For any dental practice, dental revenue cycle management can be a challenge. However, paperwork and documentation add to the challenge. Documentation can also create collection challenges.
Many dental practices complete insurance verification formalities through phone calls. The dental team needs to verify policy details of the patient and ensure that the details in the insurance company’s system correspond to the details of the plan at the practice.
In addition to the existing patient base, there are new patients who come for treatment. Over the course of a year, along with the annual policy benefit reset, the team can spend a vast amount of time on verification. The team could spend such valuable time on activities that deserve more focus and attention.
The team can outline the benefits of the treatment and financing options available for procedures if a patient cannot afford to make an outright payment. This would help to prevent a patient from walking out of the practice to just think about considering the treatment.
When a practice presents payment choices in writing to a patient at the time of diagnosis, there is a greater chance of a patient getting ready for treatment than a patient who takes time to think about the treatment.
Another area where one loses revenue is dental claims. On most occasions, a claim is denied not because of a procedure not being covered in the plan but because of missing fields or incorrect codes. This leads to additional rework such as tracking of the claim, correction, and resubmission. Eliminating such bottlenecks without a lot of effort is possible through the introduction of automated workflows.
Dental practices that get insurance and patient billing on time and accurately are not necessarily the ones with a bigger team, but the ones who pay attention to details, documentation, and process improvements.
In an ideal scenario, a practice must accrue revenue from a completed procedure to a collected payment. This does not always happen, as there are multiple steps that take place between completing a procedure and receiving payments from the insurance company or a patient.
Dental billing services include claim creation, patient billing, claim submission, collections, reconciliation, etc. With each step, there are chances of an error or delay that can lead to a claim rejection or delayed cash flows.
A few glitches in dental billing services and claim submission can lead to inefficiencies. While some of these slips might seem small, together, they can create a considerable amount of loss.
Identifying the gaps in dental revenue cycle management is tough if the team lacks visibility into where and how often they happen. Understanding how revenue gets impacted and how the gaps can get resolved is important.
When the team adheres to recommended dental billing guidelines, the outcome is process efficiency and compliance, as well as smoother cash flows. The billing process and activities have a direct bearing on the patient experience and revenue.
Many claim submissions get delayed or denied due to incorrect usage of codes, incomplete documentation, or insurance eligibility issues. Reports outline an average value of 9% of collectable revenue slipping due to an inefficient billing process and errors thereof. Following stipulated billing guidelines helps reduce errors and boost claim approvals.
An effective billing system accelerates reimbursements from insurance companies and overall cash flows. If the team garners an average collection rate of 98% or more, it indicates that the practice is effectively handling the RCM.
Transparency in billing and providing patients with accurate estimates of treatment costs and insurance coverage before beginning treatment eliminates confusion and builds trust with patients. This helps in faster settlement of dues.
Guidelines govern the billing process. Adhering to them helps in compliance. Accurate documentation and coding help the practice to be compliant, boost revenue, and safeguard reputation.
Recognizing revenue leakage is easier if the team has a holistic view of the system and process rather than targeting isolated incidents. The bulk of the revenue leakage issues are of the following types:
The practice has completed the procedure, and the patient has left the practice satisfied with the treatment. However, the associated insurance claim is not prepared and submitted to the insurance company.
This could be due to no clarity on responsibility for the task. It is possible for the claim to get sidelined due to the challenges of routine operational work.
Such a situation is a process challenge and not due to the insurance company. The practice must establish a process that automatically reminds the team of claim submission when treatment is completed.
In several cases, a claim gets rejected due to the use of wrong codes, policy coverage, or missing documents. When faced with a rejection, the practice needs to correct the claim and have it resubmitted. If left pending, the claim will get denied due to the expiry period for resubmitting it, and revenue gets lost.
While the practice might focus on submitting claims at the earliest, there might be no systematic monitoring and action taken for claims that have been denied or not reimbursed.
When a practice has a large volume of patients, the number of denied claims can accumulate due to lack of monitoring.
The practice must instill a workflow for handling denied claims. Denied claims must be assigned to specific team members who can then follow up on the claims. A periodic schedule for reviewing denied claims can help to track and address them quickly.
The team might follow up on reimbursements by insurance companies. However, patient dues might still be pending and can pile up over time. Such dues can eventually become write-offs, and this can affect the financial health of the practice.
The team must understand that recovery of patient dues after the treatment has been completed is considerably harder than ensuring payment before treatment or just after completion.
The collection process must be an integral part of the patient journey along with the recommended treatment. The team must try to collect all dues during checkout. For payments not received, the team should use automated reminders or follow-up calls to control outstanding dues.
The procedure can get billed under incomplete code combinations or even lower-value codes. There can be cases of claims submitted that do not reflect the true value of treatment delivered due to improper documentation.
When the team is under pressure and is not fully conversant with updated codes, undercoding can be tough to recognize. This has an impact on revenue. The practice must ensure that the team is trained periodically and that all expensive procedures get audited. This can be done by comparing the documentation against claims prepared by the team.
Payments not received on time keep accumulating in aging reports. As time passes, recovery from patients or insurance companies is not easy.
This happens because the team does not periodically monitor the aging reports and responds to them only reactively. When older dues are not recovered, new claims enter the report for payment follow-up.
The practice must set a process for a periodic review of aging reports and follow up on balances regularly. The recovery must also be based on chronology and not recency.
Every practice yearns to have a healthy pipeline of patients. Once treatment is over, billing and collection need to take top priority. The practice must ensure that it gets compensated for the time and effort taken to deliver quality care. Between care and collection, there are slips that usually happen. There are areas where a practice can lose revenue.
Complexity in billing and coding can cause potential revenue loss. Automation can help. The practice can look at outsourcing to a critical partner that can help drive cash flow while freeing the team to focus on care and service. A few steps can be followed by the team to ensure that no opportunity is lost in billing accurately and completely.
To learn more, talk to Capline Dental or write to info@caplinedentalservices.com
