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No More Mistakes With Claims Billing

by carerevenue

The framework for Revenue Cycle Management is supported and established by claims billing, which provides cash flow for the practice. Errorless claims billing, among other things, sets the foundation for the revenue cycle management of dental healthcare. Therefore, poor billing and coding practices can result in denied claims, which holds down the collection and reimbursement and negatively impacts the overall revenue cycle. Proper claims billing ensures that the accurate amount for the services provided to the patients is reimbursed in a timely manner. Without a proper billing system, practices won’t have any way of generating revenue from their patients, and therefore it becomes a crucial step in the revenue cycle management.

So, what exactly is claims billing?

Claims billing is the process of generating insurance claims and patient bills using dental codes obtained via the dental coding procedures. After each patient visit, the provider assigns different diagnosis and procedure codes to the interactions and a bill is produced by adding the price of the treatments or services provided to the patient’s balance. The patient’s copayment and insurance coverage are also taken into consideration. The different codes help insurance companies in analyzing the claim and related coverages. Later, a clean claim is created and processed, and if the claim gets denied, then it needs to be properly addressed before the claim can be paid. The practice also needs to be well versed in the different billing and coding guidelines as well as the insurance policies, as ignorance of these may result in claim denials.

Common difficulties in dental billing

Missing tooth clause

The patient might be eligible for coverage for a fixed bridge, but only if the lost tooth was pulled while the patient was still covered by their insurance. There is no coverage for the replacement if the tooth was extracted while the patient was not covered under the specific plan. When confirming the benefits of the insurance plan, this is a crucial question to be considered. Ignoring the verification can result in the denial of claims.

Contractual limitations

Some policies do not cover certain procedures at all, even though it may be the same insurance company that has previously paid for the same procedure for someone else. This can be a real struggle for your billing team and can create a lot of confusion, which may disturb the entire revenue cycle.  

Incorrect CDT coding

Every year, CDT codes undergo changes and adaptations, and if you are not aware of these code and nomenclature changes, you may send a claim without the required information for timely reimbursement or bill an insurance payer using a different code. This can become a roadblock to your billing process and can disturb your complete revenue cycle.

Age of patients

There may be age limitations for services based on the insurance plan. Not keeping up with these changes can cause havoc in your billing process and even revenue loss. Therefore, it becomes important that you check these limitations before beginning the billing process for a timely and complete reimbursement. 

Unreadable documentation

Unreadable or illegible documentation is another common mistake made during claims billing. In their hurry to get the billing process completed, practices do not pay much attention to the documentation and often overlook such errors without realizing that such small errors can lead to claim denials, disturbing the revenue cycle.

Insufficient information

Insurance companies demand accurate, full patient information and any incomplete or insufficient information won’t provide them with the details that they need. This delays the claims processing and, thereby, the payment process. Therefore, make sure that you have all the necessary information before starting the billing process .

How can you improve your billing process?

Regular update on coding changes

The codes for dental procedures are frequently updated, therefore, the practice must always stay informed of any such changes to the existing codes, learn new codes, and be familiar with any codes that have been eliminated in order to avoid dental claim denials. A regular update on coding changes can save your practice time and energy needed for reworking denied claims.

Tracking Frequencies, Exclusions, and Limitations

Usually, frequencies, exclusions, and limitations vary according to different insurance plans, and the amount available actually depends on these factors. There are even policies with age group limitations for certain procedures. Therefore, it’s crucial to obtain a copy of the patient’s information as well as an insurance certificate that details exclusions, age limitations, and plan benefits before the claims billing process.

Collecting detailed information

The claim form needs to have complete patient information, including patient ID numbers and service dates, as well as information on dental procedures, as it helps in processing the claim further. Remember that a lot of denials return to the providers with a pending status and no revenue payments because of improper documentation and incomplete or inaccurate information.

Dental Care provider’s information

For error-free claims billing, you must collect information from the patients as well as the dental care provider. Prior to submitting the claim, double check to make sure you have included all the required information to prevent a denial.

Specific documentation for particular claims

For certain claims, insurance companies will need specific documentation in order to proceed with the processing. Insurance companies, for instance, would need X-rays and prior charting that demonstrates bone loss in the cases of scaling and root planing. Therefore, having information or documentation on the various treatments and procedures involved can prevent claim denials to a certain extent.

Deadlines are critical

Deadlines are very critical for the proper running of an RCM. Therefore, it is important that you keep track of and properly follow the deadlines without making a mistake. Make sure to complete the claims billing process within the given timeframe, as any delay can lead to claim denials and can delay the entire payment process, resulting in revenue loss.

Regular auditing

Regular auditing is necessary to strengthen the claims billing process at your practice and wipe out any potential errors. These assessments and audits help your dental practice cut down on the maximum amount of unnecessary expenses.

Partnering with an RCM service provider

Partnering with an RCM service provider helps your practice complete their claims billing service without any interruption or errors. With an expert professional by your side, your claims billing process becomes more effective and also provides your practice with the time to focus more on patient care and treatment.

A proper and well organized claims billing process can greatly reduce the risk of denied or rejected claims. The revenue cycle management of any dental practice heavily depends on its claims billing. Therefore, make sure that you carry out the claims billing process without any delay and without any errors. Otherwise, the entire payment process would be at risk.

The Do’s & Dont’s for an Effective RCM

by carerevenue

Having a healthy revenue cycle is the key to a successful and well established practice. In the long run, for a practice to continue operating profitably and to deliver high-quality treatment to its patients, successful and healthy revenue cycle management (RCM) is crucial. A well organized RCM is what provides financial stability to a practice. Therefore, it becomes important for a practice to allocate top priority to its revenue cycle management. 

So, What is Revenue Cycle Management or RCM?

Revenue cycle management, or RCM, refers to the process of identifying, collecting and managing the revenue of a practice based on the services that it renders. The cycle begins the moment the patient makes an appointment and ends when all the payments are collected. There are several steps involved in RCM that should be carried out efficiently to ensure a faster and better payment cycle. Revenue cycle management can be highly difficult and complex, therefore requires a great deal of effort from the side of the practice to learn and understand the various processes involved. Any inefficiency in the management can disrupt the full functioning of the practice and can reduce the revenue flow. Identifying and rectifying the mistakes in RCM could be the best way to minimize the loss in revenue for your practice.

Here are some of the common mistakes in RCM

1. Inaccurate and Incomplete Data Collection

Accurate patient information collection is very important for strong revenue cycle management. If any errors or inaccuracies occur, then claim denials are bound to happen. Therefore, make sure that you have accurate and complete patient information and data. Double check the information collected before submission to make sure that all the information recorded is complete and correct. Remember, a lot of claim denials happen because of such errors in patient information and data collection.

2. Not staying up-to-date with insurance regulations

The practice needs to stay up-to-date with the frequently changing insurance rules and regulations to produce clean and successful claims. If your practice is not updated with these insurance rules, then there are more chances of mistakes or errors prompting denial of claims, which in turn may reduce the revenue of your practice. Not following through on this can create a lot of difficulties in the proper working of the practice.

3. Late Submission of Claims

Delayed claim submission is one of the most recurring reasons for claim denials. A delay in claim submission can disrupt the entire revenue cycle process, thus delaying the full payment process. It greatly hits the revenue of a practice and can create a lot of hassles. Remember, late submission of claims can make your already complex revenue management process even more difficult. Therefore, it’s better to submit your claims within the given time frame to avoid unnecessary trouble.

4. Inefficient denial management

Denial management is one of the most important steps in the proper management of the revenue cycle. Effective denial management could greatly help in increasing the revenue of your practice. It happens quite often that the practice pays less than necessary attention to its denial management without realizing that it could actually impact their revenue. It is no secret that claim denials can lead to the leakage of revenue, impacting the entire functioning of the practice. Therefore, reworking and resubmitting denied claims on time should be of top priority in a practice. 

5. Bad patient eligibility and benefits verification

Many practices, often in a hurry to submit claims within the given time frame, pay little or no attention to proper eligibility and benefit verification of patient insurance. It may seem like a small thing, but it can have a huge impact on the revenue production of your practice. This is one of the most crucial and important steps in the process of RCM and any mistake or carelessness in it can in turn lead to easy denial of claims. So, remember to be careful in your patient eligibility and benefits verification processes. 

6. Slow Accounts Receivable Follow-Up

It’s no secret that the larger the number of days in AR, the higher the risk of payments going unpaid. Therefore, the more time you take on accounts receivable, the greater the revenue cycle gets hit.  As a result, accelerate your AR follow-up for better and faster revenue cycle management.

Here are some solutions to these common mistakes 

1. Tracking of claims

Efficient tracking of claims could be the best way to avoid any mistakes occurring in your RCM. Always keep track of your claims to know if any claim denials occur. It also helps you in determining the reasons for claim denials, so you can take steps to prevent the same from happening again. Tracking claims helps you prevent recurring mistakes in claim submission that cause denials. Make sure to track your claims until you receive your payments.

2. Proper patient registration

Do proper patient registration before providing the services to avoid any mistakes in patient documentation and the submission of claims. As earlier mentioned, any errors or inaccuracies in the information collected can lead to claim denials. Therefore, it becomes highly important to ensure that you have complete and accurate information on your patients before providing any treatment. This helps in preventing claim denials to a huge extent, thus improving your revenue cycle management.

3. Proper communication with patients and insurance providers

Do not shy away from contacting the patient or the insurance providers if any additional information is needed or any doubts need to be cleared. Maintaining proper communication with them is important for maintaining a healthy revenue cycle. Proper communication helps you stay up-to-date with patient data and information, as well as the changing rules and regulations in insurance payment. It also helps your practice in building trust with the patients.

4. Make the process patient-friendly

Patients are always the top priority in a practice, and they determine the success or failure of a practice, so it’s very important that you provide the best experience for your patients in your practice. So, make your revenue cycle management process as simple as possible for your patients. Make sure that they are updated at every point of the process. Make them updated on the payment process so that no surprises come their way that may lead to them paying out of their pocket. The failure to which, can result in patients losing trust in your practice, which can create a huge revenue loss for your practice and can disturb your entire RCM.

5. Opting for an RCM service provider

Opting for an RCM service provider is the best way to reduce any mistakes that happen while managing your RCM. Handling the RCM is a very difficult and demanding task which takes up a lot of your practice’s time and energy, especially with the limited staff. This could even prevent your practice from giving proper attention to other important needs of your practice, but with an RCM service provider by your side, you can easily focus your complete attention on the more important needs such as patient care as well as the expansion and growth of your practice while letting them manage all your RCM related worries and difficulties. This improves your RCM and, thereby, the revenue earned by your practice.

Conclusion

Improper management of RCM can cost a huge loss of revenue for your practice. Therefore, RCM becomes one main aspect of maintaining a healthy and successful practice.so, always make sure that you have proper knowledge on the various processes related to RCM and how to handle it. Most importantly, remember a successful RCM is critical for the growth and development of a practice.

Delegate your Dental Revenue Cycle Management Services

by carerevenue

As more patients start showing up, it becomes exceedingly demanding to manage various aspects related to the Revenue cycle management of your practice, especially considering the limited staff. Just when the practice starts seeing growth, the key responsibilities arising from patient care make it difficult to devote round-the-clock attention, time and concentration to insurance collection, which in turn affects the flow of cash and patient experience. The disturbance in revenue management could eventually end up disrupting the overall functioning of the firm. As a result, it becomes fundamental to outsource RCM or Revenue Cycle Management to expert professionals-Thus making the process easier, cost effective and time-saving.

Revenue Cycle Management consists of several tasks which need to be carried out in a timely and efficient manner, the failure of which can lead to leakage or block in cash flow, affecting the overall payment cycle which subsequently impacts the patient experience. In addition to excellent patient care, the true result is dependent on timely payments from insurance carriers and patients, as well as accurate claim submissions. It is almost impossible for any provider to manage both excellent patient care as well as to stay up to date with the changing insurance regulations and acting according to them. Outsourcing RCM can assist in eligibility checking, timely submission of claims, payment postings and appealing to denied claims. 

Reasons for outsourcing RCM services

  • Checking and verifying a patient’s insurance coverage can be hectic with the limited staff.
  • Failure in collecting payments and balances can hamper the cash flow cycle.
  • There are high chances of human error, which can lead to claim denial. 
  • Staying in touch with the various changes in insurance processing can be a challenging task.
  • Delay in any of the insurance processing stages can lead to claim denial.
  • Insurance denials need to be followed up in a timely manner, failure of which can cause loss in revenue.
  • Hiring in house staff can be costly and stressful 

When outsourcing RCM services, a lot of things need to be considered. Recognize the range of services offered by the company. Consider the terms of the contract, the insurance companies to which they submit their claims. Make sure that they offer experienced professionals. Thus, with a professional company backing you, you can devote your time and effort to patient care. 

Services provided by outsourcing RCM

  • Patient Enrollment and Schedule Management

Patient Enrollment has a huge impact in your revenue cycle as inaccurate entry of patient details and other information could result in denial of insurance claims and other complications. Therefore it is important to enter accurate information. With outsource RCM services, patient schedules and other information are accurately maintained and updated.

  • Eligibility checks

RCM services make sure that the patient is eligible for insurance services  as it is one of the main criterias for insurance claim.They see to it that the inaccuracies in eligibility is eliminated ahead of claim submission.

  • Claim submissions

RCM services makes sure that clean electronic claims are submitted. They remain up-to-date with the changing insurance processes and make changes accordingly before submitting your claims. Submitting proper claims can lead to faster reimbursement, ultimately improving your overall revenue.

  • Error-free coding

RCM services help in ensuring that the insurance claims are properly coded. The claims are properly analyzed and the various errors in coding are found and resolved immediately. 

  • Payment Posting

RCM services process all patient’s payments with extreme accuracy and post the payments into the patient’s account. It provides an opportunity to analyze and maximize the overall revenue. 

  • Denial Management

RCM services help in analyzing and resolving the various reasons leading to claim denial. Once the issues are resolved, the request is resubmitted and appeals are filed. Denied claims can lead to a huge loss in revenue. Therefore it is very important  that the denied claims are acknowledged as soon as possible.

Benefits of Outsourcing RCM Services

  • Increased Cash Flow

With no outsourcing, the RCM needs to be handled by the staff and the absence of any of the staff could result in unattended insurance claims and denials, which eventually reduces the overall revenue of the practice.But with outsourcing, these issues could be avoided, thus increasing the cash flow. With this the practices and providers will be able to receive the revenue that they deserve by solving the denied claims, thereby avoiding uncollected insurance revenue.

  • Increased focus on patient care

Patient care is essentially one of the most important aspects of any practice. But with the growing number of patients, it becomes extremely difficult to prioritize both patient care as well as revenue cycle management. It at times can become difficult to provide uninterrupted attention to patient care and engagement, which can even break the interest and trust of the patient in your practice. But with outsourcing RCM services, the practices can provide undivided attention to their patient care.

  • Time saving

Since your RCM service provider handles the entire revenue cycle, it gives you enough time to focus on other critical aspects of work. With a less number of staff and more time, it will be easier to allocate more time to patient care.

  • Reduced Denial of Claims

Your RCM service provider will ensure a complete error-free billing process. Since the complete revenue cycle is handled by expert professionals, there are fewer possibilities of any error happening. This in turn reduces the possibility of claim denials and increases the claim acceptance rate.

  • Reduced Number of staff

Your RCM provider ensures the handling of the entire revenue cycle, thereby eliminating the need for an in-house staff. The time, effort and cost required for managing the staff could thus be avoided.

  • Staying up-to-date with changing Insurance processes

Your RCM service provider will stay up-to-date with the varying insurance processes and will accordingly make changes to their work so that you don’t have to worry or stress about any of it.

CareRevenue could be your ideal RCM service provider as we deliver services that help you maximize your revenue. We extend our team of expert professionals who would manage the overall revenue cycle. We help you deliver uninterrupted time and focus on your patients, presenting them with excellent care and treatment without any other worries or stress.

Best Practices For Your Revenue Cycle Management 

by carerevenue

For a practice, cash flow is something that constantly stays on top of their mind, as it is the driving force of the practice. Getting paid is as important as patient care or treatment. Taking care of your practice’s revenue cycle is important for the success or growth of your practice. Always keep in mind that the long-term success of your practice depends on the proper management of your revenue cycle, which includes accurate claim submission and timely payment from both the patients and the insurance providers. Required attention needs to be given to revenue cycle management if you want your practice to run smoothly and successfully. Careless revenue cycle management can lead to the denial of claims, resulting in a loss of revenue. Practices often struggle with the management of complex RCM processes, with their constantly changing insurance rules and regulations. Delivering top-quality patient care along with all the complex revenue management can be a demanding and time-consuming task for your practice, which can hinder the performance of your practice and its staff. Having said that, learning and improving your RCM is very important for the growth and success of your practice.

So, here are some of the best practices for your RCM 

Accurate documentation of patient details

Do not submit incorrect information about patients. Make sure that you collect accurate information on your patients. Do confirm the data you have collected in case there are any mistakes.  Important information such as the patient’s name, demographics, medical information, and insurance information must be gathered. Any error in the information documented can lead to claim denial, which can create another set of difficulties for your practice and its staff. In addition, make sure you have the complete details on the patients. Incomplete documentation of information can also lead to claim denials.

Check for eligibility and benefits verification before providing any services

It is important that you check the insurance coverage and eligibility of the patients before providing any services. Many practices, in their hurry to submit claims within the given time frame, give less or no attention to proper eligibility or benefits verification, hampering the entire revenue cycle process. A lot of claim denials occur due to mistakes or errors in eligibility and benefits verification. This shows exactly why we need to do proper eligibility verification. Thus, you can improve the revenue of your practice and reduce any unnecessary loss of revenue.

Error-free coding

Make sure that you do the coding error-free before submitting the claims. Proper coding of insurance claims can be a really complex and time-consuming task for your practice staff. Getting the claim accepted on the first try itself is important for your practice, as claim denials can create havoc in your practice. Since it is a complex process, extra attention or care needs to be taken while coding for your insurance claims. Remember, even a tiny mistake in it can cause claim denials, which can delay the entire payment process.

Make the process patient-friendly

It is no secret that patients are the most important aspect of a practice. They determine the success or failure of your practice. Therefore, the main priority of your practice should be to make them feel comfortable and at ease by making the complex RCM process easier and simpler for them. Patients should be notified about their responsibilities and payment options before providing the services so that they know what to expect while availing the services and are not exposed to any surprises. The longer the patient stays confused about the RCM process, the longer it will take for them to make the payment. So it is important to prioritize your patients for a faster and smoother payment process.

Timely submission of claims

Practices  frequently miss the deadlines established by the insurance providers, making late claim submissions one of the most frequent errors committed by practices. It is critical to understand that late submission of claims can result in their denial, making the already difficult RCM process even more difficult for the practice. Make sure that you submit your claims within a given time frame for an easier and faster payment cycle. The longer it takes to submit claims, the longer the payment cycle becomes, increasing the risk of claims going unpaid and resulting in revenue loss.

Effective management of your accounts receivable

Your accounts receivable is the key indicator of how well your practice is working and how well the RCM is being managed. The higher the days in AR, the higher the risk of payment going unpaid. It is highly important to keep your AR days low for the smooth running of your practice and an increase in revenue. Remember, claims with AR days above 90 days are at a high risk of going unpaid. If the AR is not managed properly, then it will affect the overall revenue cycle and can even result in a huge loss of revenue for your practice.

Mitigate and manage denials

Claim denial management is one of the last but one of the most important steps for effective management of RCM. Claim denials are one of the most important and frequent reasons for the loss of revenue in a practice. Denied claims need to be identified and addressed as fast as possible for the maximum reimbursement. The best way is to avoid claim denials as much as possible. The rework and resubmission of denied claims can take a lot of time and effort from your staff and can create a lot of hassles in the revenue cycle. Therefore, it is better to avoid claim denials to the best of your capability. Even if claim denials occur, make sure to address them in a timely manner.

Partnering with an RCM service provider

Revenue cycle management is a complex and demanding process that can take a lot of time and effort from your practice and its staff. As a result, most of the practices often struggle with their management and end up losing a great deal of their revenue. Partnering with an RCM service provider can help you take the extra burden off the shoulders of your practice staff. With an RCM service provider by your side, you can focus your attention on the more important needs of your practice, including patient care and treatment.

Conclusion

Practices often focus their attention mainly on quality patient care and treatment and overlook proper management of RCM, as it is a complex and time-consuming task. But it is important to realize that any error or mismanagement in it can create a huge loss in revenue for your practice. Make sure that you properly manage your RCM for the success and growth of your practice. Opting for an RCM service provider can also be a good step in easily managing your revenue cycle without your staff having to overstress themselves. Remember, understanding and improving your revenue management can take your practice to huge success.

Why Should You Pay Attention To Your Accounts Receivable Days.

by carerevenue

Accounts Receivable days, or days in AR, are one of the crucial performance indicators that determine the success of a practice. Accounts Receivable(AR) indicates the payment amount that has not yet been collected from the patients or the insurance companies. It is the amount owed to the practice, and AR days refers to the amount of time it takes to get the complete payment for a claim. An increase in AR days can lead to a decrease in the revenue of the firm. Therefore, it becomes highly important to have a proper Accounts Receivable management. Proper and careful AR management can help in increasing the overall revenue of your practice. Higher AR days can have a negative impact on the overall operation of your practice. It can negatively affect the quality of patient care and treatment, which in turn can affect the patient experience, leading to patients losing trust and contentment in your practice. For the healthy working of your practice, it is important to manage your Accounts Receivable so as to reduce your days in AR.

Here’s why you should pay more attention to your AR days:

  • To receive maximum reimbursement from insurance companies.

 The AR management team makes sure that the claims are submitted or resubmitted to the insurance payers properly without any delay. They ensure that all the required steps are taken to collect the money if the claim is underpaid so that the practice receives maximum reimbursement.

  • Cut down the cost, time and effort that go into the resubmission of claim denials.

 A proper AR management helps in handling claim denials without any loss in time or money as fast as possible.

  • Proper AR management helps in tracking denied claims.

 It helps in identifying and analyzing the reasons for claim denials and submits appeals for these denied claims on a timely basis. Thus reducing the days in AR.

  • Helps keep track of the amount that goes into the aged category every month.

 This is one of the crucial aspects of maintaining a healthy revenue cycle as accounts that are aged over 90 days are at a high risk of going unpaid. Proper management of AR days thus helps in avoiding insurances going unpaid.

  • Helps in identifying the customers or accounts that are at high risk of being unpaid.

 It helps to identify late payers, thus helping the practice in taking measures to prevent the same. It also helps the practice in taking appropriate actions to guarantee that the payment is precisely collected if the majority of the past-due amount can be attributed to a single customer.

  • Helps in the fast submission of claims

With the proper management of accounts receivable, you can make sure that the practice is submitting the claims to the payers without any delay. Any delay in the submission of claims can cause a lot of trouble for the smooth functioning of the practice therefore it is important to make sure that the claims are submitted as soon as possible so that the days in AR remain low.

  • Helps ensure the smooth functioning of the practice.

 Less days in accounts receivable helps in increasing the overall revenue of the practice, which in turn provides the practice with the money to recruit and pay their staff, get new and improved technology and high capital for expansion. 

  • Helps improve the patient experience.

 With decrease in accounts receivable days, the quality of patient care and experience increases, thus building the trust and contentment of the patients. 

Accounts Receivable Management

Accounts receivable management services include the administration of reports pertaining to insurance, write-offs, bad debt evaluations, collection analysis, and ratio analysis. They are responsible for the management of denied claims, finding the reasons and analyzing claim denials so as to maximize patient payment and increase the overall revenue of the practice. Therefore, managing accounts receivable requires a great deal of knowledge about the various reasons for claim denials and the ways to reduce them. Don’t shy away from contacting the insurance providers or the patients for a better understanding of the reasons for claim denials or if any related doubts need to be cleared. Go through the claims thoroughly, making sure they are accurate and error-free, before the submission.The AR management also needs to do proper follow-up on patients, and accounts of patients who do not make timely payments need to be monitored continuously, which helps the practice in taking the proper action needed to reduce such instances from happening again. By properly tracking denied claims and appealing for them, AR management helps a practice collect the maximum portion of accounts receivable. Successful AR management requires careful planning and the allocation of appropriate resources to achieve maximum performance.

Why consider an RCM service provider

Reducing days in AR is crucial for the smooth functioning of your practice, but it can be a constant struggle for the dentists as well as the staff, because any error or negligence in AR management can result in poor cash flow and loss in revenue. Managing the various aspects of the revenue cycle, including AR management, along with patient care can be a hectic task for the practice. Therefore, hiring an expert RCM service provider can be a perfect solution as they help your practice with managing the various AR-related processes thereby helping in decreasing the days in AR and increasing the revenue of the practice. They provide you with expert professionals specializing in AR management and make sure that your practice is successful and equipped to treat more patients. They help your practice reduce its days in AR by increasing the claim acceptance ratio. They help you do proper follow-up on denied claims and resubmit them as soon as possible so that the chances of claims going unpaid can be reduced, thus reducing any loss in revenue due to claim denials. They make sure that payments are collected on time and do proper follow-up on patient accounts. Thus, you don’t have to allot extra time or effort for any of these processes and can provide your full-on attention to other important needs of the practice. It gives the practice the opportunity to focus more on patient care and its expansion while letting your RCM provider handle all the complex and difficult tasks of revenue cycle management.

How To Improve Days In Accounts Receivable

by carerevenue

Knowing and understanding your receivables is a key factor that helps in the growth and development of your dental practice. Managing AR days in a practice is never easy, but is one of the crucial aspects to maintaining a healthy revenue cycle. To start with, Accounts receivable is the amount that the patients or the insurance providers owe to the practice, while AR days is the amount of time it takes for the practice to collect all these payments. The higher the number of AR days, the higher the risk of unpaid claims, which can ultimately lead to a huge loss in revenue for the practice. 

Proper management of AR days can indeed be a demanding task, and many practices often struggle with it, which adds to the pressure of managing an already complex revenue cycle process. Any negligence in tracking the AR days can have a negative impact on the AR collections in your practice. Make sure that you keep your AR days to a minimum so as to ensure that your practice doesn’t suffer from revenue loss because any loss in revenue can impact the quality of treatment and patient care in a practice. Imagine losing your patient because of low-quality treatment and patient care. That can be terrifying. Therefore, it becomes highly important that you maintain reduced AR days.

So, here are some tips to improve your days in accounts receivable:

Maintaining Accuracy

Accuracy is the key to effective revenue cycle management process, especially in minimizing AR days. It is important for practices to make sure that the information collected and recorded is accurate before submitting the claims because any mistake or inaccuracy in it may lead to claim denials, thus increasing the AR days. Remember that rework and resubmission of denied claims can be a hectic task, which can delay the whole payment collection process and can even lead to claims being unpaid. Accuracy should be the top priority while collecting information from patients or insurance providers.

Setting goals

Setting goals for increasing both the number of clean claims as well as reducing  AR days is one of the best and most effective ways of improving your AR days. Setting a goal makes you want to work harder towards achieving those goals, which ultimately improves your AR days. So, try to set a proper goal before claims submissions and then start working towards achieving those.

Timely submission of claims

Make sure that you submit your claims without any delay, as delays in claim submission can disrupt the entire revenue cycle, making the process even more complex. It can even lead to accounts payments going unpaid and can lengthen the AR days. Delays in claim submission can even have a negative impact on patient experience, making them lose their trust in your practice. On-time claim submission should always be one of the top priorities of your practice. 

Form a proper payment policy

Another important way to manage and improve AR days is to implement a payment policy that highlights payment expectations, fee implications, refunds for overpayments, service charges, discounts, old balance collection and collection fees. It helps in establishing clear payment guidelines at the beginning of the process itself so that the patients do not receive any sudden surprises in between and can plan accordingly. This increases the chances of your practice getting paid without any delay, as the patients are aware of payment policies from the beginning itself. This reduces the AR days of your practice and increases its revenue.

Staying up to date with the various insurance payment regulations and patient data

Make sure that you stay up to date with the insurance regulations and patient data so that your claim submissions do not get denied. A lot of claim denials happen because of the practice not staying up-to-date with the frequently changing insurance rules and regulations as well as changes in patient information. Therefore staying up-to-date is very important for the easy and fast acceptance of claims. Do not shy away from contacting the patients or the insurance providers if any additional information is needed or if any doubts need to be cleared. Keep in mind that staying up-to-date with the various insurance rules saves up a lot of time that is spent in AR, thus effectively reducing the AR days.

Expert AR follow up

A proper AR follow-up is critical in identifying and reopening denied claims so that the maximum reimbursement can be obtained as soon as possible. The AR management team has to do proper follow-up on the claims even after the submission to make sure that the claims do not get denied. Even if there is a denial, proper follow-up should be conducted to identify the reasons and to resubmit the claim. Thus, expert AR follow-up can greatly reduce the time spent on denied claims and reduce the AR days.

Effective eligibility and benefits verification

Effective eligibility and benefits verification reduces the number of denied claims, thereby reducing the AR days. There are various steps involved in the process of eligibility verification, which should be followed through without any mistakes for the timely reception of payments. The verification should be completed before providing the service so as to make the payment process faster and easier.

Timely denial management

One of the main aspects that a practice needs to follow to reduce its AR days is reducing the number of claims denials. It is no secret that claim denials can disrupt the revenue cycle and can even lead to revenue leakage. Hence identifying and resubmitting denied claims without any delay should be of top priority in a practice. The AR days in a practice can be significantly reduced if the denied claims are tracked and submitted on time.

Opting an RCM service provider

The tracking and management of AR days can be a laborious task for the practice. It can be really difficult for the practice to provide equal attention to all the aspects of the working of a practice, especially with limited tasks. An RCM service provider could be a perfect solution for this. With a dental RCM service provider by your side, you can deliver round-the-clock attention to the other important needs of the practice, like efficient patient care. This relieves the practice from unnecessary burden of managing the complex process of the revenue cycle. They help you collect the payments as fast as possible, thereby reducing the AR days.

Conclusion

Days in accounts receivable is a key performance indicator, so it should never be overlooked and should always be prioritized. Remember, keeping your AR days between 30 and 40 days is important for maintaining a healthy revenue cycle. No matter what, never let your pending receivables go beyond 90 or 120 days because claims with such lengthy accounts receivable days are at high risk of converting into unpaid claims. Maintaining low AR days should be one of the top goals of your practice for better and quality performance. 

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How to Calculate Accounts Receivable Collection Period.

by carerevenue

The Accounts receivable collection period refers to the amount of time it takes for a practice to collect payments owed by its patients and insurance providers. It can be used to make sure that your practice has enough revenue to meet its financial obligations, thus improving the proper working of your practice. It serves as an indicator of how well your practice handles its accounts receivable, thereby making it a crucial factor for practices that depend largely on their revenue or cash flow for its smooth functioning. A practice should always be able to maintain their accounts receivable collection period to the minimum if they want their practice to be successful and their revenue to be high. Remember, the lower the accounts receivable collection period, the faster the payment would be and the higher the revenue would be. Knowing how to calculate and analyze your collection period will ultimately help you increase the effectiveness of your accounts receivable management.

How can you calculate the accounts receivable collection process?

In order to calculate the average accounts receivable collection period, first, divide the company’s net credit sales for the year by 360 or 365 days. This gives you the average credit sales per day. Now divide the average balance in accounts receivable during the year with this result. 

Some of the processes involved in the calculation of the accounts receivable collection process are:

Gathering the data

Keep a tab on the data you need for calculating accurate account receivable collections. The various requirements for calculation need to be identified and collected without any errors or mistakes. The important data that needs to be collected include net credit sales, average accounts receivable balance, and accounts receivable turnover ratio. 

Calculating the collection period for accounts receivable

The formula for calculation needs to be clearly understood for an accurate accounts receivable collection period, and the data collected should be appropriately used in the formula. Once all the collected data is put into the equation, you can easily solve it to get the required result easier and faster.

Why should you calculate the accounts receivable collection period?

A practice can use its accounts receivable collection period to identify trends in its own insurance claim processing. It can be used to compare your practice’s revenue cycle with that of your competitors. So that you can identify your practices’ shortcomings and work towards improving them. Doing a proper calculation of the accounts receivable collection period can help your practice identify any mistakes in claim submission and take steps to prevent the same from happening again. This helps in reducing the number of claim denials and improving the overall functioning of the practice. The main goal of your practice should always be to reduce the accounts receivable collection period to the least and get the payments from your patients and insurance providers as soon as possible without any delay so as to help your practice in its growth and development. But just identifying and analyzing the areas of improvement won’t help your practice. Instead, you need to take steps for improvement from the data calculated. Remember, the revenue flow of your practice depends highly on its AR collection period and knowing it would help your practice to take measures to collect the payment without any delay within the given time frame.

Role of AR management

It is the responsibility of a practice’s AR management to keep track of their AR collection period and to make sure that the payments are collected within the given time frame. Make sure you keep an eye on your practice’s AR collection period so as to monitor its performance and growth at every point without making any mistakes. It also helps your practice in implementing strict rules or policies for collecting timely payment from your patients without any difficulties by tracking trends that may show continued payment delays or unpaid claims by certain patients. 

How does it affect your practice

It’s important to understand that claims with accounts receivable collection periods of more than 60 or 90 days are at a high risk of going unpaid, which can greatly hit the overall revenue of the practice. Therefore, it becomes important to limit your accounts receivable collection period to below 50 days. If claims take more than 50 days to process, then strict measures need to be taken to collect the payments on time so that the functioning of the practice is not affected. 

Do not forget that as the revenue of the practice gets hit, the quality of facilities in your practice also gets affected. Complete payment of accounts receivable translates to increased cash flow, leading to better quality of services at your practice. Have your accounts receivable collection period minimized to the lowest so as to prevent maximum leakage in revenue.

It can also help you determine the effectiveness of your RCM and work on the areas that need improvement. It shows how well your collection policies are working out, whether they are helping your practice or not, so that you can work accordingly. You can continuously monitor your accounts receivable collection period and compare it with your previous years to check the performance status of your practice for points of improvement.

Make sure you know the accounts receivable for all payers individually, so you can easily identify patients with high accounts receivable collection periods and take measures to get the payment faster. Practices often overlook the need for the proper calculation of accounts receivable among the other complex processes of RCM, without realizing that it is one of the most crucial and important steps in RCM, which can determine the success of a practice. Ignoring or paying less attention to the calculation of the AR collection period can harm your practice in many ways.

Conclusion 

The Accounts receivable collection period can be a really powerful tool for measuring the 

success of your practice. Calculating accounts receivable and all the other related tasks can be really stressful for your practice. Partnering with an RCM service provider can be the perfect solution as they guide you through the complex process of RCM so that you can concentrate on the more important needs of your practice. They help you calculate the accounts receivable collection period and determine the growth of your practice without you having to worry about it in any ways.

How to increase your claim rate and why does it matters?

by carerevenue

The “claim rate” is a vital element in RCM (Revenue Cycle Management) that shows how well you are managing your revenue cycle. To improve the overall revenue cycle, the first thing that a practice should focus on is its clean claim rate, as claim rejections can be costly. The “clean claim rate” of a practice refers to the percentage of claims submitted that are error-free, complete with all necessary information, and submitted within the specified time frame. Every time a claim is rejected, it impacts your revenue cycle and reduces the overall income that your practice generates. Rejected claims increase workload and disrupt an already lengthy and complicated revenue cycle process. With claim payments and denials being the top concerns of the provider, it can distract the practice from providing a focus on other equally important functions. The process of rework and resubmission of denied claims can take up a lot of time and effort on your part and can disturb the smooth functioning of your practice. Therefore, it becomes important that you get the maximum number of claims accepted on the first try itself.

So, how can the claim rate be increased?  Here are some tips:

Accuracy Over Speed

Collect accurate patient data because any inaccuracy could result in the claim being denied. This is the crucial and most important aspect of developing clean claims. The information that you have collected should always be accurate and precise. Most practices, in their hurry to submit claims, often overlook the need for cross checking information collected. Presenting accurate claims should always be of prime importance. Make sure you have all the necessary information on patients, including their medical data. Even a tiny error in the claim, such as a spelling mistake can lead to its denial, so make sure to go through the claims multiple times to avoid any such errors. 

Elaborate Eligibility and Benefits Verification

Most claim denials occur because of errors in eligibility checking, while every successful insurance payment is largely dependent on successful eligibility and benefits verification. Proper eligibility verification provides the practice with a clear view of a patient’s insurance coverage, benefits and payment obligations so that they can submit clean claims without any mistakes. It is important to go through patient information and insurance coverage details before providing any services. It is also important to do proper follow-up on this information to make sure that any changes in the patient information are updated regularly.

Staying up-to-date with insurance rules as well as patient information

The insurance payment rules and regulations undergo changes frequently. Therefore it is very important to stay up to date with these changing policies so as to produce clean claims. Any inconsistency in it can lead to the denial of claims. It is equally important to keep track of the patient information and data so that any changes in it are updated as soon as possible. Depending on the rules and regulations, even a small error or tiny missing piece of information can lead to a lot of hassle. Don’t shy away from contacting the patients or insurance providers if any additional information is needed or any doubts need to be cleared. 

Partnering with an RCM service provider

With an RCM service provider by your side, you can focus your attention on more important tasks such as patient care and the growth of your practice without any worries about the claim being denied. They help you by ensuring that the claims are submitted error-free and with all the necessary information. They pay attention and stay up-to-date with the changing insurance regulations without you having to worry about it. They provide expert professional services that help you submit clean claims, thus reducing the number of denied claims and speeding up your revenue cycle.

Managing denied claims

Denied claims are not just a loss in revenue but also an amazing opportunity to learn from your mistakes so as to prevent it from happening again. Proper analysis of denied claims can provide you with answers to why claim denials happen and how they can be reduced. It could be your best chance to improve the clean claim rate. Analyzing claim denials helps you in identifying the most recurring reasons for claim denials, which should be addressed as fast as possible to avoid further denials. By tracking, analyzing and measuring denied claims, practices can work on improving their clean claim rate.

Why does it matter?

The high clean claim rates show the quality of your practice. It shows the quality of data collections as well as the effort and time that goes into error correction in your practice. It also helps in tracking the efficiency of your claim submission process. Increasing the clean claim rate helps in reducing the time and effort required for the insurance payment process. An increase in clean claim rates implies a decrease in time, effort and expense involved in insurance payment. It entails less work, reduced cost and fewer days in accounts receivable(AR), which ultimately leads to faster payment. It ensures faster and more efficient payments so that no time is wasted on delayed or denied claims. Denied claims can create a lot of difficulties, including loss in revenue, time and effort but with the submission of clean claims, these difficulties can be avoided. Not just that, but submission of inaccurate claims can even lead to legal trouble, as submission of too many inaccurate claims can lead to your practice being flagged for potential fraud and abuse. The clean claim rate of your practice can directly impact your overall revenue. Therefore, it is important to maintain a high claim rate for the financial success of your practice. 

Conclusion

The clean claim rate may not completely eliminate claim denials, but it certainly helps to reduce the number of denied claims to a significant extent. Clean claim rate can hugely impact the success of your practice. It can be detrimental to the increase in the overall revenue of a practice. Therefore, it is important to maintain at least an average clean claim rate for the smooth working of a practice. Considering an RCM service provider could be your perfect solution for maintaining a high clean claim rate, but remember to choose your service provider carefully as it can make the whole difference. 

6 Ways to Increase Productivity in your Dental Service

by carerevenue

Managing and organizing a dental practice is often a laborious task. It can get extremely challenging to allot equal attention and care all aspects of the work process. The excellent treatment that your practice provides alone cannot lead to its success. In fact, there are various other factors such as the patient experience, services provided, dental revenue cycle management and patient information that contribute to the success of your dental practice. Here are 6 tips that can help you increase the productivity of your dental service:

1. Understanding What Makes You Unique

Understand what makes your practice unique among your competitors. It could be the array of dental services or patient treatment that you provide. These days the customers have a series of dental care options to choose from, especially with the intrusion of social media. Many of the patients are even willing to travel a very long distance for quality dental services. At a time like this the productivity and success of your practice depends on how you separate yourself from the rest of the practices. It is this distinctive factor that makes the patients choose you over the other practices. Therefore, it is very important that you acknowledge and promote your unique trait through the dental services that you provide to your patients. This drives more patients to your practice and helps in retaining them, thus improving the productivity of your practice.

2. Offering Additional Services

Providing additional dental services undeniably increases the productivity of your practice as the number of patients starts increasing. When you provide different services within your practice itself, you don’t have to refer your patients elsewhere, thus increasing the cash flow into the practice. It also brings in new patients to your practice. Opting for new dental services or treatments would let people know that your practice is staying on top of the trends in dental care, which would make them want to visit your practice and try out the services provided. This would let them know that you care about their interests and comfort. This doesn’t mean that you should compromise on the quality of the dental services provided. Quality should always be at the forefront.

3. Paying Attention to your patient reviews and Feedbacks

It is really important for the success of your practice that you pay attention to all your patient reviews on the dental services that you provide, whether it is positive or negative. Bear in mind that feedback provides you with the opportunity to improve your practice. It is the reviews of patients that help a practice grow, as it gives valuable suggestions and points on the improvement of patient care. Be open to negative critiques as well as complaints. Make sure you never let these go unnoticed, as these reviews can only add to the fear or anxiety about dental care that already exists among most of the patients. There are even chances that it could damage the reputation of the practice. That being the case, ensure that the complaints are resolved as soon as possible by interacting with patients privately and answering their concerns. Now there are several online platforms where people can share their opinions and feedback on the dental services availed, which lets the practice know their shortcomings. Make sure that you update your patient on the changes that took place because of their review or complaint. This helps in building trust in your patients, making them want to revisit your practice. Always give a proper response or take action on your patient complaints. Be sure that you don’t ignore it and think that it won’t affect your practice. Patient care and experience should be top priority in a practice.

4. Considering RCM Service Providers

The key responsibilities  arising from patient care make it difficult to devote round-the-clock attention, time and concentration to insurance collection and dental billing process, in which case dental RCM service providers assist you in handling your entire revenue cycle, thus providing you with the time and opportunity to maximize your focus on your dental services, patient care and experience, without worrying about anything else. It also helps you in reducing denied claims while staying up-to-date with the changing insurance processes. Managing the revenue cycle on your own can be a really time-consuming job with a greater chance of human error, especially given the complexity of claim processing. With an RCM service provider, you can get professional help in managing your billing process, thus cutting off the number of staff and the additional workload, ultimately increasing the productivity of your practice.

5. Providing Efficient Front-line Customer service

One of your top priorities should always be providing the best of dental services, as patients are always the primary concern in a dental practice. It is the patients or the customers who influence the success of a practice. If they don’t find your practice up to the mark, they will search for some other practice. The first consideration made by a patient while choosing a practice is their customer service alongside their dental services. It is thus important that you provide superior dental service to your patients, making them want to revisit you. Make sure that you take your patients through every stage of the patient’s journey with love and care. Long waits, difficulties with insurance payment, lack of proper communication on important matters etc. will only cause your patients to leave your practice, so it is important that you give proper attention to these aspects while providing the best treatment.

6. Reducing No-Shows and Cancellations

No-shows and treatment cancellations can greatly affect the efficiency of the dental services and the overall productivity of your dental practice. Missed appointments can have a series of effects including loss of time, effort, revenue and can also impact your daily schedule. Scheduling patient appointments and following through it, by providing timely dental services could help in reducing no-shows. It would be perfect if the patient could schedule their appointments themselves. Remember that your patient can also have a busy schedule and can forget their appointments. Therefore, it is important that you continue patient contact through calls or texts between appointments, thus giving them reminders. When a patient misses an appointment, be sure to call or text them, encouraging them to reschedule their appointment for the dental services with your practice. Let your patients know the significance of the treatment in maintaining their dental health, and the benefits of following through with it, so that they don’t miss their appointments just because they don’t understand its importance.

Every step that you take towards increasing the productivity in your practice helps in guiding your practice to success. Running a dental practice can be a hefty task, but by using these tips the dental services your practice provides could be made a lot more seamless. These tips alongside effective dental revenue cycle management, will help you to drive your practice towards success. Always remember to give top priority to your customers as they are ones who ultimately determine your success. 

Importance of Eligibility & Benefits Verification

by carerevenue

Verifying insurance eligibility and benefits is one of the first and most important steps in revenue cycle management. It is the process of confirming a patient’s active coverage and eligibility with an insurance company. A majority of Americans are insured. As a result, it becomes critical to verify their insurance eligibility before providing any patient care. Proper eligibility verification provides the practice with a clear view of a patient’s insurance coverage, benefits and payment obligations so that they can submit clean claims without any mistakes. With today’s changing and increasingly complex insurance payment processes, it becomes necessary to pay careful attention to the verification of coverage, benefits, co-payments, and unpaid deductibles. Most claim denials occur because of errors in eligibility checking, while every successful insurance payment is largely dependent on successful eligibility and benefits verification.

Processes Involved in Eligibility and Benefits Verification

  • Patient Scheduling and Enrollment: The first step of eligibility and benefit verification includes scheduling patient appointments. This can be done through phone calls, text messages, or through online booking methods. During the appointments, the patient’s information as well as patient health details are to be collected. Essential information such as patient name, phone number, address, medical history, diagnosis and more is to be collected carefully without any mistakes.  
  • <Patient Insurance Verification: It is one of the most important processes, where the patient details such as insurance coverage, benefits and more are verified and cross checked. It is usually done before the patient’s appointment. Ensure that the information you have on the patients is correct and up-to-date as any error in this information can lead to denial of claims. With the frequently changing insurance processes, it is important to remain up-to-date so that you don’t make any mistakes. Check through the information and claims thoroughly as many times as possible, because denied claims can be a huge hassle.
  • Collecting additional information from the patients and the insurance company: If any doubt arises about the patient information or insurance coverage details, make sure to contact the patient or the insurance provider if needed. It can be through a simple text or call. Do not hesitate to contact the patient if required. It could help in clearing doubts and staying up to date, thereby producing clean claims without any errors. In case of doubts regarding the insurance coverage, you can always contact the insurance provider for more clarity on those. But make sure you always collect the precise information.
  • Updating the RCM System: The revenue cycle management system needs to be updated with the collected patient information and insurance coverage details. Make sure to update it correctly without any errors. This is the last stage in eligibility and benefits verification and therefore must be given careful attention.

Benefits of Eligibility and Benefits Verification

  • Submission of Clean Claims: Eligibility and benefits verification help you in submitting error free clean claims. It helps in eliminating all errors in insurance claims before submitting them. The various patient information and insurance coverage details are cross checked before updating. This helps in avoiding any errors that may occur in patient information and insurance details. This makes the whole payment process easier and quicker.
  • Lower Claim Denials: Since all the errors are rectified during the verification process itself, there is only a very low chance of claim denials. Submission of clean claims reduces the rate of claim denial and increases the claim acceptance rate. The complicated task of reworking and resubmitting denied claims can thus be avoided, making the payment process a lot easier.
  • Increase in Cash Flow: With an increased claim acceptance rate and a low denial rate, the revenue of the practice increases significantly.  Consistent and accurate eligibility and benefit verification is important for the growth of revenue in a practice. Any error in this can impact the overall revenue of the practice. In cases where the policies do not cover the services or have expired, eligibility verification protects the practice from any impact on revenue and improves the overall cash flow.
  • Increased Patient Satisfaction: Patients are the main priority in any practice, and eligibility and benefits verification help in providing your patients with quality services and giving them maximum satisfaction. Eligibility verification enables you to be transparent with your patient through open communication, thereby earning their trust. It will also inform the patients about their responsibilities prior to their appointment so that they can come to the appointment with proper payment preparation. This gives them a sense of security and satisfaction and would make them want to continue service with you.

Failure to carry out proper eligibility and benefits verification can have a huge negative impact on the overall working of your practice. It affects almost all the aspects, including cash flow, patient care and experience, insurance payment and billing and more. Any mistake in this can lead to an increase in denied claims, complex process of rework and resubmission, delays in patient care, which impacts the patient experience and satisfaction, and increased payment debts. In fact it is very important for practices as well as patients to understand the eligibility verification process and its importance in facilitating fast and easy insurance payment. But with the changing insurance rules and policies, it becomes really difficult for the practice as well as the patients to stay on top of these requirements. Not just that, managing the insurance payment processes, including eligibility verification, along with patient care and other needs can prove to be a really laborious job, disturbing the complete working of the practice. Therefore, most people nowadays opt for an RCM service provider. They help you manage all aspects of your revenue cycles so that you can provide your complete attention to patient care and experience.

An RCM provider helps you stay up to date with the changing insurance rules and regulations in insurance payment so that you can give your undivided full attention to patient care, thereby increasing patient satisfaction. They interact with the practice as well as the insurance company, handle the paperwork, and verify patient information, thereby improving the revenue cycle and maximizing payment. They can do the work with maximum efficiency and save the practice and its staff extra time, effort and energy. An RCM provider could be the ideal solution for managing the complex task of insurance payment and verification.