Payment is mandatory for running a business; asking for payment from a patient is equally vital. Above that, protecting the relationship with the patients is far more crucial because any hindrances can negatively impact future transactions.
What if the patient skips the bills? That is normal, and they start ignoring the staff calls for payment. What your well-deserved money is not their issue, and in that case:
Dental billing solutions are paramount. There are factors for enhancing revenue. Capline Dental Services highlights the challenges and strategies for practices to grow without affecting operations.
Currently, 35% of dental professionals work with different sites. The rapid expansion presents opportunities with challenges. Dental billing solutions improve profits, reduce administrative overhead, and decrease claim denials. Billing processes are conflicting for dental practices.
As the dental practices expand through various locations, mergers and acquisitions come with undermining efficiency and profitability. Dental billing inconsistency with multiple locations can create challenges for the practice:
Insurance Follow-up Collapses:
One location has a rigorous workflow for follow-ups, while the other does not follow up at all, leading to lapses. That jeopardizes the RCM and affects patient satisfaction.
Chaos in the Processes:
Each location has a distinct approach to patient registration, insurance verification, and coordination of benefits handling. Dental practices with expert resources use advanced billing solutions in real time. Other practices rely on manual billing methods. The disparity affects the patient experiences and creates inefficiency in the workflow.
Coding Faults:
Sites at multiple locations have varying training and education on coding. That affects compliance. The significant risks could be over- or undercoding due to the encouragement of not following the internal guidelines. Additionally, compliance issues result in financial losses and breaches.
Poor Experience:
The absence of a unified approach towards patient statements, payment collection, and financial responsibilities can create confusion that diminishes the patient experience. Patients appreciate transparency regarding costs, which saves time.
Varying Key Performance Indicators:
The lack of standardization in KPI monitoring creates gaps in performance evaluation. Various locations have varying metrics; for instance, one location prefers claim submission within 24 hours, while others settle for 48 hours. The inconsistency affects the individual's performance; addressing these issues can promote long-term success while creating a patient-centered practice.
Dental practices are facing challenges in RCM. A unified approach to consolidate the execution at multiple locations. Revamp revenue with the following strategies:
Centralize RCM:
The integrated revenue cycle department strategy does not allow each site to operate its own independent department. Optimization removes the need for tedious tasks.
Consistency:
It is the key for all the locations to adhere to the standard protocols for all aspects of the RCM, including eligibility verification, patient registration, coding, follow-ups, and patient support. Consistency ensures coordination that enhances patient care.
KPIs are standard for all the sites that consistently monitor the performance, along with benchmarks for collective progress. Data analysis serves the purpose.
Training and Documentation:
Training with the standard module develops the staff across all locations with the necessary instructions. Creating a guideline that ensures clarity with detailed information to ensure everything gets captured for patient billing. Use of templates and standard charting for providers improves accuracy.
RCM Tools:
Practice management systems align all locations and have a seamless exchange through a cohesive dental billing approach. That streamlines scheduling and safeguards revenue. All team members are working towards the goal that drives success at multiple sites.
Patient billing solutions help patients and providers in establishing realistic expectations about the financial aspects of care. An association with Capline Services can effectively manage dental billing and reduce outstanding payments.
To build a successful practice, dental practices need strong patient billing solutions. The dental services market reached $195 billion. Billing plays a crucial role. It is worth outsourcing to a dental billing company like Capline Dental Services to improve RCM.
Despite having patients in the clinic, a practice can still have financial issues. Any misstep means lost revenue. Understanding the number is mandatory, and knowing how to use it for billing optimization to improve patient satisfaction.
Unpaid patient balances, delayed or denied insurance claims, and unaddressed financing issues are the biggest concerns. Approximately 13% of the total revenue is lost, causing a financial shortfall. That stems from uncollected debts and pricing inefficiencies.
Dental practice wants to reach new heights in collecting payments, and there is a journey between billing and payment. The shorter the wait, the more it confirms the cash flow; an extended duration, on the other hand, highlights potential issues that require attention.
Accounts receivable under 30 days, as per the guidelines, have a higher probability of receiving payments than exceeding 90 days. The metric also helps in monitoring payments between 90 and 120 days and identifying the chances.
Insurance Delays
Inaccurate patient information on claims results in payment delays or denials, depending on the medical necessity of the treatment.
Procedure Specific Denial Rates
SRP has a low acceptance rate. Whenever possible, clarifying non-covered policies to avoid the need for follow-ups.
Billing Errors
Incorrect CPT codes in claims, incomplete submissions, and delayed claims have a direct correlation to extended accounts receivable (A/R) and cash flow. To reduce overdues, the practice has to follow up and settle its bills.
Unpaid balances lead to challenges in collections. And by addressing issues, the practice can enhance its capacity to serve patients.
In this post, Capline Services highlights the steps for improving collections.
The dental practice should improve its internal policies if collection fees are taking longer than stipulated. The ADA suggests that regular updates for protocols and internal policies can save resources.
The steps clearly state the patient's financial obligations before or after the treatment. Accurate details about the procedure when collecting fees can save time.
Patients pay their part as per dental benefits at the time of service. Do not wait for the pay portion until the third party receives the payment. Ideally, payments get settled within 7-10 days of claim submissions.
What if a patient has a due balance even after they have paid their estimated portion? A patient statement with the remaining balance tracks down the missing payments. Many practices have a pre-authorization form that allows the deduction of the charge for the balance after receiving the third-party payment.
Acquaint Patients
Patient education about payments minimizes unpaid accounts. Familiarizing oneself with the terms through a brochure and reference sheets can remove doubts regarding their obligations. Staff members addressing patient inquiries about claims and payment ensure that you care about your patients without jeopardizing the daily operations.
Patients having access to 24/7 self-service can quickly notify patients about outstanding amounts. They have information about payment balances and due dates.
Patient Reminders
Patients appreciate reminders. Mailing weekly statements pointing out the unpaid balances with a due date on each statement keeps patients informed about their account status. The reminder phone call with a reminder notice expedites the follow-up procedures. The monitoring is crucial for accounts receivable. Invoices can prevent disputes or potential errors.
Overdue payments more than 30 days require attention. The ADA suggested having a dedicated person responsible for communications with patients by phone about the payments. The final process involves negotiation, which highlights the payment plan procedures for receiving payment. The collection process should include all professional communications, documented and recorded.
Meeting Filing Deadlines
Delay in claim submissions is the highest issue for growing accounts receivable. Insurance payers have submission deadlines within weeks or months of the treatment.
Technology works as a guide to navigate the complex financial processes. Software tools expedite the process, and electronic claim submission ensures accuracy and improved financial oversight. EHRs, financial management software, digital practice management systems, and scheduling platforms minimize errors along the way.
Days in AR for each payer
Each payer has individual AR, with a breakdown to identify prolonged AR periods. Capline Dental Services ensures that dental bills are correct. Experts reduce the chances of claim rejections and enhance billing efficiency.
Billing accuracy reduces errors and improves patient satisfaction. Patient billing is a reputational risk, leading to delayed payments, and negatively impacts RCM for dental practices. Professionals like Capline Dental Services ensure adherence with no awkward payment collection.
A dental practice can face several challenges when generating dental patient statements. These challenges can straddle printing or mailing issues. For the dental team, recovering payments on time for dues owed by patients can be cumbersome and stressful.
Healthcare costs are rising across the board, and expenses incurred by the average patient have increased accordingly. How does this impact a patient statement in dental healthcare processes? An increase in healthcare spending indicates a possibility that patients can delay or avoid paying their dues. Hence, a dental practice can witness a rise in outstanding debts and a longer collection process.
One of the ways to mitigate such risk is by creatively using accurate patient statements for patients. Dental statement follow-ups help to spur the collection rate and keep the cash flows ticking.
A practice uses patient statements as a summary of the treatment offered to the patient and the cost for the same. It also contains details of the patient's name and location, dentist details, policy coverage, details, etc. The main reason for patient statements is to garner collections due to the practice.
The patient experience is not limited to treatment. It can encompass the billing process or a patient statement. This can hamper cash flows. Some dental practices still depend on physical bills and statements sent through the post.
Statements sent by mail can get ignored, and a patient might not even look at them. This leads to a loss for the practice, which has incurred expenses for printing statements and postage. Any mode of statement needs adequate follow-up mechanisms if patients have not remitted the payment.
Calling patients as a reminder for pending payments is not always effective, as attempts to reach them might not always be fruitful. The team might not have the time to repeatedly call patients about pending payments.
Automation is a choice for many dental practices and is an effective option for dental patient statements. It helps to curtail costs that would have to be incurred on printing and postage. Automated patient statements deployed by the team can notify patients of dues on their preferred device.
Automation also offers a smooth payment process that can be made online with multiple options such as NEFT, debit cards, etc. Convenient options offered to a patient make it easier for them to pay and improve the rate of payments. Besides, the elimination of paper and postage is also an environmentally friendly option. Digital engagement options also augur well for younger patients. The benefits are varied.
Automation offers flexibility as statements can be set for delivery to a single patient or to a group of patients. The team can select from multiple filters that include patient demographics, outstanding balance information, aging, and more to create patient record sets that can then be used for electronic statement transmission.
Electronic statements can be sent to patients in a single click. A patient can open the patient portal to clear dues through a computer or a mobile phone. There is no need to open any additional apps or write cheques.
A few ways the practice can benefit through patient statements by adopting a few measures:
Avoid Shipping Delays
Average debts by patients are rising gradually, and to avoid unwanted increases in dues, a dental practice must send patient statements on time. A delay can make a patient forget their dues, and this delays payments. The team must ideally generate statements within a single business day.
Since the treatment has just been completed, all necessary details captured in the system can be referred to while making the statement. An overload of work is the main reason for a delay in sending statements. The practice needs to prioritize billing tasks.
Draft Simple And Clear Statements
The practice needs to make patients aware of outstanding dues. It should also encourage and convince them to make timely payments. When a bill is ambiguous or difficult to comprehend, a patient may become confused and prioritize making payments according to the schedule.
The main reason for sending a statement is then lost. On receiving a statement, a patient needs to know what the statement is about and expected responses are. Clear communication can help prevent unnecessary calls to the practice.
Margins, spaces, and alignment can make a difference and help patients to grasp what's needed. Unwanted codes and jargon might confuse a patient. Use simple and broad fonts that make it easy for patients to read statements. Underlining sentences and italics must be used as required. Adequate white space in the statement makes the overall look clean and neat while making patients pay attention to the necessary elements and complete the action that is needed.
Boosting The Revenue Cycle
Patient statements for billing and follow-up can boost the revenue cycle. All relevant documents, invoices, post-treatment instructions, etc, can be included while making mailing programs for statements. It enables patients to pay faster by offering details when needed.
Clarification Of Insurance Details
When generating a patient statement, the team should ensure that details of primary and secondary insurance plans are included. Any pending amount from the insurance company needs to be added. This enables patients to stay aware of dues and payment amounts to be made. These details should ideally be right at the top. This makes the details easier for a patient to understand.
Highlight The Amount Due
Clearing dues payable is the key objective of every patient statement, whether initial or follow-up. The team should draft statements that are not challenging for any patient. The amount due to the practice must be highlighted clearly and in bold.
A patient statement can have multiple figures and descriptors, and hence, differentiating these figures and the amount payable by the patient must be clearly visible. The team must design different sections of the statement in a way that makes the pending payment stand out.
Adding Contact Details
A dental practice needs multiple touchpoints to attract and retain a patient. Some patients prefer calling a practice over the phone and may not be comfortable with indirect modes such as apps, emails, etc. Some might prefer quicker and convenient digital options.
All key contact details, such as the website link, email address, and phone number, must be added to the patient statement. Several contact modes in the statement indicate flexibility and availability of the practice to answer patient requests.
The dental practice can offer various offline and online payment options to patients. This increases the possibility of faster payment. Moreover, every practice can have multiple profiles of patients, and hence, a choice helps to cater to all payment preferences. The team can also include a phone number in the statement to address payment-related queries.
A practice can outsource the job of billing and collection to any reputable third-party firm. These experts can leverage their skills and experience to draft statements that are appealing and convincing. This will also help the existing team to focus on other core areas.
A practice can integrate an automation software solution to manage billing tasks and send patient statements with ease and minimal effort. Automation results in accurate bills and statements. More importantly, saves the precious time of the dental team.
The dental team can effectively use patient statements as an important component of the billing process. Accurate patient statements sent on time make patients aware of outstanding dues. It also increases financial transparency and builds trust with the patients.
A denial of claims leads to a disruption in cash flows. Claims that are delayed and submitted beyond the deadline can cause a disturbance in workflows and can demotivate the dental team.
The team at the practice must confirm patient details concerning the insurance policy plan of a patient at least three working days before the patient arrives at the practice for a scheduled appointment. When dental insurance verification is done in advance, it enables the team to allow for timely planning with patients about payment. It also facilitates a smoother patient experience.
The dental team needs to confirm details such as effective coverage dates, waiting period for coverage to begin, if benefit maximums have been reached, or if any deductibles are yet to commence.
If the dental team does not address these problems earlier than the scheduled appointment date, the team is not prepared, and the patient can get a higher bill than expected. This hampers the patient experience, and, more importantly, the patient might also not make payment on the day of the appointment due to a lack of adequate time to prepare for funding arrangements.
The team can make the patient experience smooth and can clear dues on the day of the appointment itself if the dental team has confirmed insurance coverage details in advance.
The team can ask for a predetermination request from the insurance organization if needed. The predetermination is a tentative estimate that outlines a suggestive amount of insurance coverage as well as the patient’s financial payout. This is done even before the start of dental treatment.
When briefed by the dental team, the insurance reviews the request and accordingly prepares the predetermination and shares the same with the practice. The details that can be included in the predetermination include the patient’s eligibility status, services covered by the plan, amounts payable, plan maximums, and details of co-payments or deductibles.
While the above is exhaustive, the team must make an error by solely depending on predetermination and not carrying out any insurance verification. While there may be an overlap between predetermination and insurance verification, there are some stark differences.
A predetermination does not reflect payment by the insurance company and might not always be dependable. The predetermination might hold good only for the date that it was processed. Insurance verification, on the other hand, enables the team to interpret the data, plan the appointment date, and share details with the patient accordingly.
The dental team may have to wait for the predetermination request, as an insurance company might not share it immediately. This can lead to a delay in treatment for a patient. When the team performs a due verification check, it has better control over information and can act appropriately. Once insurance verification is done, the team can plan the treatment schedule with patients.
In case the dental team is pressed for time, the insurance verification process can be outsourced to specialists. They ensure that all necessary details, including copays, OPE, etc., are shared with the practice well before the scheduled appointment.
They can then explain the coverage benefits and empower the patient to plan the treatment with confidence.
The dental team can also make it clear to patients that they are ultimately accountable for the cost of treatment rendered to them.
The dental team must take care to avoid verifying the insurance benefits of regular patients. The team need not assume that coverage of a regular patient should be taken for granted. The team must update the records in the practice management system and ensure verification is done for every appointment scheduled at the practice.
There are times when the insurance coverage of a patient can change sooner than the team can anticipate or realize. This could be due to a change in employers or marital status. It could also be due to retirement. Some patients also change their insurance company periodically.
In some cases, there could be a new policy offered by the same insurance company with some additional benefits added. In such cases, the team needs to ensure that newly added benefits are in effect at the time of the appointment, as there could also be a possibility of a waiting period. Moreover, changes in the policy plan for patients that has recently changed might not reflect in the portal. Hence, it is advisable to verify the coverage benefits of a new patient as well as a regular patient.
Performing the insurance verification process for a few patients seems simple and not very time-consuming. But for the verification of multiple patients booking an appointment daily, the process can be cumbersome and time-consuming.
The team should avoid hurrying through the process of verification. It should not skip a patient or even rush through a patient’s verification step without complete due diligence. This can unintentionally lead to an increase in the number of claim denials.
There are many instances in which a practice has patients who are covered by multiple insurance plans. In such cases, the dental team needs to understand how the insurance verification process will identify which insurance policy will cover the patient for the treatment offered.
In these cases, the rule of coordination of benefits (COB) will apply. The primary, secondary, or tertiary insurance policy will have to be identified by the team, and claims submitted as per the COB rules.
The sequence by which a patient’s insurance policy coverage gets selected is known as coordination of benefits, and is tricky for the dental team to identify the primary insurance company covering the patient. It can also depend on the specific situation of a patient. An incorrect order of the patient’s insurance coverage will result in a claim denial.
Hence, the team needs to be adequately trained about insurance coverage rules and thus help the practice collect more from the insurance organizations.
Most insurance organizations have tight rules and deadlines with respect to the filing of claims. There are also dates to be adhered to by the dental team for filing of revised claims.
Some claims might have to be submitted between six months to a year, while some insurance companies ask for submissions within a fortnight or a month from the date of the scheduled appointment.
The team needs to submit accurately filled claims within a couple of days of the treatment offered to the patient. A failure on the part of the dental team to submit claims within the set deadline can lead to a potential loss of revenue. This can cause an interruption in cash flows.
While the reasons for missing a deadline could be many, the practice must ensure that all such reasons are identified, and all efforts must be made to ensure timely claim submission.
The dental team must ensure that all claims submitted to the insurance organization are precise and accurately filled out. Failure to do so, either omission or incorrect data, can lead to denials. Missing data or inaccurate details can be a lack of codes, wrong codes, or incorrect personal particulars.
There are multiple options that a patient can select while confirming an insurance policy. Some patients may not desire treatment coverage for all services. Some services might get covered by the plan, while may have to be paid by the patient. Claim denials can happen when the dental team has not verified the insurance coverage accurately and on time.
The team must also ensure proper documentation accompanies all claim submissions. A failure to support claims as proof for the need for particular procedures or services can also lead to a denial.
The key reason for claim denials is not conducting timely and accurate verification processes. This can lead to an interruption in cash flows for a practice. Adopting a few recommended measures, as mentioned above, can considerably reduce such issues.
Any dental practice must focus on quality treatment and care, as this helps to attract and retain patients. However, the practice must also keep an eye on profitability to run the business successfully. A practice can deliberate a shift to real-time insurance verification in order to reduce denials in claims. This helps to accelerate the revenue cycle. An investment in the right software can lower manual effort and claim denials while also reducing costs.
It is the process of confirming the benefits of insurance coverage by using an automated software solution as compared to traditional manual means. The dental team can submit patient information directly to the insurance organization or to a clearinghouse. The team then gets instant access to patient details such as policy coverage details that include copay, validity dates, and more.
According to various studies, the primary reason for claim denials across dental practices is an eligibility issue. Nearly ten per cent of insurance claims are rejected on the first attempt. A practice can lose nearly three per cent of patient revenue due to denials.
Moreover, the practice has to spend on appealing for a denied claim. The best part is that a large portion of such denials could be avoided if the dental team took adequate steps to prevent them.
For the practice, insurance eligibility verification in real time can become an integral component for success. It makes the process of claim submission smooth by reducing the probability of claim denials, as well as bringing down costs associated with claim submission.
Insurance eligibility verification for a patient before rendering procedures or services is a vital step for a practice to deliver quality and timely care to a patient.
Verification of insurance details before the scheduled appointment can prevent unwanted denials and financial setbacks. More importantly, the practice can render optimal care the patient needs without a delay.
This helps the dental practice to lower administrative work. A reduction in wait time can enhance the patient experience. The patient is not surprised by an unforeseen financial outlay. The process involves confirming various aspects of insurance coverage based on the policy plan. These include benefits, possible out-of-pocket expenses, etc.
Performing such a task before the appointment results in accurate treatment plans. It also results in a more productive appointment for the practice and a pleasant experience for the patient.
The solutions available to a practice are varied. Automated batch workflows, code error detection are among other options available. These solutions can be integrated with the existing PMS of the dental practice. Estimates can be automatically generated and sent to patients by email, while copays and deductibles can be identified through automated batch workflows.
Real-time insurance eligibility verification checks coverage instantly by connecting directly with the insurance organization. Practices benefit because the process does not involve slow and manual checks. Some of the benefits include:
Denial rates of submitted claims fall because of a reduction of errors, both data and unforced. The number of days taken to receive payments is also reduced. This helps to improve cash flows. Unlike manual means, real-time verification takes help from electronic data exchanges while adhering to HIPAA rules. This results in precise and accurate data.
Real-time verification enables greater cash flows due to accurate checks and fewer denials. The process is faster, and this means better cash flows. When service is stopped before care has been rendered, the team spends less time handling claims and can concentrate on other activities. The practice does not have to hire an additional resource merely for insurance verification.
Most patients are covered by an insurance policy. They could be covered by an individual policy or through the company insurance policy. Most of these patients are not aware of their policy costs or benefits.
When the dental team uses real-time verification, they get access to accurate information about deductibles, copays, and balance amounts based on coverage. As surprises are avoided, patients are satisfied and place greater trust in the process.
Practices can outsource the task of insurance verification to a specialist or opt for a platform that can connect with multiple insurance organizations. The team can share a tentative cost to patients. Real-time verification lowers wait times while making patient visits smoother and easier.
The regular manual process of insurance verification consumes time, effort, and is cumbersome. Moreover, there could be unexpected errors that lead to claim denials. Since automated systems verify coverage and benefits in real time, the team can focus more on patient care. Real-time verification includes scanning of insurance cards and placing information into electronic health records.
Practices can scale operations effectively while using accurate data consistently in real time. Compared to manual modes, the practice can respond to patient needs more precisely and fast. This also positions the practice in a better light and makes it more aggressive in a highly competitive market.
The data format and structure can vary across insurance organizations. Using advanced insurance verification APIs, a practice can circumvent this challenge and generate standardized outputs. This curtails the need for the dental team to address challenges posed by insurance companies while simplifying the verification process.
These APIs provide comprehensive data through multiple sources and enable customized verification processes. They can sync with existing workflows while receiving accurate and timely data syncs. The dental team is thus empowered to make informed decisions faster.
Beyond EDI data, other useful information, such as coordination of benefits, missing tooth clauses, exhaustive patient history, and complete coverage of ADA codes. These insights help to lower claim denials and boost cash revenues through faster collections. It also helps to reduce administrative time, phone calls, and overtime expenses.
Real-time eligibility verification needs to be adopted by dental practices today, as the benefits are manifold. It boosts the patient experience through transparency. It builds patient trust and ensures negligible claim denials.
Revenue loss and unnecessary reimbursements stemming from simple coding errors when generating a bill or from missing a claim submission date. They are a waste of time, but also negatively impact cash flow, and hence, denial management needs to be looked at by the dental team. These errors also tend to irk and lose goodwill with patients. Multiple errors happening periodically can also make a practice financially unviable.
A few challenges that are faced by a dental practice when it comes to billing, and especially claim denial management.
To prevent dental claim denials, CDT requires the team involved to stay up to date on changes to existing codes, learn new codes, and be aware of deleted codes. This is because the codes for dental procedures are updated frequently.
Billers must cross-check and authenticate the patients' coverage details before the appointment to determine whether the payment methods for the services to be rendered are not covered by insurance.
Retention of workers is vital to ensuring that the knowledge and proper consideration of process details are closely monitored, thus aiming for the successful processing of all claims.
There might be increased denials and revenue loss as a result of attrition, absenteeism, and frequent staff changes that impact billing quality.
A few ways to avoid such errors that hamper business operations are as follows:
As innovation and medical equipment have evolved, so too have the tools used in dentistry for procedures and implants. As new equipment and methods emerge, so does the need for coding to assist them with new tools and techniques. In case of a coding shortcoming, an annual refresher is there to assist even the most seasoned practice supervisors.
Practices must examine and record the progression of codes often used and evaluate the ways of their impact. The coding refreshers address new methods and help focus on more effective ways to increase payback efficiency. There are changes in materials and even advancements, thus leading to better methods for submitting claims and payments.
Billing processes for a dental practice can be easily streamlined by outsourcing to a reputable dental billing specialist. They can help the practice by bringing overhead costs down as well as boosting cash flows. Dental billing eligibility verification, dental claims processing, etc., are just some of the services that could be outsourced to the firm.
To guarantee prompt payment, it is crucial to have the best dental billing professionals when submitting insurance claims. It is crucial to establish a streamlined procedure for reviewing and validating daily claim submissions so as to eliminate inaccurate information, maximize quality, and well monthly collections. Billing and coding specialists help monitor the claims' progress to determine the reasons for claim rejections and denials, and thus, as a result, they resolve all claim-related concerns and guarantee efficient dental billing and coding.
Poor follow-up and missed deadlines are not the only reasons claims are denied. Inaccurate patient information or coding errors are detrimental to your practice. Your practice may lose thousands of dollars in revenue if dental claims are filed after the deadline without a clear system or if the information provided is inaccurate.
Each insurance provider has a different date for submitting. While some permit six months for filing claims, others might provide a ninety-day window. However, waiting too long lowers your chances of getting compensated, no matter how valid the claim is.
Once treatment is completed, the dental team must file completed claims within a couple of days. This means a minimal possibility of a mistake or error. There is a greater chance of forgetting steps, reporting treatment incorrectly, or failing to submit at all if a claim is created after waiting for some time.
By grouping several operations under a single code, Insurance payers pay less than they would if the procedures were billed separately. Bundling is frequently practiced by insurance payers to lower reimbursement. A practice may miss out on income without even recognizing that the team fails to assess and understand when and how bundling applies.
When an insurer defines two or more different procedures as one "comprehensive" service and considers reimbursement on that reduced rate, it is known as bundling.
For example, the dental team undertakes two distinct X-rays, such as a bitewing and panoramic. It bills these services separately. The insurance company, however, considers both these X-rays as a full mouth series (FMX). It offers reimbursement to the practice as a bundled rate applicable as FMX.
Understanding what is permitted as per the guidelines and which of the procedures included need to be bundled. Review the recent CDT codes and changes, as previously grouped services could have been unbundled in certain recent revisions.
Accurate CDT coding is vital to further support a claim for separate billing. Additionally, include any available documentation with the claim submission to further support such claims.
Most insurance companies have made it necessary that the practice recovers the patient's financial dues completely, and ignoring such rules may result in fines. The practice must avoid charges of making false statements or a waiver of the pending amount payable by the patient.
Managing deductibles, copays, and co-insurance amounts
Not just an error, but insurance fraud occurs when procedures that were never performed are billed for. This involves submitting claims for unfinished, discontinued, or never-delivered services. It is a very serious abuse in dental care that can lead to unwanted fines, audits, or prosecution, depending on the extent of the violation. Steps to avoid billing for services not rendered are as below.
The issues that arise due to billing errors can be detrimental, and this can be manifested in the form of restricted cash flow, unhappy patients, and additional work for the staff. Following a few easy and proven measures can help the practice avoid unnecessary billing errors.
The dental recredentialing process is a vital process for any dental practice. It helps it to stay compliant with the prevailing rules and regulatory guidelines.
In-network dental credentialing is important for a practice to run profitably. As the practice needs to update all documents and certifications that were done earlier during credentialing. This process helps a dental practice to remain compliant as regulations keep changing over time.
The recredentialing process can include the acquisition of additional licenses and certifications. It also includes renewal of existing licenses and certifications. The process can consume a great deal of time and follow-up.
The credentialing and recredentialing process can consume time and also needs some focus. While not a glamorous task, its importance needs to be noted. For a new or established practice, maintaining the credentialing status of dental practitioners is vital for keeping the practice running smoothly and profitably. It is unethical and wrong for any practitioner to offer services to a patient, and hence, maintaining status or recredentialing can help generate positive cash flows.
Maintaining status or recredentialing of dental practitioners ensures that the dental team has a good standing with the insurance organization.
This is because all insurance organizations insist that dental practitioners stay credentialed regularly. The usual validity period is three years, after which the team needs to start the recredentialing process again.
For recredentialing, the dental team needs to commence the credentialing process yet again to confirm that there are no major changes and that the dental practitioners are still eligible to participate in the insurance organization’s network and offer services to patients.
The most important point of consideration is to ensure careful monitoring of the status and ensure that the practitioner’s status does not lapse. Once this happens, the service to a patient from such a practitioner is not permitted.
This means that the practitioner is now out of the insurance network, and the dental team will have to start the entire process of credentialing from scratch.
The dental team needs to ensure that the status of the dental practitioner is live and valid. The team needs to be aware of when the dentist was initially credentialed. All dental practices have an effective date with the respective insurance organization. The team needs to calculate a period of three years from the effective period for getting recredentialed.
This timeline could fluctuate in case the dentist was credentialed before or after joining the dental practice. Hence, tracking of validity dates is important right at the start.
The dental team needs to ensure that the effective and validity dates are properly documented and are easily accessible. The team can also mark the calendars for about three months before the validity dates for the respective dentists. This allows the dental team to finish the recredentialing process on time.
The easy way out for the dental team is to depend on the insurance organization to send a reminder to the dental practice with regards to the validity date.
This can be risky for a dental practice, as not all insurance companies might send a three-month notification. It is also possible that the notification can be misplaced or left unread. It could also be sent to a non-functional email ID. When contact details are not updated with the insurance company, the practice might miss out on reminders. In case of a lapse in status, the entire process of credentialing must begin again.
Hence, the team can set reminders to ensure the process of recredentialing begins before the validity date and is completed before the time.
Documentation is vital for any dental practice. The team responsible for the credentialing and recredentialing process must be responsible for maintaining files, documents, and the status of the dental care providers.
This includes the dental practitioner’s effective date, the contact numbers, and the continuing education records up to the last three years would be useful. The liability insurance cover page is also needed. These details are needed for the recredentialing process. Hence, the team needs to keep such details and documents accessible so that the recredentialing process can start well ahead of time.
A lapse in credentialing can spell trouble for any dental practice. In the case of a lapse, the practice cannot submit any claims to the insurance organizations for reimbursement. This means a halt in payments that can affect cash flows. For a practice owner, this could indicate salary payouts for a dentist who cannot render any service.
A few insurance organizations can consider a lapse as a red flag. As a result, the recredentialing process could take longer, or they might keep the process on hold for a particular period.
Since tracking the credentialing status is critical, setting up a smooth process is a must. The process must be streamlined and organized so that all details and documents are captured and accessible as and when the need arises. A few steps need to be followed.
Tracking The Effective Dates
All dental practitioners have unique effective dates with insurance organizations. The dates need to be recorded in any applicable software package used by the practice for easy access. Tracking for any dentist must be done for every insurance company they’re credentialed with.
Calendar Alerts
Calendar alerts must be set for at least 3 months before the credentialing due date of the respective dentist. The team can use convenient options such as Google Calendar or Outlook. This helps the dental team to avoid dependence on the insurance company for a reminder. This provides plenty of time for the team to commence the recredentialing process.
Collation Of Documents
The recredentialing process requires documents from a dental practitioner. The team must ensure that the necessary details and documents are in place. This includes Continuing Education (CE) records for the last three years, contact details, etc.
Connection With Insurance Organizations
The dental team must build strong relationships with the insurance companies. These teams can prove useful for the dental team when there are issues with the re-credentialing process.
On submission of the re-credentialing application, the team needs to rigorously follow up with the insurance organizations to ensure that all things are in order. One cannot wait for the insurance organization to respond. A few allow dental practices to check for the status online, and this can prove useful for the team to keep checking on it regularly.
Like credentialing, the recredentialing process ensures that qualified dental healthcare professionals offer care and solutions to patients, thereby curtailing potential errors and reducing medical errors. The process takes time, so the team needs to initiate it at least three months before the validity date. The efforts are worth it as credentialed dental practitioners boost the reputation and trust of the dental practice. Partnering with Capline Dental Services can make the credentialing and recredentialing process smoother, ensuring compliance and helping your practice maintain profitability.
