Revenue Cycle Management(RCM) is an extensive process that starts right from the patient’s appointment scheduling and ends with reimbursements from all the concerned parties whether it be the insurances or the patients themselves. Effective management of the revenue cycle requires prolific knowledge of the dental industry and the complete billing process. Every single step of the process has to be optimized and standardized to reap the best results. Oversight at any stage of the process can have a detrimental effect on the practice.
Evaluation metrics that should be carefully examined to ensure an effective Revenue Cycle Management:
What are the key factors that have to be optimized for effective Revenue Cycle Management?
What are the positive impacts of effectiveness of the Revenue Cycle on Dental Practices?
Covid-19 is here to stay for a while until its vaccine reaches the people. The pandemic has already derailed businesses across the world including the healthcare sector. The ongoing year has brought possibly one of the biggest financial challenges for the healthcare sector which is already facing the shortage of healthcare professionals during the crisis. As the sector is moving towards easing out for normal business proceedings and the practices are opening their doors for the patients with all necessary safety measures, practices need to look at all the possible perspectives to improve their Revenue Cycle Outcomes to keep the business running.
In this article we talk about the Top 10 tips to improve your Revenue Cycle outcomes in 2020. Let’s take a look.
Collecting complete information from patients and validating it with records is quite imperative and is one of the primary factors which decides if the claims would be accepted or denied by the insurances. The office staff, especially the front-line staff including front office executive, medical representative, or the first person the patient meets after entering your office, need to be educated and made aware about its importance as incorrect details in important information such as patient’s data, if shared, can result in returned or denied claims. Make your staff aware of the significance of the information received from the patient and the way it’s communicated further with insurances which plays an effective role in improving revenue cycle outcomes.
The patient should be provided with an online portal for payments. They can login into the portal and select the method of payment which suits them (credit card, debit card etc). They should have financing options and EMI options also available for payments. This will not only boost up the total revenue but also provide facility to the customers to pay at their comfort.
Thoroughly examine all the unbilled accounts and denied claims. It will allow you to create a follow-up plan for those specific accounts. Categorize the accounts as per their deadlines so that your billing staff can work on them accordingly. Connect with the patients who have pending dues and start following-up with the insurance companies for delayed or denied claims. It will help you increase the much required cash flow.
The timeline of payment collection is crucial for your practice. If all your patients pay on time, your revenue cycle will be maintained. However, it doesn’t always happen how we expect! For self-paying patients and the ones who pay through health insurance and other means, you should always create a billing and payment timeline. Experts suggest that creating a follow-up plan along with the timeline helps to improve the revenue cycle. This includes timely sharing of invoices with the paying parties and requesting payment at a certain time. In case the payer is an insurance, regular and timely follow-up through established channels is equally important.
It's said that prompt contact and follow-ups usually deliver the best outcomes when it comes to bill payments. Make sure the patients are well aware of these milestones and all the services that they are paying for, well in advance!
As the businesses across the globe are starting to open up steadily, it’s been observed that prices for many services have been increased. If rates for oral procedures, routine check-ups, consultation, etc. have risen due to the Corona pandemic, it becomes your professional and moral responsibility to inform the current and prospective patients in advance and assure them of the best possible treatment.
Easy payment modes/options are something every patient looks for! Simplifying payment options and offering multiple modes for payment has become even more crucial during Covid-19 when the financial crisis seems to be impacting not just industries but individuals as well. Allow a patient to choose a payment mode as per his/her financial suitability. If possible, offer whatever payment mode your patient asks for! Offering flexible payment plans and a comfortable timeline will boost your revenue cycle.
It has always been said, and has been proved time and again as well, that you should leave it to professionals. In the current crisis, bringing a billing and collection expert or a team of professionals on board is the best way to boost the revenue cycle outcomes. Even if your patients have missed the bill or forgot to pay as per the provided timeline, the experts exactly know how to approach a patient when it comes to getting your bills paid on time, particularly in the fragile economic situation of current times.
Claims, alone, play a vital role in the revenue cycle. Denied or delayed claims can give a setback to your financial gains. It’s essential not just to process the claims correctly but the claims approval rate has to be on the positive side to better the revenue cycle outcomes. Make sure your staff or your billing partner knows how to get the claims approved faster.
Your regular patients are possibly your biggest payers. Maintaining an effective communication channel with them all the while and constantly reminding them of your existing, additional, and new services and products is an integral element for improving revenue cycle outcomes. You can also offer or maintain quarterly or yearly contracts with your regular patients. It will not just assure your patients of timely services, but will also help you maintain the pace of your revenue cycle as well.
The Covid- 19 pandemic has forced us to push our limits and adapt to the new working conditions in almost all sectors and the healthcare sector is no different. With the use of right technologies healthcare professionals have been able to provide care even during such testing times. Stay updated with the technical advancement in your industry. Use relevant and latest consumer and commercial technology such as updated billing tools/software, AI-based coding software systems, and online solutions to customer queries, etc. It improves the overall quality of your services and is directly proportional to the improved revenue cycle outcomes for your practice.
Revenue generation is an essential part for every sector including healthcare. As the Covid-19 crisis continues to impact the industries worldwide, it’s vital for dental practitioners to be proactive and take the necessary steps, like the ones explained above, to improve the efficiency of the revenue cycle of their practices.
Dental billing plays a pivotal role in the revenue cycle for every practice. Thus, creating a professional team to handle dental billing becomes necessary. For many practitioners, outsourcing dental billing services seems to be the best option. It betters patients’ billing experiences and gradually improves the revenue cycle while dental practitioners’ focus on the core i.e. patients’ dental care!
Dental billing in the RCM is the process that coordinates between patients, insurance companies, and healthcare providers. It ensures that your practice receives appropriate reimbursement, especially now requiring heightened care for efficient and accurate approval of claims to improve the revenue cycle.
Let’s take a look at the benefits of Healthcare RCM and Denial Management in Dental Billing below:
Complexities of the dental billing processes and evolving healthcare insurance programs make dental claims management in-house very difficult. Outsourced strategies provide dentists with a robust range of dental billing tools to adequately pay for their care and focus on their key activities.
The following points explain the benefits/importance of denial management and healthcare RCM in dental billing.
When the rejected or unpaid claims are processed in the right way, the rate of claims getting approved improves and saves a lot of time, of both practices and patients. The denial management team in sync with the healthcare RCM team works closely to file claims while abiding by the guidelines of a particular insurance provider to deliver accurate information. This directly improves the revenue cycle management and patients have a reason to smile with your dental billing services.
The primary goal of a dental practitioner is to focus solely on patient care, not on billing, claims, or any other administrative task! When a dedicated denial management and healthcare RCM team is in place to handle everything related to claims, billing, and revenue; you will have more time to spend on patient care rather than focusing on other things.
Filing clean claims haven’t been an easy task for many dental practices. The denial management team does this task really well and obtains less rejected claims. This helps you to get paid faster for your work. An expert in billing and coding ensures that your practice submits precise and thorough claims which are accepted the very first time.
Importance of outsourcing billing services?
Outsourcing the dental billing services including denial management becomes a necessity for dental practices when the claims add up but not the income and you do not have an in-house team of billing experts. This is a sure sign that due to timely filing rules, an organization will not collect all of the revenue it owes. It directly impacts the entire billing process and revenue cycle that makes it vital for an effective dental billing process.
If there is not enough time in the day to work, the claims denied or the rejection follows-up. Patient care is a priority, but if the demands of the sales cycle tend to move to tomorrow, then the practice needs to determine whether current workflows can be changed, the company is understaffed, or the requisite experience in billing and coding is lacking.
Dental billing systems are geared at acting as an expanded arm of the dental office, handling the billing section carefully so the primary staff can concentrate on the work. This helps you to increase productivity and even manage more customers with fewer billing and claims concerns.
A successful dental practice is defined not only by the capabilities of the dentist handling it but also by the overall quality of the services that is provided to the patients. Denial Management is one of the key aspects that every practice requires to improve in order to improve its Revenue Cycle Management (RCM) and ultimately the quality of service that it is able to provide to patients. This article is going to talk about Denial Management, an integral part of management of a dental practice, and its importance in RCM.
A straight answer to the question - What makes Denial Management in RCM so important – would be its role as one of the most important elements in healthy cash flow! But, managing claim denials has always been a difficult thing to handle for every healthcare organization. While traditional approaches to denial management focus more on symptoms rather than causes and solutions, the modern-day approach focuses on uncovering the causes behind denials and getting a solution to either avoid them or get paid for them faster. Let’s understand the Denial Management Process.
Understanding Denial Management Process
According to a report in California, health insurance companies reject one out of five claims that makes denial management an extremely critical element not just for a dental practice but for every healthcare organization. An effective denial management process usually covers the following:
However, for many practices or healthcare organizations, handling the claim denial process in-house is not easy as besides handling the operational tasks, they need to focus on patient care as well.. So, outsourcing denial management services seems to be the perfect solution.
Let’s understand how the entire Denial Management Process, step-by-step, improves Revenue Cycle Management for a practice!
The denial management process begins with finding the cause of the denial. According to a report, the most common claim denial reasons show that 90 percent of the denials can be prevented, but they still happen! The usual reasons for claim denials are – Late claim submission, Duplicate claim submission, Incorrect or missing patient information, Service mentioned in the claim not covered by the insurer, incorrect registration data or documentation error, pre-authorization errors, etc.
Filing for claims while taking care that errors listed above don’t creep into the process is the main task for a denial management team. From creating a denial control system to appealing for rejected claims right away, it takes a lot to remove the common denial causes to improve the RCM.
It’s critical to outsource denial management services. When a team of experts handles the claim denials, it reduces the chances of claim denials considerably. But why or when you need to outsource the services?
How does an efficient Denial Management help?
The following points explain the benefits/importance of denial management in RCM.
When claims that are either rejected or are unpaid are processed in the right way, the rate of claims getting approved improves and saves a lot of time. The denial management team works closely to file claims while abiding by the guidelines of a particular insurance provider to deliver accurate information. This directly improves the revenue cycle management.
The primary goal of a dental practitioner is to focus solely on patient care and not on claims! Practices, sometimes, fall short on effectively handling the claim process as the staff spends training hours focusing on providing patient care rather than handling paperwork. When a dedicated denial management team/system is in place to handle everything related to claims, you will have more time to spend on patient care rather than focusing on administrative things. This way, practices do not lag behind on collecting revenue and exceptional patient care will always be provided.
The filing of clean claims with health insurance companies has always been one of the biggest obstacles for dental practices. A dedicated Denial Management Team is an ideal means to avoid rejected claims. It helps you to get paid faster for your work. A team of experts in billing and coding ensures that your practice submits precise and thorough claims which are accepted the very first time.
Fewer denials lead to improved cash flow resulting in the achievement of revenue cycle goals which makes for a successful dental practice!
Having a proper revenue cycle in place opens the chances of being paid on time. Dental practices often lose revenue due to the number of denied claims, failure to pay Copay and many other reasons. These loopholes in the revenue cycle are slowly draining profits from the practice. This is the reason it is extremely important for dental practices to have their RCM process well organized.
Given below are some necessary steps that any dental practice must follow for an effective revenue cycle management process.
Patient scheduling is the foremost step wherein the patient’ appointment is scheduled and they are entered into the system.
The next step is verifying the patient’s eligibility for processing insurance. Our experts do this wonderfully by contacting the agents. They verify each aspect carefully and make every possible effort to pass the claim for billing. We help practices significantly reduce the burden and let them focused on improving other aspects of their practice. Verifying insurance eligibility before the treatment allows practices to upfrontly tell their patients about the payment. When patients will be pre-informed about the payment, their dental treatment bills won’t leave them open-mouthed. This ultimately leads to improved patient satisfaction
The next step is the collection of Copay and Deductible. Once the insurance eligibility verification is done successfully, it becomes easier to collect copay and deductible.
When the above mentioned three steps are completed successfully, practices will be able to focus only on taking care of their patients.
Once the treatment is done, the next step would be the submission of claims to the insurance company. Claim processing starts when a dental care provider treats a patient and sends a bill to the insurance company. After this, the claim is evaluated on the basis of various factors. Once the evaluation process is done, the provider decides which claim to process and which ones to deny.
In the next step, we send patient statement that is easy to understand, clear and concise. Our experts bill your patient for their remaining balance on the services availed.
The above given are some useful steps that encompass a great revenue cycle management process. Missing any of the steps would result into claim denial or unsuccessful billing, thereby deteriorating the revenue of your practice. It’s good to keep an eye on these steps and see how your practice’s collections will skyrocket.
Every dental service provider needs to have an efficient process for keeping their practice financially healthy. This is where revenue cycle management comes in.‘Revenue Cycle’ is a term used by dental practices to manage the admin and other necessary functions associated with claim processing, payment and revenue generation. In simple terms, it can be defined as the process that dental practices use to pay the bills. As a dental service provider, you often expect immediate payments from your patients for all the diagnosis, treatment and services you provide. However, in most cases, this is not as straightforward as it looks. The process starts when a patient makes an appointment to seek dental services and end when the claim and patient payment has been done.
In brief, it is the process that your dental office has to go through to track the earnings from patients, starting right from the first appointment to the final balance on completion of treatment. This process takes a lot of time because most cases end up involving insurance companies which are obligated to pay for the whole or part of the patient’s fees as a part of insurance.
We, at Capline Dental Services, understand that the primary job of a provider is to focus on treatment and patient’s health. This would not really be possible if the practice isn’t financially sound. Revenue Cycle Management is the financial backbone of most dental offices because if the revenue is not managed properly, chances are that your practice will not be in good financial health.
Hence, we bring out new opportunities for dental offices in the form of an effective Revenue Cycle Management (ERCM) so that they do not lose focus from their patients.
In today's age, what's difficult for a dental office is to generate revenues due to claims which are rejected or delayed.
1. By Reviewing Codes: Our team regularly views the code, analyze and keep abreast with the times to make sure claim denials do not happen in the future. This lets them be in sync with latest codes because one of the major reason for a large number of denials is the use of an outdated code.
2. By Submitting Claims on Regular Basis: We, at Capline, ensure a steady inflow of revenue by submitting regular claims which results in much more effective and efficient handling of claims. Our experts follow-up regularly and consistently to eradicate denials and delays in billing.
3. By Efficiently Handling Denials: All dental service providers should come up with an efficient technique to manage denials and make quick appeals for claims to be settled. There are times when you get stuck somewhere and don’t find much time to address denied claims. In such a scenario, the financial health of your practice gets impacted. That's where we step ahead by quickly identifying the reason for these denials and then plan out something useful.
Managing the administrative task of your practice turns out to be quite challenging especially when you start attending more patients. The more patients you serve, the more your practice grows and ultimately the more are chances of revenue expansion. And then there comes a time when it becomes laborious to deal with logistics issues that come with growth. In such a situation, practices look for someone who could easily deal with the pressure of handling the revenue that is coming in. This brings the need to outsource Revenue Cycle Management or RCM services to professionals.
Here’s how outsourcing RCM services can help grow your practice at an unprecedented rate.
Insurance claims getting approved faster
When you outsource your practice’s workload to a team of experts, there are zero chances or errors. This is because each team member works with close attention to file out claims. They also make sure adhering to a specific insurance provider’ guidelines to deliver information that is accurate and precise.
These experts are available at the right time and can help every single patient file an insurance claim.
When you entrust your in-house team for the same task, you will come across a lot of errors. These errors not only delay the entire process but also results in untimely paid dues. So, you should consider outsourcing RCM and get your practice’s finances back in shape.
More time spent on quality care and less on paperwork
Practices spend hours of training to focus on patient healing, not on paperwork. So, their prime objective should be to focus only on patient care because it directly impacts the revenue cycle. When you outsource Revenue Cycle Management services to an expert team, you will have more time to spend on delivering quality care. This way practices will not be missing out on revenue and an exceptional patient care will always be promised.
Saves you money and time
Outsourcing your practice’s revenue cycle to a team of experts saves you the time and money associated with in-house insurance and billing. An experienced team also assures you with maximum claim reimbursements. With outsourcing, you get high-quality revenue cycle services for lower cost. The outsourcing team serves as an extension to your office and effectively manages your claim while boosting revenue at the same time.
Lesser claim denial ratio
One of the major challenges a practice faces is filing clean claims with insurance carriers. Outsourcing RCM is an ultimate way that helps to achieve fewer denied claims. It allows your practice to get paid faster. An expert billing and coding professional makes sure that your practice submits accurate and thorough claims that get accepted the very first time.
So, if your practice is lacking the expertise to code, bill and work on denials, connect with us today. At Capline Dental Services, we have the knowledge and resources to process your claims faster with lesser errors. By choosing us, your reimbursements will maximize and your business profitability will increase.
