Every industry faces challenges. Maintaining high quality in the dental industry is the key to delivering excellence to patients. With no room for treatment errors and a focus on cost-effectiveness, dental credentialing emerges as a necessary process.
Credentialing is a quality assurance measure that reduces errors by thoroughly vetting educational qualifications, licensure, training, and past practice history. This critical process occurs before hiring dental care professionals or engaging with new insurers.
Credentialing guarantees that patients receive treatment from skilled practitioners. Likewise, in dental care facilities, hiring qualified professionals ensures harmonious quality care and reduces the risk of breach. Insurers benefit from having professionals, which helps maintain treatment trajectory. For professionals, having credentialing with a network of payers promotes a thriving practice.
However, no dental practice wants delayed payments, dissatisfied patients, claim denials, and lost revenue.
The process typically follows: completing the credentialing application and collecting all essential documents. That is essential for ensuring a smooth enrollment process and for updating the billing system with the new insurance provider.
For accurate provider billing, the practice should pay meticulous attention to the payer contracts when billing for non-credentialed providers.
When a provider steps in for an absent colleague, the billing options turn more nuanced.
If locum tenens or reciprocal billing arrangements are not the practice billing needs. There are other effective strategies to bridge the gaps while the providers obtain their credentials.
Incorrect Data Feed: When an application lacks correct details, it becomes a prime target for delays and denials. Working with Capline Services, look for misspelled information, incorrect postal or email addresses, misentered identification or license numbers, and erroneous NPI numbers to avoid these issues.
Unbundling: It raises significant concerns for audit teams and potential fraud or misuse.
Duplicate billing: A provider files the same claim with different insurance companies or a technical glitch in the system.
Inadequate Documentation: Disorganized or poorly handled documents can lead to ambiguity and complications throughout the application process. It can lead to resubmission. Taking the time to organize and present supporting documents can make all the difference.
Insurance verification: Accurate insurance information before appointment scheduling is crucial to avoid billing issues, claim rejections, and delayed payments.
Incorrect coding: Relying on wrong or outdated codes can result in claim denials, impacting the cash flow.
Dental billing and collection make money moves. It is burdensome to manage endless tasks and deal with issues. Dental billing software provides dental practices the convenience of handling the data. That results in positive outcomes.
Modern dentistry relies heavily on effective dental billing software. Choosing the right dental billing and collection system is essential for meeting a practice's needs. Reliable cash flow and happy patients can significantly improve the practice's success. Choosing the right dental billing software is a critical investment. It streamlines operations and enhances financial management. That leads to minimizing costly errors.
However, the dental billing process requires strict adherence. The mistakes can lead to unhappy patients and delayed payments.
Dental software helps to streamline operations and simplify complicated tasks in the office.
Dental billing software is a way forward in scheduling appointments, documentation, and record-keeping. The software tools reduce errors and provide a delightful experience for practice and patients.
Before getting into the dental billing software, it is essential to understand the practice needs. Here are three main options to consider by Capline Services.
There are patient payments, insurance claims, and other intricacies of the billing processes. Each practice has specific billing needs. For instance, the practice offers specialty services that focus on cosmetic dentistry. In this case, the practice requires flexible payment options and solutions that can handle expensive procedures. The dental practice operates general procedures that require billing for insurance verification and reimbursement process.
The number of employees in the dental practice determines the specifics of the billing software needs. For instance, a practitioner working alone in an office with a smaller clientele needs a simple dental billing solution to meet their requirements.
On the contrary, a dental organization at different locations that manages thousands of patients daily would benefit from an advanced solution equipped with exclusive features.
Dental billing software integration affects the existing workflow. It becomes a top priority when the practice selects the software that synced with the system. Software integration presents challenges to an existing practice. It should never be an afterthought. Overcoming the challenges, such as eliminating redundant platforms, can save time and resources.
If the dental practice uses a scheduling system, examine if it is ideal for managing patient responsibility.
Additionally, the integration will simplify the current process. Choosing the right billing software will improve accuracy, reduce disputes for better patient experience, and enhance billing information.
Capline Dental Services has robust features when selecting software billing for payment plans, patient invoicing, and automated reminders. The electronic reminder turnaround time for payment is faster.
Capline Dental Services excels in streamlining claim submission and tracking through advanced technology that results in a thriving practice. Automated submission, real-time tracking, and proactive alerts can reduce errors and delays. That leads to faster reimbursements, consistent revenue, and a stress-free environment for the administrative team.
The analytics help monitor performance and deliver valuable insights. Select dental billing software that matches reporting tools based on the practices needed to expertly track and analyze data such as collections, write-offs, and outstanding balances. The real-time financial analysis through dashboards assesses revenue cycles efficiently and makes impactful adjustments immediately.
When selecting dental practice billing software, it prioritizes insurance verification tools to validate patient eligibility, active coverage details, co-pays, and limitations. Automation can verify benefits for multiple patients at once. It reduces administrative workload, minimizes human errors, and prevents claim denials.
Software Blending
Compatibility is essential with all the EHR and practice management solutions that minimize data entry and reduce errors. It helps to save staff hours and ensure positive patient care experiences.
A user-oriented interface maximizes staff efficiency and cuts down training time. Capline Services' accessible design empowers new team members to master its advanced billing features within hours, ensuring smooth daily operations. It boosts overall productivity, allowing the team to concentrate more intently on patient care.
Dental credentialing is an essential process for dental professionals to join insurance networks, ensuring they can provide services to patients with various insurance plans. This vital service saves time, reduces errors, and helps dental practices grow by streamlining complex paperwork. Whether you’re starting your practice or optimizing operations, partnering with the right dental credentialing company can make all the difference.
Here are the top 10 companies offering the best dental credentialing solutions in 2024.
Before diving into the list, here are a few things to consider when choosing a dental credentialing provider:
Capline Dental Services is a leading dental credentialing provider, offering seamless support for practices of all sizes. They handle everything from initial applications to re-credentialing, ensuring compliance and minimizing delays. Their personalized approach, combined with cutting-edge technology, makes them a standout dental credentialing provider.
Whether you’re a solo practitioner or part of a large practice, Capline delivers efficient dental credentialing solutions that save time, boost patient access, and support practice growth.
The Practice Booster provides dentists with effective solutions for dental credentialing solutions to reduce mistakes and shorten the approval time. It has a dedicated team that relieves you of all the paperwork so that you can concentrate on the patients.
This company stands out for its user-friendly technology platform. They provide full-service dental credentialing with a focus on accuracy and quick turnaround times.
ProCred is a firm that aims to assist dentists in the tricky process of joining an insurance plan. Their dental credentialing providers are well-acknowledged for being fast and reliable.
CredPro is also different from other services as it utilizes the elements of artificial intelligence but is also ready to offer individual assistance. Becoming your insurance network participation solutions provider, their dental credentialing company services target dentists.
As for the most important issues, InsureEase Dental aims to decrease credentialing time. Their team provides the best dental credentialing services that help to solve insurance issues without much effort from the team.
This company is reliable for dental practices all across the country because it is a hands-on company. Many of their dental credentialing providers take care of all the gears and gears so that the process is accurate and quick.
SmileSync has been designed particularly for multiple practitioners' dental practices. Their dental credentialing services are more sophisticated to guarantee efficient and timely approvals for the insurance networks.
Being acknowledged as a detail-oriented company, Verified Dental is able to perform all necessary actions in the sphere of credentialing. They provide dental credentialing services to practices irrespective of the size of their team.
Another strength is that DentalPro Network always puts its customers first. Their dental credentialing providers provide extensive assistance to make sure that every application is fast and accurate.
Credentialing requires significant time and effort. By outsourcing to a dental credentialing service, you free up your team to focus on patient care.
Professional dental credentialing providers ensure all forms are accurate, avoiding costly mistakes that could delay approvals.
With streamlined credentialing, you can join insurance networks faster, attract more patients, and grow your practice effectively.
Dental credentialing doesn’t have to be a daunting task. By partnering with a trusted dental credentialing company, you can focus on what matters most: providing exceptional dental care to your patients. These top 10 companies of 2024 are ready to support your practice with efficient and reliable dental credentialing solutions. Choose wisely, and let them handle the heavy lifting for you!
EFT in dental practices is more secure than checks. Capline Services helps in dental practice payments that are fast and safe without compromising patient care. Adopting EFT simplifies things, resulting in no mistakes.
Accepting EFT in dental practices is a modern approach toward payments. It is deposited directly into the practitioner's bank account. EFT (Electronic Funds Transfer) has become an increasingly popular and practical choice for claim payments, streamlining the payment process for patients and practitioners.
The question is whether the dental practice is ready to come out of virtual credit cards and paper checks. A few parties use them to cut administrative expenses, but it comes with additional costs. For instance, virtual credit cards charge 2-3% as a merchant fee and 10 cents as a transaction fee. Say a reimbursement of $1000 will cost the dental practice $20.10, whereas, through EFT, it is $0.34 in fees.
Mastering EFT may seem challenging, but it has become a regular way of receiving payment. It is safe and efficient. Embracing technology might appear daunting, but it significantly simplifies the life of dental billers. Capline Dental Services helps dental practices track EFT and ensure accurate posting. It is necessary to check if the reconciled amount matches the one received in the bank account.
Remember, while reconciling bank accounts is a private matter, it's essential for dental practices to handle it diligently.
This article will help the dental practice balance and handle EFTs to catch early errors or possible thefts to the practice's bank account.
The insurance portal has these two things available. Before checking a claim off the list, confirm the trace number (a unique number associated with the deposited amount) and deposit date of the EFT into the bank account. These details clarify whether the money insurance companies owe to the practice is deposited or not. Receiving the payment for the rendered service is the target for the dental practice, and there is no point in closing the claim before that.
It is natural for dental teams to feel concerned when they don't see an insurance payment posted in their software, whether it gets handled by remote billers or in-house staff. However, it's crucial not
Record the payment in dental software until the confirmation is that the funds have been deposited into the bank account.
EFTs are quick but can cause a headache if something goes wrong. For instance, if the claim gets denied, the entire thing goes through the tedious appeals process. Double-check everything before processing an EFT to avoid unnecessary stress and confusion.
The balance EFT of the dollar amount in the dental software, bank account, and insurance portal must match. Insurance companies have specific days in the week to deposit large payments, and choosing to balance all costs from the week today, including that significant one, will enhance the clarity. Taking this step will set you up for success.
The dental practice saves time by balancing EFTs weekly instead of logging into web portals every day. While balancing the EFTs is not complicated, it can quickly become tedious.
Capline Dental Services suggests doing this weekly because some insurance companies may spread out their deposits, transferring small amounts, like a few hundred dollars at a time. It can be frustrating to check daily for small $100 deposits. Instead, set aside one day a week to review all payments from the previous week. That will streamline the process and save you the hassle of daily logins for minor payments.
It is crucial because some dental teams post insurance payments and EFTs simultaneously. Embracing hyper-focus can feel like a superpower, but proceed with caution. Juggling multiple web portals and entering figures at once can lead to confusion. That is especially true if the insurance company deposits EFTs into different bank accounts. It opens the door to potential mistakes, so approach this multitasking challenge carefully to avoid errors.
Discover the Optimal Billing Schedule for the EFT in Dental Practice.
Creating the schedule at the dental office can be liberating, but determining the best times to post payments or manage the EFTs is a challenge. That is complex because of the wait for claim payments from insurance companies, whether it's a quick EFT or not.
Capline Dental Services provides customized posting schedules for remote billers that meet the specific needs of dental practices. Each team has its methodologies and a tailored time management strategy that can improve efficiency.
How does the dental re-credentialing process enhance the practice's efficiency? Staying with the dental re-credentialing process substantiates cost savings and achieves a streamlined operation. This article by Capline Services helps providers maintain compliance and builds a solid reputation with the insurance networks.
Credentialing and re-credentialing are where the payers invest heavily. The dental re-credentialing process feels redundant and creates problems in dental practices' operative efficiency, claims, collections, beneficiary safety, and dental billing. The ever-changing reality in the dental industry dictates dental practitioners be on their toes, and re-credentialing is time-consuming and costly. However, it ensures that the professionals have the skill before seeing patients.
The parties involved are verification sources and government agencies. That results in comprehensive background checks, past work history, references, and dental provider board certifications.
Managing the credentialing process guarantees the best patient care without compromising patient safety. The credentialing & re-credentialing process is daunting and complex. This article by Capline Services clarifies how to make re-credentialing less burdensome and more effective.
Re-credentialing is a process to validate that dental providers continue to have the professional skills, knowledge, and qualifications by offering patient care with industry standards. It safeguards the patient and the practitioner. The process renewal takes place every 2-3 years to ensure high standards. There is daily technology and practice evolution. And to keep up with those frequent reassessments is a mandate.
Re-credentialing has many reasons, each distinctive. The factors affecting dental credentialing are the duration since the last credentialing, the type of credentialing provider is carrying, and any recent updates on industry standards. Apart from this, the organization's procedures and policies demand re-credentialing now and then.
Capline Dental Services learns how often the dental providers should go for re-credentialing.
The dental industry is changing exponentially due to upcoming technology and procedures. The dental providers have to ensure that they keep up with the standards. Re-credentialing ensures dental professionals stay abreast of treatments and maintain excellence in patient care.
A critical issue is the lack of knowledge, and the professions directly impacting patient safety require re-credentialing to confirm that the dental provider is fully equipped with protocols, safety regulations, and the latest procedures. Consistent assessments help minimize upcoming risks and elevate overall safety.
The dental industry is fast-paced with adherences, evolving technology, and scientific research. Re-credentialing standardizes the procedures for professionals to adapt to the latest methodologies and findings. Recurrent assessments help to integrate new findings and stay updated with the vast environment.
The authorized organizations are strict about re-credentialing if the dental providers want to maintain their licenses. The requirements have to have professional standards that ensure continuous improvement and accountability.
Re-credentialing is a complex milestone, and it varies. So, it is not universal. However, insurance policies require re-credentialing every two to three years to confirm the patient receives accurate coverage. The occurrence is so that it aligns with the evolving standards and balances competence and growth.
To avoid re-credentialing, the dental provider should implement a few practices that lead to quicker reimbursement and financial stability.
Here at Capline Dental Services, the team of experts helps dental providers get credentialed and re-credentialed. It is undoubtedly the most used service. The stressful steps from application submission to verification of credentials, committee review of the credentials, and compliance with accreditation are all well-handled by the RCM partner.
Credentialing and re-credentialing are all about accuracy. Working with Capline Services empowers the dental practice with innovative solutions that enhance operational excellence and improve patient outcomes.
Cancellation of appointments is a regular phenomenon, and the dental healthcare industry is no exception. While practices cannot force patients to keep their appointments, they need to try and minimize dental cancellations. This helps in the smooth running of a dental practice.
The key result of this is a potential loss of business revenue, especially if cancellations are a common occurrence. A few tips that can help prevent dental cancellations of appointments are as follows:
This may seem trivial, but the dental team must confirm a patient appointment on several occasions. This is crucial if the dental appointment has been made a few weeks or even months in advance. The team should ideally call or email patients at defined dates or cycles to remind them of the date and time of their appointment.
As patients are also busy running their own lives, it might be possible that a dental appointment might get forgotten or skipped. This is more prominent when it comes to routine checkups or if minor issues need to be addressed.
If the patient has made an appointment for a major operation or treatment, the interaction about scheduling the appointment should also include details about insurance eligibility and benefits. The financial outlay for the course of treatment should also be discussed. The patient must be given all information at least a couple of days before the appointment.
These are the most important elements to be discussed with a patient, and there should always be an understanding of fees that need to be paid and the estimated insurance coverage for the same. The dental team needs to glean through all the files and information at hand and ensure that patients must not assume what is covered or not under the ambit of the insurance policy.
There are urgent procedures and services, such as root canals, that need special attention by the dental team. A discussion with the patient should highlight why the appointment must be kept as the treatment might get more extensive and expensive over some time.
At the time of making the appointment, the dental team needs to collate information regarding insurance policy details and services that would be needed. At this point, the team can ask the patient about the mode of communication that would be preferred. These could be text messages, phone calls, emails, or even calendar invites.
The team can convey to a patient confirmation of the appointment a few times depending on how far out it has been scheduled. This can be done by using the preferred mode of communication.
Such follow-up and reminders will help ensure that a patient does not miss the appointment. The team must also ask patients to respond to confirmation requests that have been sent. Practices that use automated solutions or software programs might ask for a confirmation with just a ‘yes’ or ‘no’.
Dental teams can utilize options within email, calendar settings, and practice management software that can remind patients of scheduled appointments. This not only helps to automate the reminder process but also reduces the administrative burden of the dental team.
When sending a message to a patient through a text message or an email, the dental team needs to ensure that all crucial vital information is conveyed while also personalizing the message and making it more relatable. The team can also make use of applications and templates that enable the user to customize the automated reminders.
On many occasions, it might not be viable to suggest an exact timeframe a certain treatment might take. The dental team should, however, provide an estimation of time that could prove useful to a patient.
In case an appointment takes about ninety minutes, a patient might not confirm the same due to a lack of time. This estimation also helps the practice gauge the response of patients and schedule appointments that can reduce the probability of cancellations. This also helps patients block out the time required for the appointment.
It is important to honor the time scheduled for each patient, as this makes them feel the value of honoring their appointments in turn. Complimenting the patients on their punctuality, oral health, etc., is a great way to appreciate them and connect personally with them
Patients who feel that the practice is concerned about their oral health are more likely to continue the treatment journey and keep appointments.
The dental team should focus on calling patients who are chronic defaulters and cancel appointments frequently. They should focus on calling younger patients, as they are more likely to cancel appointments rather than older patients.
Patients who avail of a government plan or Medicaid must be called, as well as those who might be visiting the practice after a long time. In case an appointment has been made by a partner or spouse, then the actual patient who will visit for treatment needs to be called for confirmation of the appointment.
Patients can forget about their appointments or overlap them due to oversight. A dental practice can minimize cancellations by implementing a few tips to keep patients on track while also protecting the revenue cycle and saving valuable time.
Going back more than five decades, the various expenditures measured include healthcare goods and services, the net cost of health insurance, public health activities, government administration, and investments related to healthcare.
The data released by the NHEA or National Health Expenditure Accounts are generally considered to be the official estimates of healthcare expenditure in the USA. American healthcare spending grew about 4% in 2022 and accounted for a little over 17% of GDP.
Given such a large volume of expenditure for healthcare as well as adherence to state and federal guidelines, a dental practice must stay updated on healthcare compliance issues and manage such issues as required.
Compliance management also ensures that a practice offers high-quality care without wondering about imminent threats of any legal consequences that arise even when it comes to dental billing.
Failure to comply with regulatory guidelines or illegal billing can have a significant fallout for the practice. Despite these problems, one needs to examine the reasons behind dental billing fraud:
The dental team may use the wrong code or an incorrect patient ID at the time of billing. While such entries may not be termed as deliberate and have no benefit to the practice at large, there are negative implications that can arise.
The practice needs to ensure that there are regular training sessions for the billing team as well as mechanisms put in place to curtail the possibility of an accidental entry of data.
The obvious intention behind billing fraud can be assumed to be immediate financial gain. By using false data or incorrect codes that can yield higher financial outcomes, a dental practice can then get more money from insurance companies than what is due.
In a bid to drive patients or to reduce barriers to dental healthcare being expensive, a practice might misrepresent the procedures to aid the customer in gaining financial benefit. In such situations, both the practice and the patient are party to the commitment of fraud and bound by the consequences or negative effects of it.
It would be more beneficial for a dental practice to devise ways to reduce operational costs and pass this benefit to the customer. Additionally, effective promotional ideas can be deployed to attract more customers to the practice or raise the standards of patient care, and increase patient loyalty.
The legal implications of committing dental fraud are harsh. It can affect the reputation and financial stability of the practice. The extent and kind of fraud concerning dental
billing can erode the trust between the practice and the patient as well as violate regulatory laws and guidelines.
Getting caught in fraud causes severe reputational damage, and this can erode the trust of the patient in the practice. It will also hamper the acquisition of new patients and can also result in a loss of industry affiliations and professional partnerships.
If a practice has been implicated in fraud, it can be subject to greater scrutiny and audit from regulatory bodies or insurance organizations. Such additional scrutiny or inspections can lead to an impediment to regular business operations. It also creates additional stress for the dental team.
It is important for a practice to understand the types and impact of committing dental fraud while also maintaining ethical standards and avoiding legal consequences.
Fraud in billing can give rise to civil penalties. This can include fines and a return of monies that arise due to overpayment. As per FCA norms, penalties of up to three times can be levied based on damages suffered by the government. Many states also enforce civil penalties for billing fraud.
Practitioners guilty of fraud can be barred from participating in federal healthcare programs. Such exclusions can create a loss of income for the practice while even damaging its reputation.
Commitment to fraud in billing can lead to criminal penalties. As per FCA guidelines, submission of fraudulent claims to the government can lead to criminal conviction and imprisonment for up to 5 years.
Practices are also bound by state laws that can levy criminal penalties for dental billing fraud. The consequences can include fines, imprisonment, and a loss of a professional license. Dental practitioners that have been convicted would it tough to find employment in the industry. Moreover, it can be difficult to acquire a professional license again. Losing a license to establish a practice or offer services as a dental practitioner is a severely damaging outcome of fraud.
A guilty dental practice can face substantial fines imposed by regulatory bodies and might have to pay compensation to any affected party. If the amount is significant, it can severely impact the operational viability of the practice.
Dental billing fraud can have a financial implication for a patient. If a practice inflates bills and a patient does not have 100% coverage, then the balance amount will have to be borne by the patient. This is a bit risky for a patient when out-of-pocket expenses need to be paid upfront and then reimbursed later by the insurance company.
The impact of dental billing fraud is far greater than any temporary benefits that ca practice can gain. It not only erodes patient trust but can create a dent in the ecosystem. A practice needs to make sure that even a patient is protected from illegal dental billing practices.
For a dental practice to be successful and profitable, dental case acceptance plays a vital role. Promotional efforts and word-of-mouth are not enough to succeed if a practice does not have patients who will accept the recommended treatment. A practice needs to focus on effective case presentations by following techniques that can reassure patients that the treatment recommended is in their best interest.
If a patient has entered a dental practice for the first time, chances are that an impression about the practice already existed before the patient entered the door.
Whenever a patient is looking for a new dental practice, a prospective patient will do an online search for opinions and feedback on practices in the area. A dental practice must have an appealing and compelling website that can draw new patients by creating a strong impression of expertise, care, and trust.
Practices can also instill a habit of calling patients before a scheduled appointment to confirm the visit and how excited the team is to meet and treat them. Such a step can create goodwill as it shows the concern of the practice by showing the patient that the practice cares about the patient.
A practice needs to always stay alert when it comes to treatment and service. Many patients might submit online reviews, and positive reviews can help build a more positive initial perception in the minds of the patient. When a strong positive impression is built, a patient is more likely to respond to suggested treatment plans.
Different dental practices can approach dental case presentations in multiple ways. For any practice, it is recommended to have a set and established template for services and treatment options offered to patients. This can help a practice deliver relevant information about suggested treatment plans without leaving a patient overwhelmed. This can help increase the case acceptance rates. An ideal case presentation must include:
A concise and clear outline of the issue at hand must be highlighted. Some patients might not share symptoms and will not look for immediate care. Some patients may adopt a wait-and-watch approach and seek treatment only when the condition deteriorates. A practice can evade such a situation by clearly outlining the possibility of the issue getting worse if left untreated and how an immediate intervention can be less expensive and painful.
These can assist in helping patients comprehend the issue and the planned treatment. A complete explanation of the suggested treatment along with the benefits and risks must be included. One must also seek clarity of understanding from the patient as assumptions by the practice can later affect the final decision of the patient.
The language must be simple to understand, and unwanted jargon must be avoided. The practice must allow adequate time for the patient to understand the suggestions offered and ask questions before going ahead.
The key concerns regarding treatment decisions are financial, the time it will take to complete the treatment and fear.
The primary concern for a large volume of patients is cost. This also depends on the scale of treatment recommended. Multiple payment options offered along with the case presentation can help a practice tide over this concern.
The dental team should not deride a patient who is nervous as these fears are also linked to the success of treatment and outcomes. Such actions can cause a practice to lose good patients.
The dental team can reassure patients about the time taken for treatment by outlining the necessity of it and accommodating any concerns the patient may have with treatment schedules, etc.
For business reasons, a dental practice generally adheres to processes based on time and efficiency. Such an approach may not create a strong relationship with the patient. While the practice might be able to offer a quick diagnosis and treatment plan. For a patient, however, treatment is a major investment, and the practice might have to spend more time convincing the patient about the value of the treatment.
An optimal approach can be a consult-first approach. The patient can receive a consultation on suggested treatment options while also clearing all doubts and expectations. Such an approach can be time-consuming, but it will help build a higher case acceptance.
The practice might also offer a shorter preview of the next steps and then call the patient for a specific consultation to provide a detailed explanation of the recommended treatment. This can help maintain the practice's efficiency while also enabling priority patient care.
While a case presentation is critical, a factor that can decide a patient's choice of practice is the cost of treatment. The dental team may not be very forthcoming when it comes to talking about the bill, especially when one might feel that a patient might reject or delay the course of treatment.
However, it is vital to elaborate on the financial aspect in the same way as one explains the benefits of a recommended treatment, clinical techniques, or the recovery time needed. One can offer multiple financial options to a patient who is delaying treatment due to cost concerns. Handling a case presentation is paramount, and if that is done, handling the discussion concerning costs is not a very difficult task.
During the initial interactions with the patient, it is crucial to collate data that X-rays and exams might not offer. One can probe the patient by asking multiple questions to elicit responses that might help a practice decide optimal treatment options.
Some questions can revolve around how a patient can benefit from the practice; the challenges faced by a patient, and the pain that a patient has borne or is currently bearing are some examples. One can end the interaction by once again reiterating if there is anything the dental team needs to know before moving forward.
Case acceptance is vital for a practice to garner a reputation, be competitive, and stay profitable. Even if a practice is strong in all areas except case acceptance, the practice will underperform. A few simple steps can help a practice increase case acceptance and retain patients more comfortably.
Dental insurance is a complex arrangement for a practice and a patient. Many practices depend on insurance verification services to confirm patient eligibility and benefits from their respective insurance organizations. This is an important step as it helps a practice gauge the extent of coverage for services and treatment recommended to a patient.
Verification of benefits that can be availed by a patient is generally done at the time of scheduling an appointment of a patient. Details of which insurance company will offer coverage if more than one policy is active, policy limitations, etc need to be confirmed.
An important consideration that needs attention is when a patient has dual coverage. This means that a patient’s treatment will be covered by two insurance companies, which are deemed to be primary and secondary dental health insurance. A practice can seek support from a dental insurance billing company to navigate billing complexities that arise when patients are covered with dual insurance plans.
Many patients have primary dental insurance that comes through their employer, while a secondary dental insurance plan can be purchased separately. A secondary plan also covers a patient as a dependent.
For any patient to avail of benefits from an insurance plan, the practice needs to depend on the coordination of benefits provision. This is needed when a patient is eligible for benefits from more than a single dental plan.
When the primary plan has provided coverage for services rendered to the patient, any additional coverage will be made through the secondary plan.
Dual dental coverage could be applied differently for different patient profiles. For an adult, the primary insurance plan is the one enrolled through employment. A plan that is covered by the spouse will be deemed a secondary plan. Similarly, a plan that offers coverage through present employment would be termed as primary, while a retiree plan would be secondary.
The dental team needs to ascertain which of the plans is primary or secondary. This also depends on specific plan provisions. Some plans might not offer a provision for secondary coverage.
When the dental team applies the provision of coordination of benefits, one plan would be considered primary and the other as secondary. A claim will not be processed by the secondary plan provider if reimbursement has not been made by the primary plan provider.
Once the primary provider has processed the claim, then the secondary provider would need a copy of the EOB or explanation of benefits from the primary insurer.
When a patient has dual coverage, the two insurance providers ensure that the total amount paid together will not be greater than the total amount the practice had agreed to accept through the primary plan or the total allowed charge. This ensures that duplication of benefits does not happen and that a patient does not gain more than what one is entitled to.
For a patient, the main purpose of having two plans is to increase insurance coverage and enable a patient to enjoy a wider range of dental procedures and services. This can help to lower out-of-pocket expenses for a patient, especially for unplanned or unexpected dental procedures.
While the patient will incur higher costs in terms of paying a premium for both plans, there can be significant long-term savings depending on the oral health and needs of the patient. However, there could be services that are repeatedly covered and this leads to overlapping benefits that may not offer additional value to a patient.
For a practice, coordination of benefits can be a complex process and if not interpreted or applied correctly, can lead to denials and an additional administrative burden. However, the practice will have an opportunity to increase the base of patients as it will become more attractive to patients with dual coverage and would need to utilize all the coverage options.
By mastering COB skills, the dental team can be able to draw more patients and increase potential revenue based on additional benefits that the plans allow. There is a vast pool of patients with secondary insurance plans. A practice will lose a business opportunity by refusing treatment to those with dual plan coverage. The team needs to be trained and equipped to handle patients with multiple coverages.
A dental practice needs to understand and accept patients with primary and secondary dental insurance plans. While understanding the coordination of benefits provision can be a daunting task, it can have significant business potential for the practice. While accepting patients with dual insurance plans, the practice must be able to comprehend the rules of each plan and bill the patient accurately. This will ensure that the practice also receives reimbursement from the insurance organizations promptly.
Staying compliant is undervalued for the dental practice. However, dental billing compliance is crucial to lower claim errors, prevent legal and financial risks, and assure patient security and ethics. Sticking to the directives demands staying updated with the changes in payers' guidelines, dental coding, and insurance policies.
Just jump onto the comprehensive guide shared by Capline Dental Services on dental billing compliance to say goodbye to the inconsistent cash flow and set a foundation for a successful practice.
To avoid the dental billing hoax is the primary thing for the dental practice to run successfully. Here are a few tips for compliance with insurance regulations.
The ongoing training is mandatory to learn about the regulatory requirements. That includes technical training in official documentation, ICD-10, and insurance verification for accurate dental billing. Legal and ethical considerations help to stop fraud and handling discrepancies in dental practice compliance.
Regular audits are one of the ways to identify problems, missing leads, non-compliance, and mistakes. Audits help to review the claim submission, documentation, and reimbursement practices. It develops existing processes and implements new changes. Partnering with Capline Services provides reliable solutions that ensure clean claims. By entrusting Capline, the dental practice can enhance revenue and boost patient satisfaction.
The dental practice must establish straightforward billing and coding policies, including coding accuracy & conventions, documentation standards & requirements, and compliance protocols. Reinforcing the team with workshops, training, and online programs confirms staff adherence. Dental practices should configure procedures for handling patient information in line with HIPAA regulations.
Dental billing companies like Capline Services offer financial reports with the information to make informed business decisions. The review defines the net collections and the number collected on fees.
The factors affecting low collections are high deductibles, non-covered procedures, and wrong posting processes. It is essential to track the money collected per patient to recognize annual trends in dental practice.
Dental practices must comply with regulations to ensure patient information security, legal adherence, and honesty. Here are some points to remember for dental practices to result in significant revenue collections:
Insurance scams can destroy trust in the practice. A malpractice to take advantage at the expense of the insurance provider and the patient. All the parties involved in the claim process are stringent and aware of the billing process.
Dental practices should observe that third parties that promise higher reimbursement for a fee lead to unethical practices. Additionally, dental practices should check the insurance claim before processing as fraudulent companies steal patient details and claim insurance.
