Practices today have a wide range of dental office automation tools and solutions at their disposal to make workflows smooth and efficient. A practice can take advantage of technology to automate routine jobs and lower staff turnover.
Some reasons why the dental team can get stressed include an overload of paperwork, missed appointments, and cancellations. Such tasks can consume valuable time, and hence, the practice must consider automating them.
Dental office automation tools are useful for producing reliable dental reports. When performed manually, the preparation of reports can be quite a challenge. The team can use tools to generate reports that can help in decision-making and improving quality. This can include total volumes of patient visits, patients’ insurance plans, treatment details, etc, on a user-friendly dashboard.
All practices are inundated with regular administrative tasks. These can include scheduling patient appointments or managing cancellations. Such activities, including sending patient reminders, can be automated. If a dental team can be overloaded with work, an important task like handling patient appointments can be jeopardized. This can lead to booking overlaps or missed appointments for patients. A disappointed client is not a welcome situation, and hence, automating the scheduling and booking process can help the practice avoid such setbacks. Enhanced visits to a practice promote a stable revenue stream and spur the patient base.
The practice can conduct basic engagement protocols with patients in addition to visit reminders. The team can send anniversary, birthday, or festive greetings that can help to maintain a personal touch with patients.
Managing patient records and accessing them through a safe and dependable software platform can boost treatment plans and procedures. The practice can achieve positive outcomes when all the critical data is stored in one place. This also helps the practice to customize the treatment recommendation for achieving desirable results.
A few categories of software solutions that a dental practice can consider are as below.
This is a must for any dental practice as it is vital to safely and securely store records of patients. A dental EHR software not just collects health data of the patient but also the results analysis, diagnoses, health history, prescribed medicines, and other records. The software makes patient data storage simple as a centralized repository and distributes information to different institutions as needed.
A good scheduling software significantly minimizes missed visits by a patient. It records the busy and available dates and sends patient reminders. A patient can make an appointment with the practice anytime based on convenience and preference. There are even options
for a patient to select a specific dental practitioner while making a booking, in addition to just the date and time.
A practice management software (PMS) is the core for any successful dental practice. It offers a comprehensive workflow solution and combines various features in one system. Many daily tasks, such as appointments, reports, dashboards, and billing, can be completed using a PMS solution. By effectively using a PMS, the dental team can boost efficiency by
minimizing paperwork and boosting the productivity of the practice.
By using analytics software, the dental team does not have to manually collate and dissect data for diverse metrics. The software provides the team with different data charts, graphs, graphics, and dashboards. This helps to save precious time as compared to manual efforts. for the team. The software can share results instantly while analysing data. This helps provide timely and incisive data that can help detect any visible trends or gaps. The team can compute various tasks such as employee productivity rates, patient lifetime value, cash flows, and survey results that can offer suitable opportunities for additional business.
The dental billing team can use billing software to handle all billing, insurance, and payment activities with no requirement for reminders or checks. Once the parameters have been set, the software will generate invoices and send them to patients immediately. This ensures a minimum lag between service and billing, thus reducing payment delays.
Moreover, the dental can access critical billing data as and when needed. The software selected by the practice must be compliant with PCI DSS and the HIPAA Act, as it assures patients of the highest security for their card data, as well as keeping all patient data confidential.
The billing team can utilize a claims processing software that will help them stay abreast of all pending claims or denials. This can be done without the need for any manual documentation. This not only curtails any possibility of missing claims but also ensures that the creation of spreadsheets for claim management is quick due to the automated tracking process.
While there are various software solutions in the market, a few tools that are available to automate tasks and processes are as below:
Dentrix is a comprehensive software solution that provides solutions for patient scheduling and communication, maintenance of the EHR, and billing. The platform can also seamlessly integrate several third-party tools for a robust suite of services. There is also an app version available for consulting or extracting any information when needed urgently or as needed.
As a popular software brand, it provides solutions for business and clinical applications. Dentrix also enables a practice to attain an innovative integrated eServices software as well as Dentrix Connected solutions through its network of companies. The practice can also use this software solution for years with its strong network of partner products.
A trending option today for a robust dental software solution is also Eaglesoft. As a solution, there are multiple features useful for a practice. Some include appointment reminders, digital imaging, and insurance claims processing. A user-friendly interface with customizable options makes it easy to operate for the dental team.
A unique quality of Eaglesoft is also the ease of facilitating digital integrations for maintenance of patient record management, performance metrics, etc. It also enhances the clinical and administrative productivity of the practice and ensures that all operations run smoothly. Thus, the practice can focus on superior patient care rather than administrative challenges.
This software solution is a cloud-based solution that provides the team with easy access to patient data, billing, and scheduling, irrespective of where the team is located. The team can benefit from reporting and analytics tools to track practice performance. Denticon removes the complexity of handling business operations.
It has a front office tool that makes managing front office tasks easier while also enhancing daily workflows, patient interactions, etc. In terms of offering operational efficiency for seamless practice management, a practice can comfortably depend on Denticon.
CareStack is a popular, comprehensive dental software solution that offers the team a superior experience for managing business and administrative operations. It is a complete solution for effective practice management, and as a modern and dynamic cloud dental software, it can strengthen business processes and drive efficiency. It has an advanced reporting and analytics function for handling operations smoothly.
Multiple dental office automation tools can considerably improve the quality of workflows and business outcomes for a business practice. These include practice management software, billing software, or other such solutions. Many cloud-based solutions today offer a comprehensive suite of solutions for a dental practice to automate most processes and boost efficiency.
Every dental practice must maintain a regular revenue flow to stay sustainable and profitable. An important element in this process is dental insurance verification. The dental team needs to focus on a patient's insurance eligibility to facilitate smooth billing and reimbursement by insurance companies.
Insurance eligibility for every patient needs to be verified and confirmed before rendering any treatment or service. This will help reduce or avoid claim rejections or other delays.
If a dental practice faces several denied claims, there is an imminent threat of putting the revenue pipeline at risk. When a crunch in cash flows becomes imminent, the dental team must understand why claims are being denied so that necessary action can be taken to get reimbursements and ensure that revenue flows are as per expectations.
As generally observed, nearly all dental practices consider dental insurance verification as a cumbersome process, and despite creating clean claims, the practice is still faced with claim denials and appeals. Insurance claim submissions are a repetitive task. If faced with a denial, there needs to be a resubmission and follow-up with insurance companies will the practice receives the payment.
Such tasks consume time, and this means time taken away from patient care. For a practice that is in-network, a large volume of revenue is dependent on efficient eligibility verification. Hence, the team needs to comprehend why dental claims are getting rejected. One needs to understand how expert handling of the eligibility process can help in curtailing errors and reducing claim denials.
There are multiple reasons why dental insurance claims can get rejected. Data entry errors, such as entering the wrong birthdate of a patient, can adversely impact acceptance by the insurance company. Lack of frequent audits or inefficient billing processes can also lead to claim denials.
A few points to consider that can spike the acceptance of dental claims are as below.
The dental team needs to do a thorough analysis of insurance claim data that includes tracking denials by type, volume, insurance organization, and frequency. The team can gather relevant details such as claims denial percentage on initial submission, the amount of time between the dates of denials and subsequent appeals. It is also vital to check the percentage of reworked claims sent by the team that got paid versus those that had to be written off.
Such an analysis can offer the practice a few insights into recognizing the source of errors that lead to denials. The causes could be human, process-related, data entry, technology, etc. It is observed that claim denials can be due to revisions in the policies of the insurance company.
Regular monitoring and audits can recognise the source of these errors, and remedial measures can be implemented to prevent claim denials in the future. AI applications and big data analysis will make a strong impact in the future. The dental team must also be prepared on how it can harness technology to streamline and enhance the billing and claim submission process. This would help lower claim denials and boost cash flows.
Once the source errors and discrepancies have been identified and evaluated, the team needs to have robust denial management plans in place. The team must maintain a record of denied claims to identify reasons and common issues. Processes need to be followed to handle each type of claim denial.
A structured process workflow to manage each kind of denial is critical. This helps to handle claim denials efficiently. For example, coding-based errors can be sent to the billing and coding team for assessment and action.
The team needs to keep a note of the timelines involved in resolving issues and resubmitting claims. Insurance companies have different windows for submissions of claims and appeals. Based on the rules of the insurance company, the reason for accepting the claim may have to be given in writing.
A precise documentation of treatment rendered, relevant documentation, etc, can be submitted again to support any resubmitted claim.
As simple as it sounds, incorrect data filled in claim forms can be a cause of worry.
Many practices have received claim denials due to incorrect data being filled in application forms. The team must note that even a slight error can lead to claim rejection by the insurance company.
A few careless errors include a spelling error in the name or a wrong insurance policy number. While an input error can be a cause, the team must also make sure that the policy details and terms have not been revised or changed. Besides careless errors, such as a name or policy number, policy details also need to be frequently verified.
The team must craft a structured process for filing appeals for denied claims. There are possible options that are available to the team.
The submission of a claim on time is critical, and all possible causes for a delay must be addressed by the practice. The team also needs to create a follow-up process for overdue payments and pending claims. If the team is proactive and keen on avoiding denials, then the possibilities of sending accurate claims to insurance companies are very high.
The dental team must confirm the insurance policy details of a patient before a visit to the clinic. All details, including demographic information and insurance details, must be
confirmed by the team. The team can ask patients about revisions and updates in the policy, or any other relevant details related to the policy, in every visit.
The practice must have periodic audits as a vital denial prevention strategy. These audits can identify and curtail errors in billing and coding, or other possible errors, before they are sent to the insurance company. Other regular errors can also be detected and rectified during these periodic audits. The practice can seek the services of a specialist third-party billing agency to provide an objective review of the billing process and suggest suitable recommendations.
The team must stay updated on the billing and claim submission guidelines of different insurance companies. This will help to avoid errors and prevent claim denials. The team must also be aware of the process for appealing any claim denial.
The team must be aware of the insurance company’s contracts and the patient's coverage plan. Meeting representatives from the insurance company often will boost the quality of the relationship and help address any issues easily.
Inaccurate or incomplete dental insurance verification can not only affect the quality of services that the practice provides to patients, but it can also affect cash flows. The practice can consider outsourcing the task of billing and claims to a third-party specialist. Verification of dental insurance eligibility ahead of time is important and saves a lot of stress for the patient and the practice while also ensuring smoother cash flows. A few steps taken by the dental team can ensure a more efficient billing and claims submission process with minimum claim denials.
Dental credentialing services in today's competitive market support practices that focus on patients rather than administrative tasks. The verification of a provider's education, board certification, licensure, and professional background is required to become an in-network provider with insurance plans. In this blog, we present a quick guide on credentialing and how automating the process improves efficiency and administrative speed.
Credentialing is a mandatory process. Insurance has become a part of people's dental care routines. Patients prefer insurance plans to bear the cost of their dental service bills. To stay competitive in the market, the providers must get credentialed to increase the patient base and revenue. Once credentialed, the dental practice has high patient traffic, prompt reimbursements, a simplified payment process, lower claim rejections and denials, and improved earnings.
An indispensable legal requirement that involves verification and examination of academic qualifications, career history, training, licenses, and practice experience. Capline Dental Services, as your dental credentialing service provider, eliminates the risk of errors. It is beneficial to utilize expert knowledge to streamline this complex process.
The practice saves time and high administrative costs in the credentialing process. By reducing administrative errors, the practice has more time to focus on patient care and avoid disruptions in revenue.
Credentialing and re-credentialing are equally vital. One verifies the qualifications and compliance, and the other ensures it gets maintained throughout the practice journey.
Revenue and Patient Loss
Patients prefer in-network providers. Due to credentialing delays, the practice can face setbacks:
Dental credentialing is a crucial early step in starting a business, typically requiring several months before a provider can see patients. And maintain the patient base without disruptions. Capline Services, as a partner, uses software solutions for notifications.
Administrative Burden
Working on rejected claims is tiring and requires extra rework for the team, which makes the process more difficult.
The experts at Capline Services continuously track the credentialing status and take regular follow-ups with payers to accelerate the approval process.
Patient Dissatisfaction
Delays are a source of unhappy patients, resulting in negative perceptions about the practice. Patients may become dissatisfied if there are lengthy payment delays or surprise bills due to disruptions in provider networks. Capline Dental Services ensures direct communication with payers to expedite it.
Credentialing errors are a subtle depletion of reimbursements. Although identifying them early on can offer a solution. Why do challenges occur in credentialing? Because of inconsistent documentation, tracking manual deadlines, insufficient training, and ineffective communication.
The problem the practice faces is that the application takes more than 90 days. It affects the recredentialing deadlines and billing disruptions.
The cloud-based system for securing data and implementing automated reminders to reduce approval timing from 90 days to approximately 45 days, achieving 100% compliance and eliminating manual errors.
The practice experiences 45% of claim denials resulting from credentialing errors. That means non-credentialed providers' claim submissions with inappropriate provider details. The best practice is to conduct an internal audit to identify uncredentialed providers before claim submission. It can save thousands of dollars and reduce denial rates by refraining from non-credentialed providers from billing.
Each payer has specific requirements, and if you are dealing with more than 15 payers at one time. The added data requirements can cause extended delays in approvals.
Creating a document with payer-specific requirements and deadlines can reduce resubmissions. A dedicated team member is assigned to handle top-priority payers to increase approval rates. The payer-specific approach can foster trust and strengthen relationships.
Many patients feel that they do not receive the appropriate dental care due to inconvenience, high costs, fear, appointment conflicts, inaccessible locations, and dentists not accepting insurance. Dental insurance verification is one of the primary reasons for claim denials and inconsistent cash flow.
Skipping dental insurance verification is not an option for the practice. Even a minor slip-up can drain all the time and energy, resulting in unhappy patients. This article highlights how dentists, verifying patient information, can secure payment in the RCM.
The insurance verification originates with the patient's call. The practice should collect key information about the beneficiary, the insurer, and the employer.
The collection of these details at the initial point of contact enables the practice to determine eligibility. Some outlined issues take time and resources.
The experts at Capline Services have years of experience in handling situations. The outsourced team streamlines the dental insurance verification process to prevent denials and upgrade the consistent flow of cash. Experts empower providers to navigate patient details and verify coverage details before treatment.
Compliance with the HIPAA regulations safeguards patient personal data.
The initial verification is just the start until the practice receives the payment. With the new month, coverage may change due to employment status.
Complete Patient Data
Firstly, gather PII to verify eligibility during the first patient visit to the clinic. A single mistake in personal and insurance details can affect revenue. The wrong start date of the insurance policy provides incorrect information about coverage.
Verifying Patient Eligibility
The step confirms the eligibility for dental services. The patient from the policy tries to cover expenses to support their dental care. Verifying accurate information about coverage and benefits helps the practice receive quick payments. Information about co-pays, deductibles, and coverage annual maximums expedites verification.
Confirm Coverage before the Service Date
The practice contacts the insurer to verify insurance coverage before treatment. Sometimes, the patient's dental plan is not notified about their termination by the employer, as stated by the American Dental Association. As a result, the details may not be accurate.
The best practice would be to ask questions on their service day to confirm the changes in their eligibility. It would look like:
It is crucial to understand the challenges associated with the COB. Beneficiaries have more than one plan to maximize coverage. The complexity of COB results in overpayment.
Choosing between primary and secondary coverage correctly ensures maximum reimbursement. Every dental plan has unique limitations. Managing primary and secondary coverage together improves the collection. It also provides patients with fair-priced services, as it follows the annual limit for dental services.
Additionally, few plans have lifetime maximums, so understanding the restrictions creates smooth dental services. If the procedure is not covered, meaning working with exclusions and deductibles to get payment for eligible reimbursement.
The dental practice submits the claim adhering to coding and billing guidelines after the completion of the treatment. The research shows that approximately 8% of annual revenue gets compromised by claim denials. Proceeding with the reimbursement process to explore why clean claims matter and how to prepare for upcoming trends.
However, some dental procedures shall be indemnified under their medical policy first. Failure to do so can cause payment loss. Technology can play a role in RCM, enabling real-time corrections.
Clean claim submission is an accurate dental insurance verification process reinforced through proper documentation. It includes eligibility details with dates, policy updates, active coverage benefits, prior authorization information, gaps in coverage, communication with the insurer, treatment estimation through written communication, and patient consent.
Managing insurance eligibility requires the right approach towards accurate information and following standard processes for faster results. Denied claims indicate manual workload and dissatisfied patients. With Capline experts as your team members, the verification process can result in timely payments and happy clients.
Attracting new patients costs more than retaining existing ones, so why not implement strategies to enhance revenue growth? That is critical. Patient retention in dental practice is not just about attracting new ones but also about building long-term relationships with existing ones. It is a single aspect of the patient care ecosystem that, sadly, often takes a back seat. And still a crucial element for thriving.
Higher patient retention measures success. It ensures the provider can offer a series of treatments to individuals. The improved outcome is that the patients want to see the same provider for long-term appointments, follow-up visits, and preventive care. High retention rates reflect trust in the provider and repeat business. Maintaining a high retention rate is not easy, and the patient can leave the service for the following reasons:
These issues can cause patients to leave the provider, the opposite of what the practice is looking for. Outsourcing to Capline Dental Services offers an added advantage with tailored solutions designed to enhance effective patient retention for dentists. It streamlines patient workflow, ultimately contributing to a higher retention rate.
Long-term success resides in an effective patient retention strategy. It is beyond increasing the cash flow.
The team at Capline Dental Services handles the end-to-end process to enhance revenue cycle management. The experts diversified their knowledge and stayed ahead with the updates to offer solutions that contribute to patient retention. Contact us for a quick appointment.
Dental billing errors are also known as silent revenue killers, hindering the practice's growth and business development. What constitutes a dental billing error at a greater and greater cost to the practice? That doesn't mean that the practitioners and the team do not care about the billing errors. It becomes easy to ignore the administrative tasks due to patient treatment, but the truth is that insurance companies thrive on dental billing errors.
People believe that becoming a dentist means high earnings and seeing a lot of patients daily, yet still barely breaking even. To figure out what is happening that leads the practice to lose money. Let's discuss dental billing errors and how to avoid them to collect more.
The staff verifies all details as soon as the patient visits the clinic to ensure the practice does not incur compliance issues. There are times when the insurance claim form has inaccurate information. Rework costs a considerable amount of money to the practice. These errors are trivial, but they can create gaps in your collections that are tough to fill. Profitable insurance billing brings a 50% increase in the overall revenue.
The details include:
Incorrect insurance verification is one of the main reasons for claim denials. It is frustrating for the practice, but this issue also occurs more frequently than you might expect. The verification process has opportunities to go wrong, and when it's inaccurate, the practice has unpaid balances, denied claims, and unhappy patients.
According to the Journal of Dental Practice Administration, the practice loses $30,000 and $60,000 each year.
Dental billing is time-consuming. The dental billing blunders lead to a 5-10% revenue loss. Incorrect coding is a reason for low collections. Correct coding is challenging for obvious reasons. ADA updates the coding to provide standards and consistency for patient care. That creates confusion in navigating the new and old codes.
Coding mistakes range from $50,000 to $100,000 every year, and that is money well deserved, but because of coding errors, the practice has to leave it to the insurers.
The best way to prevent silly coding errors is to work with Capline Dental Services and let them handle the complexities of CDT coding. Coding mistakes not only lead to claim denials but also result in lost revenue each year. There are reasons to invest in outsourcing companies to get better collections and happy patients.
Missing patient follow-ups is costly when it comes to collecting payments. It seems a bit confusing how an inefficient follow-up can lead to billing errors. The Academy of General Dentistry states that failure to prompt patient follow-up results in a revenue loss of $1,000 to $3,000 a year. How much revenue do you think you are ready to leave to the insurers because the staff were unskilled in conducting follow-ups? Dental billing services offered by Capline Dental Services can help the practice focus on taking patient care.
Clean and efficient claim submission is dependent on a smooth workflow that includes timely claim submissions, proper task delegation, and relevant processes to expedite the process. ADA reveals that practices are losing a considerable sum every year.
That means the practice needs a reliable outsourcing company to handle claims and work on outstanding insurance aging reports. The longer the claim sits in the insurance office, the more difficult it is to receive payment. Ignoring unpaid claims results in cash flow problems in the coming years.
Improving staff skills through investing in training can lower dental billing errors. Train the staff on the latest codes and billing software, how to bill, and collect details necessary for claim submission. The practice has to pay the price for noncompliance and billing errors. The ADA reports that inefficient training than expected can cause a substantial drop, costing up to $75,000 or more annually in lost revenue.
An appointment cancellation, patient rescheduling, double booking, and scheduling issues can hit the practice. These things affect the RCM and create scheduling gaps. Scheduling gaps are rising, and according to the American Dental Association, they result in a revenue loss of $150,000. That can destroy the practice if they fail to pass the bills.
Dental billing errors are inevitable yet manageable. Here are the benefits of having a dental billing service at your side that can change the way your dental billing process looks.
When the team is busy with claim submissions, what happens next? Patients do not receive attention, which pushes them off and upsets them. By outsourcing dental billing, the practice can improve patient relationships without getting distracted by administrative tasks.
Dental billing requires a specific solution with specialized knowledge. Capline Services helps to stay ahead with dental billing, resulting in fewer claim denials and quicker reimbursements.
In-house billing teams are often juggling multiple tasks, which can lead to more errors than they resolve. Capline Dental Services offers cost-effective alternatives that ensure excellent service by reducing overhead costs. This approach helps resolve problems, allowing the practice to reinvest in upgraded technology that enhances the patient experience.
The billing needs to change in response to the practice expansion to adapt to evolving patient needs. Outsourcing provides flexibility in managing patient load and expands services to ensure the practice has the support it needs at the right time.
Compliance accuracy is complex and keeps evolving. By partnering with Capline Dental Services, experts can handle the complexities of dental billing, ensuring accurate claims, maximizing revenue, excellent patient care, and good online reviews. Abiding compliance keeps away from audits and legal issues. Outsourcing offers the support necessary for thriving.
A dental practice must always try to ensure a positive patient experience for a patient. Beyond just rendering quality service and treatment, a relationship can turn sour when it comes to any financial conversation and other dental collection challenges. The team needs to display tact and patience when it comes to dental collection challenges and recovering pending dues from patients.
There are multiple reasons why collecting dues from patient payments is difficult. A few barriers to patient collections are as below:
Incorrect patient data: Billing can be effective when the dental team has access to precise patient information. When the data is incorrect or when wrong data is tracked, the team needs to make corrections, and that can lead to delays in collections and a negative experience.
Coding errors: When the billing team has entered incorrect codes, it can lead to incorrect charges. This, in turn, leads to claim denials in addition to confusion for the patient and a possible loss of trust. This causes delays in payments, which affects the revenue cycle management for the practice.
Spurt in insurance costs: The cost of insurance is on the rise, and when denials also increase, it can add to patient dissatisfaction and payment delays.
While payment collection can be a cause of frustration for a patient and an insurance company, it can also have a big impact on the financial health of the practice.
Delays in patient payments impact the practice as they may not have adequate cash available to precisely represent the revenue cycle and a more perfect view of their cash flow. Verifying patient information and demographics, as well as ensuring the timely collection of patient dues, can lower the rework throughout the revenue cycle. This then results in lower claim denials and greater cash flows.
Collection of outstanding dues is a tough task. To ensure higher collection rates, the dental team can leverage technology as well as a defined process to ensure the collection process is smooth and efficient. This would also result in a more precise receivables statement for the practice.
Mobile Apps
Nearly all patients today use some mobile app in their daily lives. A dental practice must not be left behind. A mobile app enables a patient to check for all details remotely and at a time of their convenience. They can check if their information is accurate before the appointment and reduce the possibility of any incorrect patient information.
Moreover, an app offers a patient a faster and smoother payment experience. A patient might pay bills faster if they had access to an app. A patient also gets notifications about bills and dues that are pending. An app also aids patients with scheduling and not just
payments. Such convenience can trigger patients to pay on time while also making it easier to understand what they are paying for.
Payment during check-in
Collecting payments at the time of check-in can be a great step by the dental team. Most practices take a long time to collect patient payments. Collecting payment when a patient arrives helps prevent delays in collection while also verifying and correcting patient information.
Since the payment is collected at the time of check-in, the receivables due decrease, and this helps boost cash flow. An upfront payment also lowers the administrative hassles for the team in tracking and following up on payments and any possible bad debt.
Online prepayment option
The dental team must try to collect payment from a patient through online options even before the actual appointment. This helps to boost the payment collection process. Making payment online is also easy and convenient for patients who are comfortable with such an option. The practice needs to integrate an online prepayment into the patient registration process. This helps a patient to be aware of the financial responsibilities that would be associated with the treatment.
A patient needs collection processes to be smooth and transparent. A patient is more likely to cancel or postpone an appointment if no accurate estimate has been provided. Many patients are in a better position to pay if the practice offers payment plans and options that increase their ability to pay.
An automated patient estimate equips patients with an accurate view of the expected cost of care in advance. This intimation helps a patient to utilize the time between fixing the appointment and the actual treatment to make financial arrangements. The patient will also not be surprised by a bill amount that has not been anticipated.
The practice can also offer flexibility to patients through structured payment plans. Analytics and data can gauge individual patient details and judge their ability to pay.
An absence of training and tools can affect payment collections. The practice must enable the team with the latest tools and data that can help in addressing payment issues quickly and prevent them from creating problems in the future.
Tools can offer comprehensive insights through interactive dashboards. The team can receive real-time data on revenue, activity reports, aging of invoices, as well as rejection details. This data makes the collection process prompt and precise.
A dependence on manual processes can hamper registrations and payments. Patients need help in comprehending insurance coverage. Automation tools can be of help here, as they can scan patient details and enlighten patients on the extent of coverage available.
One can build the capability to suggest alternative payment methods that can lower the financial strain on patients. This can drastically reduce any financial risk for the practice and the patient.
The dental team needs to be periodically trained in handling patient interactions and boosting collection rates. The team can be provided with sample dialogues and role-playing exercises. Objection handling can be part of the training process.
The practice needs to conduct regular training workshops that take into consideration evolving patient issues. The team can also be trained in financial counselling. This can help them offer solutions to patients with extra care. The team can also be trained to settle minor patient billing disagreements within specified limits. This prevents declined payments and bad debts.
Patient collection for any dental practice is vital as it helps manage cash flows that ultimately affect the financial health of the practice. The practice must instill best practices to make collections as smooth and accurate as possible. Partnering with Capline Dental Services can support these efforts through proven strategies and expert guidance. Regular training and following predefined guidelines will help boost patient collections while also maintaining positive cash flows.
Technology has advanced rapidly, and payment means and formats have also changed for businesses and consumers. In many ways, this can be an advantage for a dental practice. But it can also be a challenge. For making payments, a consumer may find it simple and convenient to use new-age digital payment options such as dental EFT payments.
For the dental team, however, such payment options bring a lot of documentation along with them. The team needs to follow processes to ensure that documentation and reconciliation are properly followed and completed so that all receivables and dues are properly accounted for.
A dental practice can get dental EFT payments or electronic funds transfers from an insurance company as well as from the patient. These payments are directly credited to the bank account of the practice. The dental team needs to ensure that all EFTs are properly accounted.
As is well known, EFTs are a safe, low-cost, and viable alternative to regular cheque or card payments. In some cases, some payers also use virtual credit cards to lower any administrative costs. This means of payment comes at a price for a dental practice, as they need to pay additional merchant fees. On the other hand, payments received through EFTs cost much less,
Accountability is very important, and the team needs to work to avoid any financial complications or errors from occurring through regular reporting and transparency in communication with the insurance company and the patient.
The American Dental Association has issued an EFT implementation checklist for dental practices. The highlights and benefits of EFTs are outlined as well, and steps to get started are explained. This includes an implementation plan to complete training, software requirements, banking arrangements, and getting enrolled with insurance companies.
Trace Number and Deposit Date in the insurance portal before posting
The dental team needs to check with the insurance portal for two elements before ticking off a claim from the pending list and posting it on the software system as paid. They are as follows:
Trace number: This is a unique number that is linked to a particular deposit amount
Deposit date: The date when the EFT was deposited into the bank account of the dental practice
Once the team has confirmed these two indicators in the insurance portal, one can be assured that the dues that the insurance company owes the practice have been deposited into the practice’s bank account. The amount and date of the transaction will be displayed. The team can then close the claim once payment is confirmed.
There can be times when the dental team might not be able to view posted insurance payments, even when done. The team, however, must not post the payment to the dental
software system until one is certain that the funds have entered the bank account of the practice.
Balance EFTs weekly rather than daily is adequate.
This is a simple but vital task that needs to be done by the assigned dental team. Balancing EFTs received by the practice is simple. One needs to ensure that all values in the dental software system, bank account, and insurance portal match to the last cent. This means that the amount paid by the insurance company is reflected everywhere.
When it comes to making payments, a few insurance companies might deposit one large payment on a certain day of the week. The team can then decide on a particular day when all payments of the week are balanced and confirmed. Any discrepancies that arise can be addressed by the dental team immediately.
Even if insurance companies pay on a random basis, it makes more sense for the dental team to define a particular day to balance all payments received in the past week. The team must ensure that this dedicated day for balancing EFTs and deposits without interruption is a great way to keep accounts organized.
While balancing your EFTs and deposit reconciliation is simple, the task can be cumbersome and time-consuming. The team must concentrate on the job and not lose focus.
It has been observed that some insurance companies might stagger payments across the week or in lots. Hence, it makes more sense for the team to reconcile and balance payments weekly. Thus, a weekly schedule of checking and balancing can help make the process smooth.
It has been observed that some dental practices post insurance payments received by payers into the Dental Practice Management System while simultaneously balancing all EFTs and deposits on the same day.
Ideally, this kind of process is not recommended as it can get confusing for the team to switch back and forth between various web portals. This also needs to be done by inputting numbers. It could also be possible that an insurance company can make transactions across different bank accounts of the dental practice, and this can lead to errors.
Hence, the team must ideally post all payments received by insurance companies on a particular day of the week. Hence, balancing bank accounts with the dental software system as well as the insurance portal is the optimal way to ensure that everything matches up.
As per data from the American Dental Association, nearly a third of dental practices have been embezzled at least once. This can be of grave concern for a practice, and with the lack of accountability or transparency, a practice may not realize that remittances are being allocated correctly. A dedicated team at the practice can lower this risk if there are checks and balances in place at the practice.
There is a possibility that an insurance company provider might transfer funds incorrectly into the account. The dental team must immediately detect the inaccuracy. It must then rectify and redistribute such funds properly. This can happen when processes are followed at the practice.
The practice can outsource the critical task of billing and collection to Capline Dental Services. This will help alleviate the staff at the practice and enable them to focus more effectively on managing patients. Capline Dental Services can handle all queries and ensure that all payments and dues are accurately reconciled.
The dental team must ensure to follow all processes outlined for EFT and deposit reconciliation. The team must ensure that all payments made to the practice are reconciled promptly and accurately.
Every dental practice aims to offer quality care and service to patients. A practice can then be rewarded with a steady stream of patients and referrals. This, in turn, yields better cash flows for the practice. However, cash flows can be affected when the dental team fails to file claims on time.
When it comes to dental insurance claims, timely filing is of vital importance. Missing a deadline can affect the cash flow for a dental practice and revenue cycle management. The dental team must not wait to file insurance claims. Delays often lead to denied claims, which affect cash flows and lead to possible bad debts.
The team must also note that the norms for the timely filing of policies can affect the dental insurance claims submission process. The dental team needs to understand the need for timely filing and the cost of missing a deadline.
Different insurance companies have their own norms for filing and their respective deadlines. These periods can extend from 3 months or more from the date of service rendered to the patient.
Some private insurance companies might offer a 3 to 6-month filing window, and some HMOs and PPOs may provide a window of 6 months or more. The window for government and Medicaid plans is usually smaller.
Many insurance companies maintain filing timelines for submitting claims to control their spending and avoid unanticipated payouts. A sudden arrival of old claims can impact their financial projections and cash flows. Insurance companies can use late filing as a reason to reject claims and make payments to a dental practice.
A dental practice has limited control over submission guidelines. The team can, however, handle the filing process to ensure timely submissions.
A practice should ideally submit claims within 2 or 3 days of rendering the service or procedure. Very often, a delay in filing could mean a risk of the team omitting or forgetting to incorporate some crucial information required for a clean claim submission.
All the information needed for a claim submission must be included, such as patient details, insurance policy information, attachments, narratives, clinical notes, etc. A focus on all such details and a timely filing of the claim can avoid unnecessary claim rejections and write-offs.
There is a challenge in submitting clean claims in such a short period, as the dental team is also busy managing other administrative tasks of the practice. Patients who are at the practice today will have higher priority than yesterday’s document and paperwork.
The team needs to identify insurance organizations that have tighter deadlines. The team must target these organizations as a high priority. Based on the date of service rendered, the team needs to prioritize the filing of the oldest first and then advance to later ones.
The team can use the practice management software to identify the sequence of claims. The PMS will showcase the status of claims as well as pending submissions. The dental team can make a note of upcoming deadlines on the PMS too.
By prioritizing the claim sequence and submitting claims to the insurance organization that has a stricter deadline, the team can ensure timely filing, and collections are a lot easier. This process will also safeguard the practice from potential financial losses.
A few steps that a dental team needs to follow are as follows:
By maintaining an updated list, the team can stay aware of filing deadlines for insurance companies and plan the timely submissions for the same. The dental team needs to be regularly updated, as insurance policies and deadlines are dynamic and are subject to change. Such information can be obtained during the insurance verification process.
Streamlined processes need to be followed by the dental team for prompt documentation and submission. The team must ensure all necessary documentation is collated and assessed as soon as possible. The practice can assign a specific team member to track claim submissions and take remedial steps if needed.
The practice must ensure that the dental team is regularly trained and motivated to file all submissions on time and has all processes in place to ensure that timely filing can happen. Ongoing training will keep the team updated on all changes that happen in
dental insurance and billing insurance regulations. Moreover, it will also help in swiftly verifying and updating patient insurance data. This will result in all claim submissions being filed accurately and promptly to the respective insurance company.
The practice needs to conduct regular audits of all billing and insurance filing processes. These internal audits would help to detect any potential issues or delays in processes that could lead to missing the deadlines for timely filing. The practice must ensure that the dental team has all the support needed for accessing prompt and precise information for the timely submission of claims.
The practice must also track and monitor the outcomes of the billing team with performance metrics that include turnaround times from completed appointments to claim submissions. The denial rates with respective reasons for rejection can also be collated. These results can be used as inputs for overall improvement.
The dental team needs to evaluate the denial through a detailed examination. Specific causes for the claim denial need to be analyzed. It can also happen that an insurance company might have committed a simple error on their end. It could also be a case of miscommunication. There are many instances when insurance organizations have committed errors that have resulted in a claim denial.
The team has to collect all applicable documentation that supports the case for the practice. This means proof of timely submission or if the patient has provided wrong information for filing.
The dental team must file an appeal within the stipulated time frame. This timeframe varies within insurance companies. The practice needs to offer a clear appeal letter that is accompanied by all the relevant documentation. The appeal needs to contain an explanation for reconsideration of the claim, with all the supporting evidence.
The practice, over time, must develop strong relationships with teams from the various insurance organizations that they interact with. These relationships can help to accelerate the resolution process. The team can also connect representatives of
professional dental associations for support and assistance in dealing with rejected claims.
Maintaining revenue cycle management as per expectations is vital for a dental practice. Missing a deadline for claims submission can hurt the practice. The dental team must ensure the timely filing of claims with the respective insurance company. Clean claims must be submitted that contain accurate patient information and all the relevant documents needed by the insurance company.
PA or Prior authorization is a process demanded by insurance companies to ascertain if a recommended service or procedure will be covered by the insurance company based on the patient’s eligibility and policy coverage.
With healthcare prior authorization, the dental team will get feedback from the insurance company on whether the recommended service or procedure will be paid for in full or only partial coverage will be possible. This process is needed for some services or procedures before they are rendered to the patient.
The process of healthcare prior authorizations involves a set of steps. Initially, the dental practice will need to perform patient eligibility verification to confirm whether the individual qualifies for the recommended treatment under their insurance plan. Then, the practice should determine if prior authorization is required. If so, the practice must submit all relevant information, including the patient’s dental history and other supporting documentation, to justify the necessity of the proposed treatment.
The team also needs to submit supporting documents that justify the requirement and extent of the recommended procedure or treatment. Once the prior authorization criteria for the submitted case have been met, the insurance company approves the request and reimburses the treatment cost based on the terms of the patient’s insurance policy.
Insurance companies mandate the need for prior authorization as a means of controlling and justifying treatment and expenses. It controls access to medication or procedures and ensures that procedures and medication are provided to patients who need them.
The insurance companies thus ensure that recommended treatments are cost-effective, appropriate, and safe for the patient, and all the necessary criteria are met.
Treatment necessity
Being necessary from a dental practitioner's perspective means that one needs to administer a particular procedure or service that one is proposing. The insurance company is trying to determine if the criteria for such a proposed recommendation are being met. The insurance company is scouting for factors or data that suggest whether the treatment recommended to the patient is backed by evidence and a thorough evaluation.
It also needs to confirm that the procedure or tests are not being duplicated. For example, a patient might visit more than one specialist or practice. If one provider has ordered a scan, then the same scan recommended by another might not be needed. For such instances, an insurance company will not pre-authorize the second scan unless necessary.
Costs
Any insurance company wants to be sure that a proposed procedure makes financial sense for having it. The procedure recommended should be the most economical alternative for the patient. If two alternative drugs are being suggested for a condition, then the practice must suggest the cheaper alternative if the efficacy of both is the same.
There can be cases when an insurance company mandates the need for step therapy. This means that an insurance company will pay for an expensive alternative only if the cheaper one is not effective. For example, an insurance company will agree to an MRI only if the practice proves that an X-ray will not be adequate.
Benefits to the patient
An insurance company would also need to ensure that the prevailing course of treatment for a patient is helpful. If a procedure recommended to a patient and authorized by the insurance company has not worked, the insurance company might not allow the practice to repeat the procedure.
Emergency services and procedures do not require prior authorization. Time is of the essence in such cases, and the practice will not have adequate time for documentation and approvals.
An insurance company may need some dental procedures and services to get prior authorization before administering the same. This is mainly when there are complexities in the procedures recommended or if the associated costs are high.
Some examples of procedures that need prior authorization include orthodontic treatments such as braces and aligners. Prior authorization is needed for bridges, crowns, bridges, and dentures.
Surgical extractions that include difficult extractions may need prior authorization. Dental implants are costly procedures and usually need prior authorization. Periodontal surgeries, such as flap surgeries or gum grafts, must be cleared by the insurance company before treatment begins.
If a practice or hospital prescribes medication, the insurance company will determine if the drugs or medication recommended are vital and are an optimal option for the current state of the patient. Depending on the patient's case, the insurance company may sanction a short-term supply of the medication.
Drugs with serious risks, drugs that can cause addiction or lingering side effects, expensive drugs, etc., generally require prior authorization. Drugs recommended for medical and cosmetic reasons also need to be sanctioned by the insurance company.
Prior authorization is a time-consuming process and is dependent on the urgency or criticality of the need for treatment. It can also be dependent on the state where the patient lives and the type of insurance policy and coverage.
For state-regulated health plans, the guidelines for prior authorization differ from state to state. The government at the federal level also modifies rules and guidelines to streamline the prior authorization process for plans such as Medicaid. One needs to note that marketplace plans are subject to state rules for prior authorization and are bound by state regulations.
It has been proposed that in the coming year, new rules may require insurance companies to respond within 7 days to a non-urgent prior authorization request, as against the present timeline of within 14 days. Insurance companies would have to respond to an urgent authorization request within 72 hours.
Prior authorization implies that a dental practice, healthcare provider, or hospital gets prior approval from the insurance company for drugs, procedures, or treatments recommended for a patient. Various rules for prior authorization are prevalent depending on the insurance company and the insurance plans. Dental practices, including those partnered with Capline Dental Services, must follow the mandated guidelines for prior authorization to ensure claims are processed and approved without delay, allowing patients to receive the most appropriate and effective procedures or services available.
