The dental industry keeps evolving for the providers and the patients. A balance between clinical work and practice management is very much needed so that the new challenges, such as regulations and value-based compensation models, do not impact the cash flow.
Financial success depends upon the dental billing process, how properly the team communicates with insurance companies, and staying on the latest developments. As a result, dental professionals do not compromise on service quality due to too many denials.
Here are a few proactive dental billing tips to increase revenue and stay compliant with dental billing trends.
Minimizing Dental Coding Errors
- Accurate dental coding is the foundation and is essential in terms of compliance. This step is vital and, if done correctly, reduces claim rejections and denials while ensuring the best reimbursement for the service.
- Coding errors are common. Hire certified dental coding specialists or professionals to code the cases, as they are on top of the latest developments and can do it right.
- Use ICD 10 diagnosis codes rather than ICD 9 codes, as they are more detailed.
- Never use expensive procedures for coding. Stay away from upcoding as well as under-coding. Upcoding is illegal and can result in denials and delays. Under-coding will leave money on the table for the service rendered.
Review Patient Collection Process
A collection process in place is a necessary step towards the financial growth of the practice. Usually, the patients do not know their financial responsibilities. Lack of communication or a robust approach towards collection sometimes does not improve the revenue cycle.
Here are a few practices attempting to optimize collections successfully:
- It is worth it to collect all the necessary details about the patient and avoid any further discrepancies, like present address, mobile number, photo ID proof, employment details, email address, etc., before or during the first visit.
- The contact details of the patient to reach them correctly can save a lot of time and money. Make a check of that regularly.
- Inform them about the co-pay and how it is crucial and necessary if we go further with the treatment.
- Verify patient eligibility with every visit using the advanced verification system to avoid disputes, queues, or buckets of the claim.
- Different payment options increase flexibility for them to pay, such as credit cards, cash, checks, and payment plans.
System for Denial Management
Effective denial management is essential for improved cash flow. The standard clean claim ratio is 97% or above. However, the denials increase the average number of days in AR and put pressure on revenue.
- These are some strategies for optimizing denials to maximize revenue:
- The denial cases should be equally prioritized. Regular follow-ups with the insurance companies within 48 hours can impact the cash flow.
- Dental practices should also create a CARC (claim adjustment reason code) list based on further follow-up actions. That will ensure no denial cases are left unturned. As a result, these simple modifications can increase revenue by 25%.
- Define the appeal and dispute strategy, as all the denials do not need the appeal request. Therefore, what is acceptable and what is not is clearly defined.
- It is necessary to have an approved standard format for the appeal. It increases the success rate.
Today many dental professionals realize that outsourcing is the best option for cost-effectiveness and revenue cycle. The companies keep on top of the changes and avoid losing money. As a result, revenue increases by simply outsourcing to experts.
