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Want a Denial Free Claim Submission?

by [email protected]

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?

Talk to Our RCM Expert

Improve Patient Experience At Your Practice

by [email protected]venue.com

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

by [email protected]

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

by [email protected]

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

by [email protected]

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.

Is staff replacement really a problem in RCM?

by [email protected]

“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)

by [email protected]

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.

Appealing Claim Denials

by [email protected]

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

by [email protected]

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.

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.

Payment Posting Doesn’t Have To Be Hard

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Have you ever felt payment posting to be a weight on your practice’s revenue cycle management process? If you have, then you are not alone. Almost all practices struggle with it and find it hard to balance their time and effort between payment posting and other processes in RCM while managing the important needs of the practice. But payment posting is not something that can be negotiated or ignored as it is one of the crucial elements for the smooth flow of your revenue cycle. It provides a brief overview of your practice’s financial health. With proper management, your payment posting process can be made easier and smoother.

So, what exactly is payment posting?

It is the process wherein the payment details are logged into the patient system to give the practice a broad perspective of all the payment information and explains how different payers’ collections work. It helps in gaining a better understanding of your practice’s day-to-day financial status and aids in enhancing your cash flow.

The payment posting cycle starts just after the submission of claims to the insurance providers. The practice then waits for the decision of the insurance providers. They may pay for claims or reject them. In either case, the practice receives an E.O.B (explanation of benefits) from the payer. If the claim has been accepted, the payer sends the payment amount via check or EFT along with the E.O.B. The process ends when the payment or denial details are settled under the patient’s account. Remember, understanding the financial picture of your practice can help you identify income leakage and take fast action to fix it.

Payment posting processes

Patient payments

All patient payments, including co-pays, deductibles, and payments from those without insurance, need to be documented for proper payment posting. Payments are deposited in the bank and reconciled with the practice’s general ledger to ensure that they match what was recorded in the practice’s management system.

Patient payment responsibilities

Important patient responsibilities, such as co-pays, non-covered services, and so on, must be identified and communicated to the patient right at the beginning. This helps in making the payments flow faster and in avoiding any misunderstanding related to financial obligations.

Balancing write-offs

The specific levels for write-offs and modifications for each client should be indicated in the process of payment posting in detail. Any requests for deviations must be acknowledged without delay, and the necessary steps need to be taken to prevent revenue loss.

Denial posting

Claim denial information must be posted into the patient’s practice management system based on which the write-off decisions can be made. Also, based on this information, necessary actions such as billing the secondary payer, transferring the balance to the patient account, making adjustments/write-offs as per defined policies, and routing the denied claims to appropriate work queues can be taken.

Payment Posting: Do You Really Need It? 

by [email protected]

Payment posting is one of the significant yet confusing and exhausting processes in the RCM cycle. It is the process of entering payment details into the patient system, thereby helping in viewing different patient payments as well as the practice’s overall financial picture. This provides the practice with a chance to identify the issues or errors within the payment cycle and fix them as soon as possible. Any errors or mistakes in payment posting can cause a huge mishap and can disturb the entire revenue cycle process, even leading to denial of claims. In such cases, both the time and effort of your staff are wasted as they must take extra efforts to rectify errors in denied or delayed payments. Clearly, payment posting is not something to be ignored or negotiated on, as it is one of the crucial steps in the RCM process which can help in making your payment cycle easier and more efficient.

But what exactly is the role of payment posting in RCM?

Resolves RCM glitches

If done properly, payment posting could be your ideal opportunity to improve and better your revenue cycle. When a payment is posted in a patient’s system, it gives the practice a chance to analyze the revenue cycle, identifying the different errors and mistakes in it and coming up with ideas for improvement. Additionally, it offers an overview of the finances, including patient payments, that aids in identifying revenue leakage for an easier and smoother payment process. Your RCM may have various problems which may be resolved through a well-managed payment posting system, thus preventing the claims from getting denied.

Handles denials

Most claim denials happen because of errors in the claims that are submitted. It is always better to have a system to track claims for a quicker and more effective correction of errors. Payment posting provides just that; it helps you keep track of each claim till it gets paid, as unresolved denials can lead to huge revenue loss. With payment posting, you have all the relevant information with you, making it easier to take the next step in case there is a claim denial, such as making a correction on a claim, asking the patient for further details about their insurance policy, or contacting the insurance providers for further clarification. This makes the resubmission of denied claims much quicker and easier.

Strengthens the RCM

By identifying and helping solve the various issues related to RCM, payment posting can greatly improve the growth of your RCM. With well-managed payment posting, you can identify weak points in your revenue cycle and find ways to strengthen them, increasing revenue at your practice. The payment posting process makes sure that the RCM-related issues are dealt with quickly and that the overall revenue of the practice is unaffected.

Solving recurring issues

Payment posting can help you identify the recurring common issues in managing the payment cycle. Since it helps you to keep tabs on the various information related to the payment process, it will be easier for your practice to notice continually recurring errors or mistakes. And in turn, coming up with solutions to fix the same, thereby improving the revenue cycle.

Managing write-offs and adjustments

Payment posting helps you process write-offs and adjustments in patient payment as well as in reporting if any odd contractual adjustments are found. And if any such odd adjustments are found, your practice will have the opportunity to take steps to prevent the same from happening again, creating a reliable and secure payment cycle. This makes your payment cycle much smoother and less complex.

Getting patient payments faster

Payment posting allows you to provide inputs on non-covered services and co-payment collection issues so that patients are aware of their payment options and are not caught off guard by unexpected out-of-pocket payments. Locating any such balances and transferring them to patients’ accounts early on helps ensure a quicker patient payment without any complexities or confusion.

Increasing profit and reducing claim reimbursement time

A well-managed payment posting system can help your practice find opportunities to boost your revenue by observing the daily trends within your dental care practice. Beyond that, payment posting can act as a perfect opportunity to relax the whole payment cycle and speed up your claim reimbursement time. Focusing on payment posting helps identify problems within the outset of the claim process itself, thus speeding up the entire payment process. The use of up-to-date data through payment posting shortens the time needed to process insurance claims, thus securing timely claim payments. This can also help in rectifying any issues in your RCM before they become critical and disturb your entire payment cycle, thus leading to an improvement in financial performance as well as faster claim reimbursement.

No More Mistakes With Claims Billing

by carerevenue

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

So, what exactly is claims billing?

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

Common difficulties in dental billing

Missing tooth clause

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

Contractual limitations

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

Incorrect CDT coding

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

Age of patients

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

Unreadable documentation

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

Insufficient information

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

How can you improve your billing process?

Regular update on coding changes

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

Tracking Frequencies, Exclusions, and Limitations

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

Collecting detailed information

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

Dental Care provider’s information

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

Specific documentation for particular claims

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

Deadlines are critical

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

Regular auditing

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

Partnering with an RCM service provider

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

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

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

by carerevenue

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

So, What is Revenue Cycle Management or RCM?

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

Here are some of the common mistakes in RCM

1. Inaccurate and Incomplete Data Collection

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

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

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

3. Late Submission of Claims

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

4. Inefficient denial management

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

5. Bad patient eligibility and benefits verification

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

6. Slow Accounts Receivable Follow-Up

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

Here are some solutions to these common mistakes 

1. Tracking of claims

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

2. Proper patient registration

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

3. Proper communication with patients and insurance providers

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

4. Make the process patient-friendly

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

5. Opting for an RCM service provider

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

Conclusion

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

Delegate your Dental Revenue Cycle Management Services

by carerevenue

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

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

Reasons for outsourcing RCM services

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

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

Services provided by outsourcing RCM

  • Patient Enrollment and Schedule Management

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

  • Eligibility checks

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

  • Claim submissions

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

  • Error-free coding

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

  • Payment Posting

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

  • Denial Management

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

Benefits of Outsourcing RCM Services

  • Increased Cash Flow

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

  • Increased focus on patient care

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

  • Time saving

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

  • Reduced Denial of Claims

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

  • Reduced Number of staff

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

  • Staying up-to-date with changing Insurance processes

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

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