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Want a Denial Free Claim Submission?

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Claim denial translates itself into a huge amount in lost revenue for a practice. This results in a serious disruption to a practice’s revenue cycle. It can be a major headache for practices, affecting both cash flow and efficiency. It not only affects the cash flow at your practice, but it can also damage / breach the relationship you have with your patients. Even though some denials can be appealed successfully, it can temporarily put the status of the claim in doubt, which is something that both you and your patients would wish to avoid. But the good news is that most of these denials can be recovered or, even better, prevented from happening in the first place!

Preventing the occurrence of a denial before your patient leaves the practice helps your revenue cycle grow faster, which in turn, increases your practice’s profitability. And there are many factors that help drive the increasing number in claim denials at your practice. Understanding these common reasons for denials is the key to preventing them from happening altogether. The only way to curtail the rate of denials is to identify the actual and specific causes for them.

Some common reasons for such denials:

Claims not filed on time

Insurance companies have strict deadlines for filing claims, including a date by which revised claims must be submitted. The deadlines for filing claims typically vary from 90 days to one year from the date of service. This can even be as short as 15 to 30 days. Failing to submit claims within the given timeframe can lead to delayed payments or even going unpaid. Practices miss claim filing deadlines for a number of reasons, but these reasons must be identified and avoided at all costs for the healthy working of your practice’s revenue cycle. Late submission of claims can have a huge impact on your practice, disrupting its revenue flow and creating disturbances in its functioning.

Inaccurate or missing patient information and data

It is important to make sure that you have entered the correct patient information and data without omitting any required information, before submitting the claims. Mistakes and omissions can lead to claims being denied. It is one of the most recurrent reasons for claim denials. Missing or inaccurate data could be anything from Social Security Numbers to plan codes, to technical errors. It is the responsibility of the practice to make sure all data entered is accurate and valid. You can even contact the patient or the insurance provider if any additional information is needed or if any data needs to be verified. Strengthening your practice’s eligibility and benefits verification is one of the keys to avoiding denials due to inaccurate or missing information.

Services not covered by the insurance

Not all the services you provide to your patients are covered by their insurance policies. There may be services or procedures that are not covered by the patient’s insurance for which the patient has to pay out of his / her pocket. Denials occur when practices fail to perform insurance verification prior to appointments to identify such exceptions in patients’ current insurance coverage plans, which results in services and treatments going unpaid. Therefore, it’s important for practices to verify the patient’s insurance coverage thoroughly prior to consultation to avoid such mistakes from happening.

Coding errors

Coding errors are another common cause for claim denials. Coding errors include missing codes, wrong codes, using the wrong coding system, etc. Dental insurance coding undergoes frequent changes, and most denials occur because providers do not stay up-to-date with these changes. It is important to stay updated on these changes for a better claim acceptance rate.

Lack of proper documentation

At times, claims can get denied due to a lack of proper documentation. In several instances, the insurance provider may require additional documentation to support the claims and as evidence for the necessity of the services provided. Failure to do so may result in the denial of claims you submit. Therefore, collect all necessary documentation from your patients as well as from the insurance provider to minimize the chances of claims getting denied.

Duplicate claims

Many a time, practices accidentally resubmit claims 1) without giving the insurance provider enough time to respond or 2) without following up on the existing one. This leads to duplicate claims being filed for the same services, for the same dates of service. Quite naturally, this results in a claim denial. Be mindful of the fact that the same insurance provider will not accept multiple claim submissions for the same patient’s treatment by the same doctor, for the same date of service. To avoid denials due to duplicate claims, always check the status of the claim before resubmitting; do not resubmit claims when the same ones are still being processed or a partial payment has been made.

Claim denials are common in practice, but can be curbed to a great extent with proper management. An efficient denial management system with strong claims monitoring and reporting potential can help your practice reduce its claim denials and increase billing efficiency.

Would you like to know more about our Insurance Eligibility & Benefits Verification process?

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Improve Patient Experience At Your Practice

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Patients are the main strength of a practice, and it is they who decide the success of your practice. Therefore, the patient experience at your practice matters more than anything, and it is your responsibility to make them feel comfortable and welcome. Different patients have different expectations when visiting your practice; some may be scared of the treatment while others may have unrealistic expectations. To ensure that your patients have a positive experience, you must provide them with the best possible treatment and care. This means doing your best to create a professional, but warm and friendly environment. Given the keen competition we face today, patient experience means much more than just a clean, pain-free visit. It is all about building trust and connecting with your patients on a personal level. With some simple tips, it is possible for your practice to improve patient experience and make an impact on their lives.

Some tips to improve patient experience at your facility:

1. Create a positive and comfortable ambience

It is important that your patients receive the best kind of care and comfort at your practice. The first step is to create a positive, welcoming environment. Remember, different patients come with varying levels of anxiety and sometimes even fear; they might even be in pain. All this already makes a doctor’s office or clinic a stressful place for the patients to be in. Therefore, the atmosphere you create for the patient at the practice can make a huge difference. Make them feel comfortable and at ease, by ensuring you have a team of friendly and welcoming staff, clean and inviting waiting rooms, providing some additional amenities to keep them engaged while they wait their turn, etc.

2. Enhance your appointment scheduling process

An important step to improving the patient experience is making the appointment booking process easy and convenient, especially in our present day scenario of intense competition. The easiest way to do this is to make sure that you have the option to schedule appointments on your website which is user-friendly. Ensure that all the necessary contact and location information about your practice is included on your website. Do not fail to mention the days and the hours your facility will remain open. If scheduling an appointment at your facility becomes a tedious task, patients would easily look for another practice which has easier and quicker options for scheduling a visit.

3. Offer a wide range of quality services

After all, patients visit your practice to get the best possible treatment. Their first priority would always be the quality and range of services provided. Therefore, if you want to deliver a great patient experience to your patients, it is important that you cater to the wide range of quality treatments that they would expect. Finding another practice that would accord them all the care and treatments they need would not be too difficult. Always stay up-to-date on the various treatments and services offered at your practice – never allow your practice to fall behind.

4. Communicate with your patients

Successful patient communication is one of the greatest and most effective strategies to enhance the patient experience at your practice. Understand that your patients may be confused and worried about a lot of things while coming to your practice. Therefore, the onus is on you to ensure your patients are well-informed about what treatment is best and how the treatment would progress. A thorough explanation of the treatment plan and why it is necessary must be imparted to the patient. It is also important to go into detail about the benefits and drawbacks of treatment plans, and to be open and honest with them so that they can make well-informed decisions. It also helps in creating a strong bond with your patients, giving them the feel of being quite valued and trusted. Give room for no miscommunication or misinterpretation as it can cause grave misunderstanding, confusion and worry for your patients as well as for your practice.

5. Improve your practice’s billing process

Even if your practice is successful in providing excellent treatment and care for your patients, a complex or inconvenient billing system can still lead to patients feeling frustrated and dissatisfied. Patient satisfaction can be improved through better billing practices such as managing patient expectations, alerting patients of charges not covered by insurance, and providing different payment options. Make sure that you bill the patient for the services as soon as possible; don’t make them wait too long as it can leave your patients frustrated. Your practice’s billing process can either make or break your patient’s experience.

Great patient expectations are more important for your practice than you can imagine. Patient satisfaction begins from the moment the patient first contacts your practice and lasts until the payments are completely settled. So, start with the appointment scheduling process and look into each step to find where more attention is needed. Know also that improved patient satisfaction is valuable in creating a better patient-provider relationship.

Errors In Your Eligibility and Benefits Verification

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The dental billing revenue cycle is a challenging but essential procedure for a consistent and steady revenue stream. It is one of the first steps in the revenue cycle management process; which means that any mistakes or errors made at this level can lead to complications and have a significant impact on the entire revenue cycle. Inaccurate insurance eligibility and benefits verification can lead to delayed payments, denied claims and even nonpayment. 

Errors made during this process can cost your practice more money than you might think. Most claim denials occur, directly or indirectly, due to insufficient or inaccurate information gathered, which is, basically, eligibility and benefits verification. The first step to reducing the number of claim denials is to establish an efficient eligibility and benefits verification process. 

Here are some of the common eligibility and verification errors:

Inaccurate patient information

Verification is done to guarantee that your patients receive accurate billing for the services rendered. At times, errors can occur at this step; one of the most common errors being inaccurate patient information. This may happen for a lot of reasons, including a mix-up in the patient’s dental records. Something as simple as a middle name not being mentioned can lead to denials. Avoiding this problem will require that information is gathered diligently. Patients and the insurance providers must be contacted directly in case additional information is required. This also ensures that the data gathered is up to date.

Inactive insurance policy

Inactive insurance policies could be another reason for claim denials. In their hurry to submit claims, a lot of practices fail to check if the policies were active during the date of service. Information like the address for the submission of claims become invalid if the plan itself has become inactive. Contacting the insurer prior to providing the service is the best way to ensure that claims are not billed to inactive policies. Remember to verify the patient’s eligibility at the time of the visit before performing the treatment to make sure that the policy you are billing on is current. 

Failure to properly check the coverage

Eligibility and Verifications is not a process that should be done once in a year. There could be several changes that are made on policies by insurers within a plan year. Practices often make the common mistake of not properly checking the insurance coverage of their patients. This again happens for a lot of reasons, but is often due to incorrect or outdated information. This could also lead to frustrated patients, as they would have to pay out of their pockets. It is always better to contact the insurance provider and get confirmation in case there are any doubts about patient coverage. It is also important to keep up with the changes to insurance plans. If a patient has a new plan or their coverage has changed, be sure to verify that the coverage for the services provided is still in place. 

Duplicate data

Another common mistake that practices make in eligibility and benefits verification is to duplicate data entry. Duplicate data can lead to delays in billing and payment, and can also cause confusion for both patients and your staff. This may seem like a simple mistake but it can happen very easily, leading to claim denials. When entering patient information into the system, make sure to check for duplicates and correct them before moving on.

Missing documentation

A claim that doesn’t have the necessary documentation would most probably get rejected. The only way to rectify this situation would be to resubmit the claim with the proper and complete documentation. This can delay payment collection and make your patients irritated and frustrated. Information regarding documentation for each procedure needs to be collected during the eligibility and verifications process in order to avoid this problem. 

Neglecting to ask about a secondary policy

Some patients may have more than one active dental insurance plan. They are usually identified as the primary and the secondary plans. In such cases, claims should be billed initially to the primary insurance provider. Claims could get denied if the claim is billed to the secondary insurance provider. The practice staff must inquire about any secondary coverage during their eligibility checks to guarantee accurate claim filing. 

Remember, eligibility and benefits verification errors can cost your practice a lot of money. There are simple things you can do to help reduce the number of errors on your claims. Firstly, make sure that you identify and understand the eligibility and benefit requirements for the services provided to each patient. Secondly, verify that the patient’s policy meets the requirements before you provide the treatment. This can help your practice reduce the number of errors on your claims and save money in the long run.

Preauthorization In Revenue Cycle Management

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Pre-authorization is permission from an insurance company that is required before a patient can receive a certain type of treatment, care, or service. Virtually every payer requires pre-authorization for physical, occupational, and speech therapy. In most cases, if pre-authorization is not secured, services will not be covered by insurance. Most often, either the provider or the patient will be stuck with the bill for the entire cost of care.

Preauthorization refers to the practice of acquiring approval from insurers in advance for certain treatments and procedures in order to receive a possible reimbursement for those services. In other words, it is permission from an insurance company that is required before a patient can receive a certain type of treatment, care, or service. Virtually every payer requires pre-authorization for physical, occupational, and speech therapy. In most cases, if pre-authorization is not secured, services will not be covered by insurance. Most often, either the provider or the patient will be stuck with the bill for the entire cost of care. However, a majority of healthcare professionals feel that prior authorizations are time-consuming and interfere with patient treatment. The crux of the matter is that though pre-authorization does not guarantee reimbursement, the absence of pre-authorization can surely result in claim denials or non-reimbursement. Once you acquire pre-authorization from a payer, you will get a pre-authorization number. This number must be included in your claims to avoid unnecessary denials. If your claims are denied based on the lack of medical necessity, you should append this pre-authorization number while preparing an appeal letter.

To answer the most important question,

“How does preauthorization help your practice?”

  • Preauthorization in medical billing helps healthcare organizations collect the proper payment for services rendered, reduce rejections and follow up on rejected claims.
  • Preauthorization is a part of insurance verification and therefore, helps ensure that the insurance details of patients are valid.
  • Preauthorization is a way to ensure that the payer will pay the reimbursement amount without much delay.
  • Preauthorization aids in the verification of insurance details and helps to curb insurance fraud by removing erroneous insurance claims.
  • Preauthorization helps to avoid denials by obtaining payment approval from the insurance provider prior to providing the services.
  • Preauthorization allows insurance providers to assess whether a patient’s condition warrants further dental care or treatment.

Preauthorization is not as easy as it seems; there are many challenges involved. These challenges include:

Time-consuming

Preauthorizations consume so much time that they become an added burden on your staff. To successfully complete preauthorization, a lot of steps need to be followed. They include filling out request forms and submitting it to the insurance providers. A lot of time goes into the collection and verification of all the information required to process a prior authorization request. Not having a pre authorization can lead to patients not getting their treatments and creating some discord at your practice.

Complexities in preauthorization

Preauthorization can be much more complex than perceived. It can be a tumultuous task for your practice to keep up with the constantly changing policies and codes. As a result, your practice would be compromised if these changes are not implemented swiftly or there may have occurred unnecessary preauthorization submissions.

Lack of transparency

Lack of communication between the practice and the insurance providers regarding the status of the preauthorization request can result in delays and costly back-and-forths between them. Lack of transparency can lead to a lot of confusion, which results in another set of discomfort at your practice. Therefore, it is important to have proper transparency between the practice and the insurance provider.

Some standards for prior authorization have been set. So, get to know some of the best practices:

  • The use of prior authorization related to emergency care is prohibited by the Affordable Care act.
  • There is a move to ban prior authorization for certain behavioral health care by some states in the United States of America.
  • The law in some states requires the use of standardized prior authorization methods and new transparency reporting.
  • The use of gold card laws that requires health plans to waive prior authorization for services ordered by providers with a track record of prior authorization approval has been adopted by some states in the US, while other states are considering doing the same.

Application request for preauthorization

Ensure the completed form with your request for preauthorization is bereft of any errors. Errors in your application requesting preauthorization would inevitably lead to your request being rejected. 

Submit all relevant documents on time

While submitting your preauthorization request, remember to submit all the supporting documents within the given timeframe.

Adhere to the guidelines

Preauthorization is dependent on many factors. Of these, medical necessity takes credence. Remember, not all procedures or treatments require preauthorization.

For example:

  • If a patient has had a medical emergency or needs emergency treatment, (it is not required) obtaining a preauthorization is not a requirement since it may take 5 to 10 days for the insurance provider to respond to your preauthorization request.
  • There has been a move to ban prior authorization for certain behavioral health care by some states in the United States of America.
  • The law in some states requires the use of standardized prior authorization methods and new transparency reporting.
  • The use of “gold card” laws that requires health plans to waive prior authorization for services ordered by providers with a track record of prior authorization approval has been adopted by some states in the US, while other states are considering doing the same.

Dental Revenue Cycle Management KPIs For A Successful and Healthy Dental Practice

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Most practices have goals and targets set for each year when it comes to their revenue collection. Structured plans are devised to ensure this goal is met. With all the steps involved in making a practice a successful one, it becomes extremely important to track the viability of these goals and any need to reform them. What better way to do this than tracking your Key Performance Indicators(KPI)?  KPIs don’t just enable you to identify areas of improvement, they also provide insight into possible future trends if you maintain the strategy already in place.

KPIs are facts, numbers, and metrics that provide insight into the efficiency of the dental RCM. They let the practice have an in-depth understanding of the various aspects related to their RCM. A practice that fails to assess their KPIs in RCM is operating blindly, as they have no early signs or warnings of any decline in the performance of the revenue cycle. Ignoring your KPIs is one of the most frequent causes of a lackluster revenue cycle.

Here are some of the important KPIs to make sure that your RCM is running effectively:

Days in AR

The days spent in AR show how long it usually takes your practice to get payment for services provided. This number aids in determining how successfully the practice is collecting payments and how efficiently it handles account receivables, thus shedding light on the flow of revenue at your practice. Ideally, it’s always better to keep your AR days within a 30-day benchmark, but never let them exceed 60 days. To measure the days in AR, you need to first consider a certain time period you would like to check. This could be the past month, past quarter or even the past year. Simply add the daily charges within this time period and divide it by the total number of days in the chosen time period. 

Net collection Rate

The net collection rate indicates what percentage out of the total payments due, is actually received by the practice. It shows how successful your practice is at collecting the payment owed to them. The net collection rate could reveal a great deal about your practice’s collection tactics and how you can modify them. A consistent low net collection rate indicates a deeper problem like internal ineptitude. As with Days in AR, the first step to calculating the Net Collection Rate is to decide on a timeframe. You then need to divide the total payments that you received within this timeframe by the payments that were expected or agreed upon. The Net Collection Rate is determined once this number is divided by 100. 

Bad debt

Bad debt is a common occurrence and is a part of having your own business or practice. Collecting patient payments on time may not always be easy but not all failure to collect instances need to be written-off as bad debt. A high percentage of bad debt is never good for your practice. Calculating the bad debt ratio will help your practice determine if there is a need to change the collection process or even if there is a need to change your approach in patient communication. To calculate your bad debt ratio, divide the bad debt written off by the total sales of your practice. 

Clean claim rate

Clean claim rate is the percentage of insurance claims that are submitted and successfully reimbursed at the first instance of submission. A high clean claim rate means faster payments. It indicates that the claims being submitted have a high quality of data. Measuring the clean claim rate helps practices monitor the effectiveness of the data collection process prior to claim submission. Rejected claims need a lot of time to resolve and involve additional work and cost to both the provider and the payor. 

 Denial rate

While denied claims can result in underpaid claims or no payments, they can also be remedied and sent back. However, making many appeals for rejections may result in additional fees and may reduce the effectiveness of the revenue flow. The denial rate can be calculated by dividing the total amount denied by the total amount submitted as claims. If the percentage is above 10, you may need to re-examine your eligibility and verifications and coding processes. 

There are several other KPIs that you can use to measure the effectiveness of your RCM like Point of Service Cash Collection, Revenue Per Patient Visit and Late charge rates. Understanding what your practice needs and ensuring the use of the right KPIs can go a long way towards maintaining a healthy RCM.

Why is Dentistry a Stressful Job?

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There is no profession that is a walk in the park, especially if you are running your own business. This applies to Dentistry as well. The difficulties and challenges associated with it make for a really stressful job. Much of the research conducted on mental and physical health of dentists points to how seriously stress and dissatisfaction affect their lives. Stress could be caused by multiple factors, from relationships with patients, working hours, time and scheduling pressure, technical issues, to job or income dissatisfaction.

A survey done by the British Dental Association in 2019 showed that out of the 2,053 respondents, a whopping 54.9% reported that they were experiencing high levels of stress related to their job and nearly half of this number claimed to not be able to cope with this stress. 

Why exactly is dentistry a stressful job? Here are some of the common reasons:

Uncooperative patients

Imagine dealing with patients who are uncooperative, demanding, and not satisfied with what you are doing. It is bound to have a negative impact on your mental health. Every day, dentists are forced to have a cheerful disposition, a cheerful smile and be a thorough professional even in front of downright rude and mean patients. Add to that, patients who do their own research and attempt at-home remedies instead of taking professional help and this creates additional work to undo damage that should not have been done in the first place. Heightened emotions, worry, stress, depression, and anxiety, all naturally build up without a meaningful outlet.

Impact on physical health

Physical labor may seem minimal in the case of dentistry. What anyone pictures when they think about dentists is someone sitting comfortably on a chair while looking into patients’ mouths. The reality is that sitting in the same slouched position while having to constantly hold your arms up and your head down can cause pain and stiffness. The shoulders, arms, neck and back bear the brunt of this. It requires prolonged periods of ensuring that precise work is done without any sudden movements. In fact, Dentistry is considered to be one of the most physically demanding jobs. If the practice is a successful one with a continuous flow of patients, it leaves no time for relaxed breaks, exercise or even a bit of stretching. 

Economic pressure

With the economic environment and increased competition, the possibility of establishing a financially robust practice has become challenging. Dentists could work 24/7 and still may only earn a nominal amount considering that most of the cash flow gets invested back into running the practice. Most dentists are forced to work even during lunch hours due to financial constraints. The low number of breaks that they get to indulge in leaves them completely exhausted by the end of the day. Continuous overtime work and a huge workload could lead to burn-out. 

Confinement or isolation

The work dentists do is confined to a limited amount of physical space. Most dentists spend all of their time working within this space. There is little or no contact with the outside world, which makes them isolated. This also means that they do not have the benefit of regular peer-support that is available to other healthcare practitioners. 

Time pressure

Dentists are forced to go through long hours of exhausting work, which takes time away from any kind of leisure or entertainment and leaves them drained. They need to provide their undivided attention to every single patient as their work involves precise movements to be made with small and delicate tools. As the day progresses though, mental exhaustion and stiffness from prolonged hours of staying in the same position can cause loss of focus. This could mean that the same work could take more and more time to finish as the day moves forward. Additionally, it is quite impossible to predict when urgent care may be needed. If emergency situations arise during a packed day on the job, finding the time to meet all the appointments becomes difficult. Regardless of how well appointments are scheduled each day, one emergency could hijack a whole day’s work. 

Stress of perfection

Dentistry is a profession where even the tiniest of mistakes could have a huge physical and financial impact on both the dentist and the patient. Every step in the procedures done by dentists needs to be carefully curated. In case there are any errors in the services, the problem needs to be rectified as soon as possible. All this must be done while remaining calm and composed so as not to affect the patients. Ensuring that every step of each procedure is done perfectly is a very common reason for stress among dentists. 

Dentistry is undeniably one of the most stressful jobs there is, but it can certainly be made less stressful by following a healthy professional and personal lifestyle. As a first step, separate your work from your personal life; take breaks if needed. Set up sensible working hours with much-needed breaks. Exercise does not always have to be about cardio or HIIT. Simple stretches in between patients or walking on a regular basis within the halls of the practice can also have a positive impact. Improving your working environment can also make a huge difference. Become less isolated and try to share your worries with your fellow colleagues. All this can make dentistry a little less stressful and easier.

Is staff replacement really a problem in RCM?

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“Will partnering with an RCM service provider affect staff employment?” or “will it lead to the staff losing their job?”.When choosing an RCM service provider, the practice or its employees frequently ask the following questions. It may also be a few of the typical explanations for why most businesses refrain from opting for a third party.

But are these worries really valid?

Definitely not…these are just common misconceptions or myths that exist among people, and have no proven database. Partnering with an RCM provider does not affect your staff’s employment, rather it makes your work easier and reduces the burden on your staff. It is no secret that staff are the most important assets of a practice and their service cannot be negotiated. It is understood that the role or the service of a staff cannot be replaced, and an RCM service provider can never take the place of your staff.

The role of an RCM service provider

The management and other staff members must feel at ease for the smooth running of a practice. The staff are the ones who interact with the patients, collect information from them, and are the ones who make them feel safe and secure. It is the staff that builds the friendly environment in a practice which in turn increases patient visits. Therefore, it becomes important that they are always in a pleasant state of mind, are not overworked, and not overstressed with extreme workload. RCM consists of difficult and complex processes that need to be handled carefully and accurately. Imagine your staff having to deal with all these complex RCM processes along with handling the other important needs such as patient care, treatment, and practice management. It can take a real toll on them. They may feel drained out and stressed with such constant overwork.

In which case, an RCM provider gives you a helping hand as they assist you in navigating through the complex process of RCM without it being a burden to your staff. It takes the weight off the shoulders of your staff and provides them the opportunity to focus their attention on the more important needs of your practice. It gives your staff the time to devote to both new and already existing patients.

Because of the workload and stress, many employees have even quit their jobs at the practices. This could ultimately end up impacting the smooth functioning of the practice. Therefore, partnering with an RCM provider can actually help your practice retain its staff .

Role of staff in RCM

The importance or the role of a staff member in an RCM process is irreplaceable, even with an RCM provider by your side. It is through the staff that the service provider gathers the necessary information related to the patients. Staff act as a mediator between the patients and the RCM service providers. Managing the RCM is nearly impossible without the help of the staff. The staff are the ones who listen to the needs of the patients and address them in a timely manner. They are the ones who help build trust and assurance with the patients. It is through the staff that the patients get to enquire about their worries related to RCM and give their honest feedback. Without the help of the staff, the entire revenue cycle of your practice may get hampered.

Why CareRevenue

We at CareRevenue value the importance of your staff and understand that an RCM provider can never replace your staff. We aim at making work easier and stress-free for your employees. We work hand in hand with your staff to create a peaceful and organized environment at your practice. Constantly keeping track of the revenue cycle prevents your staff from providing the superior care and attention that the patients demand. We help you handle the complex RCM processes so that your staff can direct their focus to other important needs such as patient experience, financial stability, and better alignment of your practice, thereby increasing the workflow of your practice. It becomes advantageous for your practice as you now have two experienced teams concentrated on bettering the revenue and work flow.

Understanding and Interpreting Explanation of Benefits(EOB)

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An EOB (Explanation of Benefits), in the first place, is neither a dental claim nor a bill. It is a document or an electronic statement that is sent out to providers and at times to patients after a claim is processed. The EOB details the dental procedures and/or services that the patients have had and breaks down the costs associated with these services and procedures. It then provides information on what service is covered and to the amount it is covered along with any responsibility that the patient may have. Every EOB is different and reflects a variety of factors that insurers consider for payments to the services rendered and also the deductions from payments. An EOB is usually sent through the mail or can be accessed online. EOBs need to be stored safely and securely in accordance with HIPAA and any state regulations.

Why is an EOB so important?

An EOB is crucial for indicating whether and how a claim was paid as well as any outstanding balance that the patient may be responsible for. An EOB gives patients the chance to confirm that they are being charged for a service or treatment that they have actually received and that the indicated amount is reasonable.

An EOB provides you with crucial information such as the date of service, the procedures conducted, and also the amount processed by the insurance company. It also shows if there are any copays or deductibles for the procedures performed. One section that is important for patients is the amount the patient needs to pay out of pocket, or patient responsibility. This includes deductibles, co-pays, and coinsurance payments. The EOB shows exactly how much of the payment the insurance plan covers and how much the patient is to pay as per the plan benefits. Additional significant data, such as codes for pending status or claim denial, can also be found in the explanation of benefits. Basically, an EOB provides clear information on the limitations of the plan and any balances that are due. 

What gets included in an EOB?

  • Dentist name
  • Claim number
  • Patient identifiable information such as policy number, group number, and date of birth
  • Treatments performed
  • Procedure description
  • The date the procedure was performed
  • Dentist’s fees
  • Amount that was approved and processed by the insurance company
  • Service and coverage information
  • Deductibles
  • Co-pays
  • Coinsurance
  • Coordination of benefits information
  • The portion of the annual maximum that has been used
  • CDT Code (Current Dental Terminology Code)
  • Details on resubmissions needed
  • Codes for pending status or claim denial

Why is it important for patients to read through their EOBs?

With all the codes and numbers, EOBs can appear complex, but it is important for patients to read through the EOB in order to make sure that they have only been charged for services that were received. A claim may occasionally be submitted by the provider which may not contain all the details required by the insurance company to finish processing it. Therefore, understanding and reading through the different sections of an EOB is pivotal in finding and avoiding many billing errors.

Reading through important information like claim codes for pending status, requests for more information, or the denial status which are provided at the bottom of the statement also gives patients the opportunity to follow up with their provider in case any additional information is needed. Patients can be certain that they are paying the correct amount by comparing the patient responsibility amount mentioned on the EOB with the provider’s billed amount. An EOB helps ensure that the insurance benefits are being utilized to their full potential.

A Healthy Denial Management System Within RCM

by [email protected]

The average claim denial rate has risen considerably over the past few years. This means that there is an increase in the number of payments getting delayed or unpaid, leading to a loss in revenue and disturbing a practice’s overall revenue flow. Practices often make the mistake of blaming insurers for claim denials, but it would in fact be a better use of time to analyze the denial management strategy that is being used. There are also times when they make the mistake of not following up on denied claims, leading to an additional loss of revenue.

What is denial management?

Denial management includes identifying and correcting registration, billing, and medical coding flaws through trend tracking in order to develop the best solutions for reducing the number of denials. It focuses on identifying the reasons for denials and developing solutions to either reduce the risk or avoid them entirely. It helps mitigate the chances for future denials, thus ensuring that a practice receives quicker payments and a steadfast cash flow.

What are the steps involved in denial management?

Identifying the root cause of denials

The real difficulty in denial management lies in identifying the root cause of most denials. Identifying the causes, especially the recurring ones, is really important for managing denials productively. Claim denials can happen for a lot of reasons, including late claim submission, duplicate claim submission, incorrect or missing patient data, services not covered by the plan, incorrect documentation, etc. Identifying the most common cause for denials will help the practice to take steps to correct the disconnect. 

Monitoring and tracking the denials

Another integral step in denial management is the monitoring and tracking of denials. It is important to have accurate records of the denied claims. This can be done according to the type, date of service, procedure codes used, patient name etc. Additionally, tracking can be done for each insurer that you file with. Maintaining the tracked date on the basis of time, source, number, and reason for denial can help with effective communication with the insurers. This aids in lowering the likelihood of future claim denials.

Managing denials

The next step is the actual resolution and the resubmission of claims. Managing the denials, however, is itself a multi-step process. It involves tracking all the denials, sorting through them to understand the different reasons for these denials and then creating a streamlined process to rectify them, if possible. The process then gets implemented and utilized each time there are denials and this needs to be done in as little a time as possible to avoid

Data Analysis In Revenue Cycle Management

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Revenue cycle management maintains and operates the financial health of a dental practice and the challenges of running a healthy revenue cycle can be plenty. From accurately entering claim data and information to securing reimbursement and payments, several steps are involved in managing the revenue cycle of a practice. Inefficient revenue cycle management can put your practice at risk, as it not only hinders your practice’s growth but also results in a negative patient experience. Finding a solution for your RCM-related worries can be like attempting to find a needle in a haystack if a thorough understanding of where those problems occur is not achieved. Practices need to dig deeper into their revenue management if they truly want to fix their RCM and get back on the track of profitability and security.

This is where data analytics comes in; it offers you an insight into how precisely your RCM is running and where the difficulties lie. It also provides insights into everyday operations and projections of future trends and functions. This helps to make data-driven decisions and correct issues even before they occur. Such data-driven insights are required on a variety of topics, from profitability to the intricate analysis of lost revenue.

Data can be analyzed in three ways:

Descriptive

Descriptive analysis basically gives your practice the answer to the question, “What happened?” This is the threshold that practices should begin with as it is the simplest to perform. It mainly involves gathering and analyzing historical data about your practice. This provides you with information on potential revenue leaks caused by problems with insurance carriers, internal operations and the like. 

Diagnostic 

Diagnostic analysis helps answer the question, “Why did it happen?” It basically unearths links between all the data collected and helps your practice pinpoint what led to the problem in the first place. Identifying the cause of the problem and any connections with other problems will help you take action accordingly. 

Predictive

Predictive analysis, on the other hand, provides your practice with an answer to the question, “What could possibly happen?” It takes the historical data collected, analyzes the patterns found, and then predicts future trends in the revenue flow of the organization. The practice can adjust its present revenue cycle billing method to reflect the trends identified from this analysis. This is also the type of analytics that a lot of practices use machine learning or artificial intelligence to perform. 

Prescriptive

Prescriptive analysis is the most advanced form of analysis and it answers the question, “what should the practice do?” It makes one or more recommendations based on collected data, allowing the user to consider the potential results of each suggested course of action. The accuracy of prescriptive analysis depends heavily on the accuracy of the earlier steps and hence can be the most difficult to perform. The end result, however, is of high import and is undeniably a powerful tool for RCM. 

From improving your practice revenue to creating a better patient experience, data analytics can benefit your practice in a lot of ways. 

Some of the main benefits include:

Reducing minor errors

Data analytics helps validate the data collected during the revenue cycle management process. It scrubs your data for any minor errors, and compares the collected data to the information from the insurance provider.

Understanding your RCM better

Data analytics helps your practice identify and breakdown its revenue cycle process, thus letting you understand your RCM better. It also gives your practice a clear picture of each step involved in RCM, thereby making it easier to identify any one that is not performed accurately. With this, you can finally assess and benchmark your RCM processes. You can now create appealing reports that provide a complete picture of the actual state of your revenue cycle. It becomes much easier to improve your practice’s profitability when you can identify the main cause of a trend that results in decreased profitability.

Determining key performance indicators

KPIs provide essential data on healthcare revenue. They keep a close eye on the claims processing to spot any errors and also assess the denial rates for improved reimbursements. KPIs are very important for the growth of your revenue cycle, and these KPIs can only be identified through proper data analysis. Only through a thorough data analysis can the trends in the revenue cycle and the areas that need improvement be identified.

Improving patient experience

With proper data analysis, patient payment collection can be made a lot easier, giving you more time to focus on patient care and treatment. Your patient experience can improve exponentially when you have sufficient data collected through data analysis and understand how payment collection can be improved without causing any inconvenience to them.

Reducing denials

You can quickly identify patients and insurance companies that have frequent denials and rejections by incorporating data analytics into your revenue cycle management. This helps your practice improve its revenue flow by lowering its denial rate. Additionally, with proper data analysis, you can easily identify the frequent trends in denials, thereby making sure that you don’t endure similar denials or rejections in the future. Thus increasing your claim acceptance rate.

Understanding the performance of your revenue cycle is crucial for the steady growth of your practice. Remember, it is vital to remain on top of trends and benefit from utilizing data analysis in its entirety. Data analysis can provide insights into your practice that can help you make better decisions, increase revenue, operate more efficiently, and improve patient care.

Create a Better Dental Huddle Checklist

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Daily huddles have been assimilated into the workings of several industries, including the oral health and dental industry. Practitioners see these huddles as a way to sync up first thing on a working day, organize the day’s tasks and provide an environment to bond. There are, however, several practitioners who find daily huddles unnecessary and ineffective. In several cases, this is, unfortunately, true. When huddles are conducted with no specific format or aim, they do tend to take up a lot of time and provide minimal to no value. The worst part is that most practices, if they fail on their first few tries, completely give up on the idea of a daily huddle. 

When done properly with specific goals in mind, daily huddles can boost productivity and morale. They can serve as an important performance indicator for a practice as they give insightful information about the impact of different strategies on the working and revenue production of the practice. They are meant to be short and succinct. The aim is to have the team/s aligned with the day’s goals and strategize for the day’s undertaking. 

Maintaining a checklist can help set up a huddle system that is pertinent to the practice.

Here are some of the important points that can be added to the daily huddle checklist.

  • A snapshot of the goals that must be reached and the methods for reaching them.
  • Targets that get met and how to improve them.
  • A comparison of the previous day’s actual collection against the projected collection or goal.
  • Updates and follow-ups on schedule modifications from the previous day.
  • Review of winning measures that help staff to attract more potential patients.
  • Discussion of challenges, difficulties, or confusions in the current day’s schedule and plans on how they can be sorted out.
  • Major procedures scheduled for the day.
  • New patients and special-needs patients.
  • Current day’s allotted emergency time. 
  • New and old patient’s details.
  • Necessary assistance with x-rays and other needs.
  • Discussions and confirmations of lab cases.
  • Results from post-op calls.
  • Overdue continuing care.
  • Financial information on the current day’s patients.
  • Patients that need X-rays or photos as per treatment guidelines. 

Daily huddles can benefit practices in a lot of ways. Here are some of the benefits of an effectively conducted daily huddle.

  • Helps in team collaboration and bonding
  • Prepares and inspires the team for the day
  • Can be used as a time-management tool
  • Helps identify any possible hiccups
  • Helps fend off any distractions
  • Can serve as a discussion and team interaction platform
  • Can be a platform to celebrate success

Daily huddles bring with it a variety of benefits. However, they can also become really boring and tiring, especially if there are a lot of topics being covered during one huddle. Each practice needs to prioritize and establish a system that works for them. It may take some time to create the perfect daily huddle system but in the end, it is sure to pay off.

Appealing Claim Denials

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Each year denied and rejected claims result in revenue loss in the millions for hospitals and private practices. This results in undue stress to a provider’s revenue cycle management. Unfortunately, both large and small dental practices, also, find it rough going due to denied claims. Despite this, a lot of practices do not appeal their denied claims because they lack time or do not know whether the claim is truly appealable. A majority of a practice’s active patient base are those with dental insurance, so not appealing denied claims can be expensive.

Appealing denied claims isn’t exactly a cakewalk though and keeping up with the frequently changing rules and regulations can be cumbersome. Updated rules, contracts, terms, and conditions serve as catalysts for dental insurance companies to delay or reject insurance claim reimbursements.

Circumventing this situation is mandatory for a robust revenue cycle, and the first step involves understanding the reasons behind claim denials.

Here are some common reasons for claim denials:

Late filing of claims

Most insurance companies provide a timeframe within which claims need to be filed. Any claim submitted after the given timeframe does, usually, get denied.

Procedures deemed medically unnecessary

Some procedures may be considered medically unnecessary by the insurance company you are submitting the claims to.  This is another reason a claim could get denied. 

Frequency limitations

If a request to perform a procedure is sent after the coverage period has ended, chances are, it will not be covered by the insurance provider. 

Exclusions in insurance plans

Some insurance plans may exclude certain procedures, and the payments for these tend to go unpaid. 

Plan maximums

Each plan is covered for a certain amount per benefit period. This benefit period is usually for a year – calendar or fiscal. Insurance companies will not reimburse claims if this annual maximum amount has been reached during that benefit period. 

Incorrect CDT codes

The Code Maintenance Committee (CMC) at the American Dental Association (ADA) makes revisions, deletions and updates to the existing CDT codes set every year. Filing claims without factoring in these updates is also a reason for insurance companies to deny claims. 

Up-coded and Bundled or Unbundled services

Up-coding a service to get a higher reimbursement, unbundling of services to get additional reimbursements or bundling services to save time are also reasons for an insurance company to deny claims. Some plans may also have clauses inserted to ward off such practises. 

Once the reason/s for denial has been identified, an appeal can be filed against such a denial. Submitting appeals, though possibly onerous, is not impossible. 

So, here are some ways to make your claims appealing easier:

Confirm the reason/s for denial

There may be multiple reasons for one claim to be denied. Before starting the appeal process, make sure you confirm that all the reasons for the denial have been identified. Examine the insurance coverage to spot any mistakes; procedures and services that are covered will be specified in the plan. It will also include a list of any restrictions or exclusions that the insurance company has stated as not covered. 

Call the insurance provider if needed

When in doubt, get in touch with the insurance provider. This should ideally be done before you begin the appeals process. It gives your practice the opportunity to get additional details directly from the source.

Categorize denials

The appeals process for claims can be streamlined, and patterns in denials can be found by categorizing them. Strategies can be designed, and appeals can be done in a more detailed and accurate way, avoiding similar mistakes. 

Appealing claims on time

Just as in the initial filing of a claim, a majority of insurance providers specify timeframes for practices to submit appeals on denied claims. Depending on the insurance provider, this timeframe can vary anywhere between 90 days to 1 year. Therefore, make sure that your appeals are submitted within this timeframe. 

Follow-up on appealed claims 

Set reminders to follow up on each claim appeal periodically. If you have contacted the insurance provider before beginning the appeals process, ask for a turnaround time to know when you can follow up for a status check. Checking on the status of an appeal can help you make sure that the claims do not slip between any cracks.

Although these tips will, undoubtedly, help you improve your appeals process, the preferred thing to do would be to avoid claim denials as much as possible. 

Some steps you can add to a checklist when you submit your initial claim are: 

  • Scrutiny of the benefits
  • A thorough understanding of the terms and conditions of the insurance coverage
  • Patient education regarding potentially limited benefits
  • Verification of the service date
  • Documentation of all necessary information required to be submitted by the insurance provider
  • Use of accurate CDT codes
  • On-time claim submission

While appealing on rejected or denied claims can be time-consuming, the process is indispensable when it comes to generating revenue and bolstering the financial health of a practice. 

Prioritizing “Days Sales Outstanding” To Get The Best Out Of Your Practice

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Consider a situation where you go through the entire claim cycle only to have it denied or not paid. Consider, also, instances where patient payments are significantly delayed. The time and resources used would seem to have been wasted and it would cause a strain on your practice, wouldn’t it? Now, you would have to contend with delays in receiving payments or worse, unpaid claims. Afterall, isn’t revenue the goal of your practice? Without a healthy revenue cycle, it would be next to impossible to provide the best treatment and care for your patients. How do you circumvent such a situation? We recommend using DSO.

What is DSO or days sales outstanding?

  Days sales outstanding (DSO) is an important metric which measures the average number of days it takes for a practice to collect the complete payment for services provided and is usually calculated on a monthly, yearly, or quarterly basis. The outcome of days sales outstanding is an important performance indicator to how well your practice manages its revenue cycle. Calculating DSO involves dividing the total accounts receivable for a certain period by the net credit sales. This number is then multiplied by the days in that period.

Day Sales Outstanding = (Accounts Receivable/Net Credit Sales) x Number of days

The ideal DSO for a well-managed revenue cycle is less than 45 days. A DSO of more than 90 or 120 days should be avoided as much as possible because it increases the risk of payments not being made. Maintaining a DSO that is neither too high nor too low can seem formidable but doing so can result in better cash flow.

What do the days sales outstanding do for your practice?

  • It shows the performance of your practice’s revenue cycle during a particular period.
  • It shows how quickly patients pay their payments.
  • It helps identify patients or insurance providers who are always late in paying their payments.
  • It helps you understand if you are moving in the right direction with payment collection.
  • It shows if your practice is achieving customer satisfaction.
  • It can act as an early warning sign for the management of your revenue cycle.

How can a standard DSO be maintained?

Have patient payment terms planned well

Make sure that your practice has well-planned payment terms which are neither too tight nor too loose. In general, a practice with more flexible payment terms has a larger DSO than one with extremely strict ones. Although strict payment terms can decrease DSO and increase cash flow, if the payment terms are too tight, chances are high that the customers will leave your practice and find one with loose payment terms. Having well planned patient payment terms helps in ensuring that no patients or insurance providers are at a risk of slow payment or non-payment.

Accurate claims documentation

It is of absolute importance to take the time and have your records accurate before submitting your claims. Practices in a hurry to submit claims are likely to make errors. Even minute mistakes can lead to huge losses for your practice. Any errors in it can cause claim denial or rejection, lengthening the payment process and increasing DSO. Always have accurate patient data and information. Establishing quality-check procedures prior to submitting your claims is a surefire way to reduce these errors. 

Do not overlook receivables

Overlooking receivables is a common mistake that practices tend to make. Just because your practice is making enough revenue doesn’t mean you shouldn’t pay attention to your accounts receivable. You never know how it will impact your practice in the long run. Observe and ensure that your practice gets paid for every service that it provides. Proper management of accounts receivable can help decrease the DSO.

Proper follow-up on claims

Submitting claims is not the last step to the claim cycle. Adequate follow-up is important in making sure that the claims get paid without delays. The longer it takes for the claims to be accepted, the higher the risk of claims going unpaid. In case your claims get rejected, remember to start the resubmission process as soon as possible for a faster payment cycle. A proper follow-up on claims helps your practice reduce its DSO, which makes faster reimbursements inevitable.

Stay focused and determined

Bear in mind that reducing your practice’s DSO doesn’t happen overnight. Making considerable improvements in your DSO and maintaining them overtime requires effort and, at least initially, hard work from your staff. It is, therefore, important to stick to the process and not lose focus. Setting goals and analyzing your previous DSO statistics can help in establishing a robust process, which eventually becomes a frictionless part of it.

On-time claim submission

Late submission of claims is a common reason for denials. Submitting the claims on time should be second nature to your practice, especially if you want to reduce the DSO. It could be your first step in reducing your practice’s days sales outstanding.

Partner with an RCM service vendor

Granted, reducing DSO requires some effort and diligence, which can add to the workload at your practice and for your staff. Your staff would most likely already have a lot on their plate and an increased DSO could prove fatal. This is one of the best reasons for you to partner with an RCM service provider. They provide your practice with skilled professionals who are efficient at clearing unpaid claims, submitting them on a timely basis, and helping you reduce the practice’s days sales outstanding so that your staff are left with sufficient time to focus on the practice.

Make Your Claims Billing Easy

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After providing dental services to a patient, billing of claims follows as a matter-of-course. Claims billing has become a complicated process today. Different carriers, their various software infrastructure, different clearinghouses and their requirements, federal and state mandates, the myriad amounts of data and documentation required for preparing claims, all could make claims billing and submission quite confusing. Add to that the different types of services that patients may avail from a dental practice, and you have virtual chaos on your hands. Errorless claims billing, among other things, sets the foundation for the revenue cycle management of dental healthcare. Without a proper billing system, practices could find themselves disoriented. 

So, how can you make your claims billing easy?

Transparent Communication

Before any service is provided, every practice needs to ensure that information regarding services and payments is communicated to their patients. Transparency in communication is a crucial and one of the simplest and most effective ways to improve your claims billing process. Your patients need to be made aware of their responsibilities and data collection requirements, before availing the services. This ensures, firstly, that the patients are not subjected to any surprises about information or payments that they are responsible for. Secondly, it prevents the possibility of denials or part payments due to ignorance about the requirements within the claims process. Such information is especially required for services that are only partially covered or those that require copayments. Organizing your data and pieces of information that need to be given to your patient, will improve the chances of building a better bond with your patients, thus increasing the reliability of the practice.

Maintain and Update Patient Files

It is important that you keep your patient files updated at all times, as any inaccuracies in them can lead to wasted time and revenue losses. A change in insurance carriers, type of plan, demographics, services covered, copays and deductibles are all examples of the types of information that could change even mid-term. If such information is not updated on time, the revenue cycle gets disrupted. All such changes must be collected, verified thoroughly and updated regularly before the submission of claims. It follows that the first step to having a well-managed claims billing process is to have an up-to-date patient information file.

Maintain Sufficient Documentation

Documentation here refers to what is prepared for each service provided. Timely reimbursement depends hugely on proper and sufficient documentation. Each carrier would have different documentation requirements for claims. Some may even require additional documentation for specific procedures. Identifying what is required and ensuring that it is ready and accurate can drastically reduce the need to resubmit claims due to denials or part payments. 

Keep in touch with the patients as well as the insurance provider

Stay in touch with your patients as well as the insurance provider in case any additional information or updates on already existing ones is required. This ensures that you keep the channels of communication with your patients and insurance providers open, which, in turn, facilitates the chances of receiving important updates on all the necessary information needed for claims billing. 

Stay Up to date on Coding Regulations

A huge number of claim denials occur because of incorrect coding of the services rendered. This is a natural probability given the sheer volume of codes there are in the dental insurance field. Any change to the coding rules and regulations amplifies the problem. Staying up to date on coding changes, additions and/or deletions can save your practice the time and energy needed for reworking denied claims.

Tracking Frequencies, Exclusions, and Limitations

Usually, frequencies, exclusions, and limitations vary according to different insurance plans. The payment amounts available depends on these factors. There may be policies that even have age-group limitations for certain procedures. It is, therefore, 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.

Quality Control

Establishing quality control measures for claims submissions is a wise decision to make. It strengthens your claims billing process, wipes out any potential errors, and helps you cut out any unnecessary expenses. In addition to this, there is quite a bit of learning to be had in reviewing any past claims that were denied. This will help eliminate the same errors being made in future. 

Partnering with an RCM service provider

Claims billing is one of the most important and crucial steps in the RCM process and therefore requires a lot of attention and focus from the staff at your practice. It is only natural that not paying enough attention to it would cause negative impacts on your RCM. An RCM service provider mitigates the stress that is involved in running a practice. Your staff and you can focus entirely on patient care and treatment, while your RCM provider guides you through the complex revenue cycle processes. A competent RCM provider helps you create a well-planned and organized system to maintain a healthy revenue cycle. 

Create A Great Patient Retention Strategy

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A lot of practices spend an exorbitant amount of time marketing for new patients. This seems logical as the more patients you get, the more your revenue, right? Not really. Sure, it’s great to have a lot of new patients but what is happening to the ones you already have? Are you spending sufficient time and resources on making sure that these patients are opting for your practice for their dental needs?  

The truth is that your efforts to bring in new patients will only be effective if you can successfully retain your current patients, keep them satisfied, and even happy. In this time of perpetual competition, changing insurance plans, and the intrusion of social media, it has become increasingly challenging for many practices to retain their patients. Patient loyalty is an intangible asset that leads to patient retention, and it doesn’t happen overnight. It takes time to grow and needs to be nurtured. Attracting new patients is important for the growth of your practice. However, not being able to retain these patients means that you are not gaining the full value of all your marketing strategies. Basically, the higher the patient satisfaction, the higher the patient retention, and consequently, the greater your revenue. 

Here are some of the best strategies or tips to retain your patients:

1. Focus on the best quality treatment

When it comes down to it, the quality of your dental service is what can speak volumes for your practice. Patients visit your practice to get the best treatment, and if they don’t receive quality treatment, they are sure to look for other options. Your priority, therefore, should be on providing quality treatment. Ensuring that you stay on top of new treatments and innovations in dental care will have a great impact on your patients remaining loyal to you. 

2. Provide an exceptional patient experience

Providing quality dental care may be a no-brainer but going the extra mile and providing value additions will go a long way to making a remarkable impression on your patients. Your patients have several options to choose from and it is quite easy for them to move from one practice to another. Creating a personalized dental plan, attention to detail on your patient’s preferences, initiating loyalty programs and holiday discount offers, early-bird offers, can all be catalysts for your patients to stay loyal to you. 

The ambiance that your practice provides can also have an impact on your patients. Consider upgrading your waiting area to make the ambiance feel warm and welcoming as opposed to being clinical. Simple things like providing ample parking areas can also have a huge impact on patient experience. 

Friendly, polite, and professional staff adds value to your logistical efforts. Train your staff periodically so that they are up to date on dental care and maintain professionalism even in touchy situations. Being approachable and returning phone calls on time are also aspects that your staff need to be aware of to make a positive impression on your patients. 

Additionally, you could also explore the feasibility of being accessible after hours. 

3. Establish a channel of communication with your patients

Establishing a transparent and continuous channel of communication is a crucial first step in patient retention. From registration to follow-up visits, there is a lot of information that needs to flow – back and forth – with your patients. This can include everything from giving them an idea of what to expect when they visit, the procedures they are likely to need, the patient responsibility, and right up to routines they can establish at home for better dental health. Establish your communication channels at the outset of your relationship with your patient. There may be a lot of information that a patient needs to plan out their dental care. Become a source for health-related information and help them reduce their information tracking needs. Over time, this practice will aid in gaining credence for your practice. 

4. Automate appointments, billing, and payment

One marketing strategy that can be utilized to positively influence your patients and build retention levels is to have a professional website set up. Your website can be a one-stop destination for your patients to get updated information about your services and dental know-how, book appointments and pay bills. Having an online appointment system available will allow them the flexibility of booking appointments at their convenience. 

The same goes for your billing and payment systems. An automated billing system ensures that your staff does not spend the bulk of their time working on billing for each patient’s visit and procedures. Providing multiple options for patients to make payments makes the process go faster for your patients and you. 

A Mobile app which allows for all these processes makes things go even faster and reduces the need for backend management by your staff. 

5. Reduce overbooking and wait times

Overbooking may be an accepted practice in the hospitality industry, but it may not fly well with your patients. It leaves them frustrated as dental care is a necessity rather than a source of entertainment. Planning appointments carefully while keeping in mind the procedures that your patients may need will also reduce their wait times at your clinic. Waiting for extended periods of time for a service that they have booked for can be a legitimate reason for them to feel frustrated and will reduce their favor. By respecting their time, you are making them feel valued and cherished. 

6. Address concerns upfront

Have regular surveys done to give your patients an opportunity to be honest about your services and their experience at your practice. Something as simple as setting up an automatic survey can be just the right step to receive great input from your patients for improvements. This will give your patients an opportunity to raise any concerns they may have.

Of course, having surveys and feedback mechanisms in place would be pointless if you do not address concerns or implement feedback on time. Your patients should not feel that their voices are not being heard. Connect with them once the feedback has been implemented and let them know of the changes you have made to make them feel extra special.   

Keep a check on reviews that your patients leave on review sites and social media as well. Address any concerns that they may have and thank them for leaving their feedback on these sites. 

Remember, every interaction is an opportunity, especially considering patients are walking testimonials for your practice. Your existing patients become your source for new patients.

Organizing Your Claims Billing Process

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Claims billing is a multi-step process involving several people and types of data like patient-related information and clinical documentation. Not setting up a robust claim filing and billing system can possibly be the worst mistake that a practice can make in their revenue cycle. Understanding the fundamentals can help providers and practices ensure that the number of claims that go unpaid or denied remains as low as is possible. Understanding claims billing starts with learning about the various steps involved and improving the efficiency of each step.

Maintaining Thorough and Accurate Data

This is a continuous process which starts at the outset of a patient’s and provider’s relationship. All the relevant information collected before and during the cycle of services provided, needs to be entered into the billing system accurately. During this process, all the documents must be scrutinized and verified. These documents include:

  • Social Security numbers of patients
  • Tax Identification numbers of providers
  • Addresses of patients and providers
  • Details of procedures done
  • Any X-rays or charting that needs to be done
  • Pre-authorization documentation, when required

It is always better to provide more data than less when it comes to the services provided at a practice. 

Any errors found must immediately be rectified and any missing information should be collected and included. This helps in preparing more accurate claims, thereby reducing the risk of claim denials.

Applying accurate standardized codes

CDT codes are a collection of codes used to identify the various procedures and services provided for oral health and dentistry. There is a vast array of these codes which go through frequent additions, deletions, and modifications each year. Staying on top of these changes and ensuring that the right codes are used, is another vital step in the claims billing process. 

Looking for limitations, frequencies, and exclusions

The amount an insurance provider pays out depends on several factors, not least of which are limitations on the amount covered for certain procedures, the number of times some procedures are covered in a particular policy year and even the patient’s age. These limitations, frequencies and exclusions affect every claim, and this is the reason information on these is usually collected before a service is provided. Unrecognized exclusions or limitations in the insurance coverage could result in claim rejections and denials. 

Quality check

The final step, pre submission of bills, is always a review of the prepared claim. This is done as an attempt at ensuring that all possible mistakes are eliminated, reducing the chances for claim denials. Vital pieces of information that need to be reviewed are: 

  • Accuracy of procedural codes
  • Patient information and data
  • Insurance provider data
  • Provider data
  • Insurance limitations, frequencies, and exclusions

Evaluating and resolving denied claims

Submission of claims can be incorrectly considered as the last step in the claims billing process. However careful a practice is while preparing and submitting a claim, there is always the possibility of claims getting denied and procedures going unpaid due to human error. Reworking such claims is another step that gets added due to such denials and non-payments, and this rework needs to be done without any delays. 

Periodic review of previously denied claims is also a great way to learn from mistakes made in the past. Implementing the learnings from such reviews helps build a better claims billing system, which in turn reduces the chance of future denied claims and unpaid procedures.

Maintaining continuous communication with patients and the insurance provider

While continuous communication may not be an established custom in the billing process, it is an important phase for the revenue cycle management of a practice. It helps reduce the time and effort that is necessary to file claims. Staying in touch with your patients not only improves the reliability of your practice but also quickens and improves your revenue cycle. 

Having a well-managed and efficient claims billing system is the key to a successful revenue cycle management. It helps minimize the workload of your staff and helps to ensure that the focus is always on what is most important, excellent dental care and patient satisfaction. 

Analyze And Improve Your Cash Flow

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One of the initial steps you would use to determine your profit margin ratio is the analysis of cash flow at your practice. A better understanding of your practice’s financial health can be achieved through a thorough analysis. Cash flow is, simply put, the money that moves in and out of your practice through a given time period. A healthy cash flow should be considered a core part of your practice, without which it cannot function efficiently. Without a strong cash flow, every aspect of the practice, from patient treatment and care to practice management, can be affected adversely. One of the best ways to improve your cash flow is to streamline your payment processes.

A crucial first step would be to identify any challenges in your cash flow.

So, what are some of the common challenges affecting a practice’s cash flow?

Time and labor constraints

For a practice, handling its revenue cycle along with patient care and treatment can be a lot more stressful than one would think, especially with time constraints. With such an imposing workload, your staff may find it hard to focus on patient payment collection. Time constraints, along with the limited staff, can further slow down the payment collection process at your practice, thereby reducing the cash flow to a great extent.

High overhead costs

Dental practices typically have relatively significant overhead expenditures, including costs for treatment, equipment, and facilities. It takes a lot of money to keep your practice going and there will obviously be a high chance of increased overhead expenditures. Your overhead costs may be reasonable depending on the services you provide and the revenue you make. However, on the off chance that it does rise, a decreased cash flow would be imminent. 

Slow payments

Dental insurance plans typically have a time limit, and not sending out the claims on time can lead to delays in payments. If any of the steps in the revenue cycle slow down, it could completely slow down your payment collection process. The situation is made worse by the fact that insurance companies frequently alter their billing policies and codes, which makes billing itself more challenging. This further complicates and delays the payment process.

Claim denials and bad debts

Claim denials are one of the most frequent causes of a decline in cash flow at a practice. Submitting clean claims can be a real challenge for your staff, especially with the constantly changing dental insurance policies and rules. A simple error can lead to denials, which, if not handled properly, can turn into bad debts. These bad debts end up disrupting your practice’s cash flow. 

Like any other problem, cash flow issues can be addressed if they are identified early, and appropriate measures are promptly implemented.

Here are some ways in which you can improve cash flow at your practice:

Track and analyze your cash flow

The first step in improving your cash flow is understanding and breaking down what your current cash flow is like. The more information you have on your practice’s cash flow, the more prudent decisions you make. This helps you take preventive actions before any difficulties strike. Take your time to carefully examine the trends in your cash flow to see what is performing well and what needs to be improved.

Develop a checklist

Creating a checklist to make sure that the billing process is carried out accurately and within the given time frame can solve the payment delay to a certain extent. Having a checklist for billing processes can help staff members understand the billing process a little better and carry it out correctly. This can, to a greater extent, help your staff manage the billing process along with patient care and treatment.

Patient-friendly billing and collection

One of the responsibilities of your practice should be to make sure that patients have as great an experience as is possible with your services and at your practice. Remember that your patients’ primary focus would be on the service and not on the nuances of revenue cycle. They may not understand why making a payment can get complicated. You definitely do not want patients opting out of your services simply because your payment process is complicated for them. The simplest solution for this is to offer your patients a variety of payment options. Be sure to also inform your patients of their payment responsibilities in advance, so that they are not surprised at the time of payment and are not forced to spend out-of-pocket.

Follow up on payments

Ensure adequate follow-up is done in the case of pending payments. Among the gamut of responsibilities, they may have, making payments for one service may not be a priority for them. Keep a track of pending payments and make sure that you get paid for every service delivered. 

Payments from insurance companies is also another component of your cash flow. Perform quality-checks before you submit claims so that the probability of accepted claims rises. In the case of denials, follow-up and resubmission need to be done as soon as possible in order to avoid unpaid services. 

A single claim denial or late payment may not seem like a significant concern at first, but over time, these could accrue to cause serious cash flow problems and reduce your revenue significantly. Cash flow is what keeps your practice running, and not paying enough attention to it can be more disastrous than you think. If a healthy practice is your goal, now is the time to focus on enhancing your cash flow. 

Pump up your Eligibility and Verification Strategy

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With today’s constantly changing and evolving insurance rules and regulations, it is imperative to pay more attention to eligibility and benefits verification. Accurate insurance verification ensures a greater number of clean claims, which speeds up the clearance and shortens the billing cycle. Other complex processes involved in RCM can deflect the attention of the practice, leading to claim denials. You can collect information with greater accuracy if you have the eligibility and benefits verification process in order. This means that providers must understand the insurance verification procedure and its significance to the dental care sector. This could also mean that mistakes made in carrying out effective insurance verification or in submitting a claim for a procedure that the patient’s insurance carrier does not cover or that is performed by providers who work outside the employee’s health insurance provider network could result in the patient feeling financially vulnerable, anxious, and frustrated.

Practices may face a lot of snags while dealing with eligibility and benefits verification, which could lead to claim denials or rejections.

Some common mistakes include:

  • Typos or other miniscule errors in the information collected from patients
  • Insufficient or incomplete patient information
  • Expired coverage
  • Services that are not covered
  • Services that require prior authorization or referral
  • Out of network coverage
  • Inactive insurance policies
  • Neglecting to ask about a secondary policy

So, how can you improve your eligibility and verification process?

Perform an eligibility and benefit verification prior to the service

To receive maximum payments for the services rendered, practices need to verify the patient’s eligibility before every patient visit. It is, however, one of the most neglected or delayed steps, which often leads to claim denials. The time leverage aids you in identifying and filling in missing or insufficient information, if there are any. The eligibility and benefit verification processes include data management, analysis, and recording skills, which cannot be performed properly if carried out at the last possible moment. This means that on-time eligibility and benefit verification help you reduce claim rejections and denials to a great extent. 

Crosscheck or review the data collected

The patient information collected, including the dental care and insurance data, need to be reviewed carefully in order to identify any errors, missing information, or the validity of data collected. This information collected is the foundation of a dental claim. An error which could seem trifling can cause claim denials. Extra care must be taken while transcribing information into the patient records. Rushing through eligibility and benefit verification without reviewing it again may result in days or weeks of payment delays or a claim going unpaid entirely, both of which can be problematic for any practice.

Always have supporting documentation for the information collected

Have sufficient proof of the collected data for future reference and in case of emergencies. These could provide swift reference and could help to avoid any errors while putting in the data. This could make your eligibility and verification processes faster and easier and save on time.

Analyzing and calculating patient’s responsibility

Determine in advance what the patient may be required to spend out-of-pocket and how much the insurance company is likely to reimburse. Some plans might have restrictions on the cost of each visit or the frequency and duration of the services that must be provided. Check if any benefit limit has been stated, indicating the number of benefits available for the patient.  Patient responsibilities such as deductibles, copayments, and co-insurance must be communicated to patients in advance for greater transparency and trust.

Have an insurance verification checklist

Make sure that you ask pertinent questions for eligibility and benefits verification. There are chances that critical information may be left out. A well-organized checklist could serve greatly for this very purpose. It will help you to have an organized and accurate eligibility and benefit verification process and can reduce the chances of the practice missing out on important pieces of information or data. Some important information to be included in the checklist are:

  • Patient benefits
  • Co-pays
  • Deductibles
  • Status of patient policy
  • Policy effective and lapse dates
  • Type of plan and coverage details
  • Services under the exclusion list of policy
  • Claims mailing address
  • The possibility of referrals and pre-authorizations being required
  • Life-time maximum

Maintain regular contact with the patients as well as the insurance providers

Keep in regular contact with your patients as well as the insurance provider in case you need any additional information or clarity on any existing information. Do not hesitate to initiate the conversation, as this could greatly improve the efficiency and accuracy of your eligibility and verification process. This could also help in creating a bond with your patients, thereby earning their trust.

Identifying pre-authorization needs

Check for pre-authorization requirements before starting the treatment, as there are several insurance companies that require pre-authorization for certain procedures.  Checking for and receiving pre-authorization ahead of time in such cases can significantly speed up your payment process and reduce the number of denied claims.

Partner with a reliable RCM service provider

Handling eligibility and benefit verification and other important RCM processes along with patient experience and treatment can be an added workload for your practice. It could significantly eat into your business hours and could leave you and your staff exhausted. With an Dental RCM service provider by your side, your practice will be free of the complexities of the revenue cycle. This will provide you with the time to focus your attention on the more important tasks of the practice. Which, of course, could help improve the overall revenue cycle, efficiency, and growth of your practice.

Many practices and patients are unaware or confused about the eligibility and benefits verification process and often make mistakes. Following through on a proper and well-managed eligibility and benefits verification process can undeniably have a huge impact on your practice, improving its revenue cycle and revenue. It also leads to a better patient experience as well as improved patient satisfaction. Eligibility and verification is the first step to your revenue cycle and mistakes made at this stage could mean starting over on the entire process. To avoid any costly mistakes and to maintain the financial well-being of your practice, a healthy and smooth eligibility and benefits verification process is indispensable.

Determine Patient Responsibility & Collect Payments Faster

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Given the rise in high-deductible payment plans (HDHP) and patients choosing to shoulder more and more of the financial obligations for treatments and services received, determining patient responsibility has become priority for a practice. Instead of relying on insurance providers for payment, practices rely more on their patients to bolster their revenue cycle. They are forced to find ways to collect more of these patient responsibility balances in order to secure maximum revenue. This is not as easy as it would seem. Estimating and collecting patient responsibility involves keeping meticulous records and ensuring on-time follow-up. You do all this while establishing maximum patient satisfaction and them consistently choosing your practice over others and leaving positive reviews.

What is patient responsibility and payment collection?

The portion of a dental bill that the patient must pay out-of-pocket, not from their insurance company, is known as patient responsibility. It is the amount that the patients owe to their practice for dental services rendered. Deductibles and co-pays are perfect examples of this. Payment collection is simply the process of securing the payment.

How can you improve your patient responsibility payment collection?

Keep a payment plan ready

It is always better for practices to keep a payment plan ready. Having a proper payment plan can help you set up a process to follow while attempting to collect on patient responsibility balances. It also reduces the chance of patients defaulting due to them not being aware of their responsibility. Following an established plan will help the patient responsibility collection process go smoothly. Given the complexity and diversity of healthcare plans, it may seem difficult to create estimates for each patient, but it cannot be avoided.

Don’t tiptoe around payment conversations

A conversation about patient payment responsibility may be uncomfortable to have but tiptoeing around the issue is never a solution. Getting your revenue is ultimately what your aim is. Be clear and direct. Your patients may already be confused and stressed about a lot of things, and you don’t want to make it even more difficult for them. Make sure that you convey the details of their responsibilities in a simple and easy manner. 

Let the patient know in advance about their payment responsibility

Most practices fail to remind their patients of their payment responsibility prior to the services without realizing the impact it could have on their payment collection process. Avoid surprises by informing your patient about their treatment plan and financial commitment right at the beginning. Patients are more inclined to pay when they know in advance exactly how much they owe. Let them know about any deductibles, co-pays, and also give them an approximate estimation of the co-insurance amount. Conveying the probability of there being unexpected changes in the procedures or services is also something you should ideally do, as these changes could also result in changes in the patient’s payment responsibility.

Patients need to be prepared for the expenses that they will incur, for a quicker payment process. You also need to convey the potential for unexpected changes in payment amounts as changes in procedures can cause the final amount to differ. Remember, collecting from a patient requires a lot more effort than collecting from an insurance provider. This effort would magnify in cases where the patients are not aware of their payment responsibility prior to the visits, which is most of the time.

Provide multiple payment options

Having multiple payment options can benefit your practice in a lot of ways. It shows the patients that you are considering their convenience as opposed to simply ensuring that you receive your revenue. Even if your patients don’t have enough money on hand, they can easily opt for any other modes of payment such as debit or credit cards, checks, charge cards and mobile payment apps. This makes the payment process much easier for them and collection smoother for you. 

Collect payments before the patient leaves the practice

Collecting payments at the time of the service is a good rule to follow. It’s always a good idea to get the payment from the patient before they leave the practice. Never leave any of the patient responsibility balances for future, especially if the patients owe more than the insurance provider. This increases the risk of payments going unpaid. In a lot of cases, late attempts to collect the payment can be exceedingly time-consuming and challenging. 

Stay in touch with your patients

Remember to continuously stay in touch with your patients. This not only helps in building a bond with them but also helps in quicker patient payments. After initially informing the patient about their responsibility, make sure that you send reminders so that they don’t miss their payment due dates. Remember that your patients are also busy and paying for one specific service may not always be a priority for them. A reminder may be just what they need. This can help your practice maintain a faster and more efficient payment cycle.

Partner with an RCM Service provider

Focusing on the actual practice may become onerous if you are constantly worrying about patient responsibility. With an RCM service provider by your side, you will not have to worry about any of these as they help you manage all your RCM-related worries, including patient payment collection. Your RCM service provider works closely with your patients and makes sure that the full patient payments are collected on time allowing you to concentrate on the actual dental service.

Client Success Reports: What It Means and Why It Matters

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For a practice, managing the intricacies of the revenue cycle along with other important needs of the practice can be a strenuous and demanding task. This is especially so with limited staff as it puts an extra burden on their shoulders. When a practice partners with an RCM service provider, they are trusting their entire RCM to the provider. It thus becomes the responsibility of the service provider to make sure that the revenue cycle of the practice is handled in a smooth and efficient way without any errors. An RCM provider may be proficient in narrowing down what changes need to be made to have your practice run efficiently. This is how our detailed client success report helps achieve a deeper understanding of the weaknesses in your practice. It can be a guide to the steps you need to take to improve your revenue cycle.

So, What exactly is a “Client Success Report”?

A skilled RCM service provider would compile a detailed analysis of your payment posting, eligibility and benefits verification, and accounts receivable. Partnering with the right RCM service provider gives you access to success metrics and analytics that help your practice grow, in size and scale. Of course, the service provider needs to collect all data regarding the revenue cycle and share it with the practice on time for any improvement to be expedited. A client success report, once prepared, allows you to analyze the patterns in the functioning of your practice. The report then enables you to identify what needs to be done to improve the growth of your practice, most notably its revenue. 

The phases involved in the client success process are:

1. Data Consolidation

Each month, data from the practice’s activities, such as monthly production, payments, adjustments, and accounts receivables, is collected and collated by the RCM service provider.

2. Data Analysis

The data that is consolidated is later thoroughly analyzed. The observations from the analysis highlight opportunities for your practice to improve its work while also increasing its cash flow. 

3. Recommendation

After carefully analyzing the consolidated data, specific challenges in the practice are identified, and a meticulous set of recommendations are created and sent to your practice to increase its cash flow and efficiency. 

Why Does a Client Success Report matter?

  • Provides minute insights into your practice

There are times when providing equal attention to all the aspects of the workings of a practice becomes tedious. This may lead to misses and may hinder the operation of your practice. However, with an RCM service provider giving you on-time client success reports, you get insights into your practice, aiding you in taking steps to prevent errors from occurring or reoccurring. 

  • Identify the source/s of cash leakage

Most practices struggle with revenue leakage and not being able to identify the source of the leakage. Getting an on-time client success report helps your practice identify the source/s of revenue leakage so that you can streamline your entire revenue cycle. This can be an added advantage to scaling your practice higher. 

  • Highlighting Action Items 

Having an on-time client success report also helps you identify the areas in the revenue cycle that need special attention. There may be areas in your revenue cycle that require immediate attention and are critical. A client success report helps you identify just that. As a result, the operational aspects of your practice become effortless. 

  • Strategize RCM improvement

A client success report not only assists your practice in identifying areas of improvement but also provides suggestions or ideas to improve your overall management. Since an RCM service provider is the one handling your RCM, they know exactly how to improve the performance of your practice. Their suggestions or ideas can help you create a strategy for improvement and expansion.

  • Increasing revenue

By helping you identify the areas of improvement and providing you with suggestions to improve your RCM, a client success report specifically helps you multiply the revenue from your practice. 
Being able to provide the best care and treatment to your patients doesn’t always guarantee a successful practice. Success depends on a lot of other aspects, not least of which is your dental revenue cycle management. It’s crucial to comprehend your facts and have a solid action plan. This is where a robust customer success report can play a pivotal role.