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

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

KPIs are facts, numbers, and metrics that provide insight into the efficiency of the dental revenue cycle management. 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 revenue cycle management 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 paid 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 dental revenue cycle management 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 thus indicating the presence of a healthy dental revenue cycle management system in place. The net collection rate could reveal a great deal about your practice’s collection tactics and how you can modify them. A consistently 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 failures to collect instances need to be written off as bad debt. A high percentage of bad debt adversely affects the dental revenue cycle management of 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 cash flow as well as the effectiveness of the dental revenue cycle management system at your practice. 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 benefits verifications and coding processes. 

There are several other KPIs that you can use to measure the effectiveness of your RCM dental revenue cycle management, 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.

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 benefit 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 minuscule 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 needs 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 is 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 the data collected. This information collected is the foundation of a dental claim and helps with proper eligibility verification. An error that could seem trifling can cause claim denials. Extra care must be taken while transcribing information into the patient records. Rushing through 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. Benefit verifications checks need to be performed to examine 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 benefit verification process. This could also help in creating a bond with your patients, thereby earning their trust.

Identifying pre-authorization needs

Checking for pre-authorization requirements before starting the treatment is an important part of eligibility and benefit verification, 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 a dental revenue cycle management 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.

Improve Patient Experience At Your Practice

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Patients are the main strength of a practice, and it is they who decide the success of your practice. Therefore, the patient experience at your practice matters more than anything, and it is your responsibility to make them feel comfortable and welcome in the dental services that you provide. Different patients have different expectations when visiting your practice; some may be scared of the treatment while others may have unrealistic expectations. To ensure a positive patient experience, you must provide them with the best possible treatment and dental care. This means doing your best to create a professional, but warm and friendly environment that gives due importance to patient satisfaction. 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 dental 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 impact on the overall patient experience. 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 to receive the dental services, 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 dental 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 dental 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. The key is to create an efficient patient communication channel to help you avoid these situations.

5. Improve your practice’s billing process

Even if your practice is successful in providing excellent treatment and dental 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 dental 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 that improved patient satisfaction is valuable in creating a better patient-provider relationship.

Want a Denial Free Claim Submission?

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Claim denial translates itself into a huge amount in lost revenue for a practice. This results in a serious disruption to a practice’s revenue cycle. It can be a major headache for practices, affecting both cash flow and efficiency. It not only affects the cash flow at your practice, but it can also damage / breach the relationship you have with your patients. Even though some claim 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 claim 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 claim denials. 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 claim 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. Claim 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 claim denials 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

A Healthy Denial Management System Within RCM

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

What is denial management?

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

What are the steps involved in denial management?

Identifying the root cause of denials

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

Monitoring and tracking the denials

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

Managing denials

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

Data Analysis In Revenue Cycle Management

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

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

Data can be analyzed in three ways:

Descriptive

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

Diagnostic 

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

Predictive

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

Prescriptive

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

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

Some of the main benefits include:

Reducing minor errors

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

Understanding your RCM better

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

Determining key performance indicators

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

Improving patient experience

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

Reducing denials

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

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

Appealing Claim Denials

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

Procedures deemed medically unnecessary

Some procedures may be considered medically unnecessary by the insurance company you are submitting the claims to.  This is yet another reason for claim denials. 

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, leading to claim denials. 

Exclusions in insurance plans

Some insurance plans may exclude certain procedures, leading to claim denial if the filed claim includes those 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, leading to claim denials, 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 denied 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 claim denials. 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 and reduce chances of claim denials.

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. Having an efficient denial management system in place can help you achieve that.

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. 

Make Your Claims Billing Easy

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

So, how can you make your claims billing easy?

Transparent Communication

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

Maintain and Update Patient Files

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

Maintain Sufficient Documentation

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

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

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

Stay Up to date on Coding Regulations

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

Tracking Frequencies, Exclusions, and Limitations

Usually, frequencies, exclusions, and limitations vary according to different insurance plans. The payment amounts available depends on these factors. There may be policies that even have age-group limitations for certain procedures. It is, therefore, crucial to obtain a copy of the patient’s information as well as an insurance certificate that details exclusions, age limitations, and plan benefits before the claims billing process.

Quality Control

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

Partnering with an RCM service provider

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

Create A Great Patient Retention Strategy

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

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. Time and patience is crucial to creating an effective patient retention strategy. 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. Therefore, if patient retention is your priority, you 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 helping increase patient retention rates at your practice. 

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. These are effective patient retention techniques that improve the overall outcome of your dental practice over time.

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, alongside an excellent patient renetion strategy in place will aid in gaining credence for your dental practice. 

4. Automate appointments, billing, and payment

One marketing strategy that can be utilized to positively influence your patients and build patient 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. This can negatively impact your efforts for patient retention at your dental practice. Planning appointments carefully while keeping in mind the procedures that your patients may need will also reduce their wait times at your clinic. This is a great way to elevate the patient experience at your practice. 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 and ultimately help in effective patient retention. 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 that 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 dental 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 which, in turn, helps improve cash flow in your practice. Cash flow is, 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 cash flow in your practice is to by streamlining 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, which may stunt your efforts to improve cash flow at your practice. 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 and may even be helping improve cash flow at your practice, 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. This could entirely rupture any measures taken to improve cash flow at the dental practices. The situation is further 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 hindrances in the efforts to improve in cash flow at a dental practice. While submitting clean claims may be paramount to improve cash flow at a dental practice. 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

To improve your cash flow, it is crucial to have a deep is understanding of 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 efficiently manage the billing process along with patient care and treatment, which in turn will positively impact your efforts to improve cash flow at your practice.

Patient-friendly billing and collection

Smooth billing and collection process directly impacts your RCM and improves cash flow at your practice. 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 dental revenue cycle management that could help improve cash flow at your practice. 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 finding ways to improve cash flow at your practice. 

 

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 collections, 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 patient payment.

How can you improve your patient responsibility payment collection?

Keep a payment plan ready

It is always better for practices to keep a the payment plan ready for their patients. Having a proper payment plan can help you set up an efficient payment 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 payment responsibility of the patient.

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 patient 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 a dental 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.

What is the Accounts Receivable Process?

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Effective accounts receivable management is a very essential step in RCM. An accounts receivable is the payment that is to be collected from the patients or the insurance providers. It determines the revenue of your practice to a huge extent. The better you manage your accounts receivable process, the greater the revenue of your practice will be. For a practice, it is very important that the payments are collected on time without a lot of delay, for its healthy functioning. Remember, the longer the days in AR, the higher the chances of payments going unpaid. As a result, effective AR process is what is required to prevent any unnecessary leakage in revenue and to collect the maximum reimbursement. However, managing account receivable for dental practice is not as simple as it appears, rather, it is a difficult and exhausting task, and the practice and its staff frequently struggle with its management. Knowing and understanding the accounts receivable and the various processes involved in it can really help in improving your revenue cycle and increasing the revenue of your practice, making your accounts receivable management smoother and faster.

So, here are some of the processes involved in accounts receivable

Follow-up with insurance companies

Connect with the insurance provider for any details or additional information on insurance payment and regulation. This helps you stay up to date with the changing insurance policies and regulations so that you can submit your claims as per these updated rules and regulations and thereby avoid the denial of claims. Don’t hesitate to maintain continuous contact with the insurance provider as it could make your claim submission and accounts receivable process easier and more effective.

Establishing credit terms and policies

Boundaries should be set, and policies must be put in place before providing any service to avoid any loss in revenue and protect the practice from any possible risks. Failure to establish such policies or raise patient awareness can result in payment collection delays or nonpayment. This can ultimately hurt your practice’s relationship with its patients. Make sure you communicate clearly with your patients about the payment process and other requirements so that they are not put in situations that make them feel uncomfortable or uneasy.

Collecting accurate information
Collect accurate information from your patients. Inaccuracies in patient information can lead to the denial of claims. It is also important to stay up to date with this information, and know when changes happen. Various patient information and data, including personal as well as insurance data, needs to be collected before providing any services.

Sending invoices

The accounts receivable process cannot proceed without a proper invoice stage. Therefore, it is crucial to establish an organized process for producing and sending invoices. Patients often anticipate receiving notification of the amount they are meant to pay. It is important to the accounts receivable process as it provides your patients with clarity on transactional information. But always ensure that you send the invoices as soon as possible, because the longer it takes to send the invoice, the longer it takes for patients to make the payment. 

Tracking claims
Tracking claims is another important step in maintaining a healthy account receivable for dental practices and, thereby, a successful revenue cycle. Make sure that you keep proper track of your claims even after the submission. This helps in identifying claim denials on time and also helps identify the different reasons for claim denials. This can help the practice take steps to prevent such denials from occurring again. Tracking claims could be your perfect solution for reducing claim denials, thereby increasing the revenue of your practice.

Recording AR activity

Recording all the payments received is another important step in managing streamlining accounts receivable process. Remember to record every incoming payment so that the claims that go unpaid and the ones that take too long to get paid can be identified. This helps the practice to take steps to prevent the same from happening again and helps the practice identify patients who are at constant risk of never making their payment. Therefore, proper documentation of payment is necessary for the growth of practice.

Establishing payment terms and due dates

It is important to establish proper due dates and payment terms for your patients as there are high chances that they may forget about the payment or may not realize the seriousness of delaying payment. Establishing such due dates reminds them of their obligations and also helps in reducing delayed payments, thus ensuring maximum payment collection. To avoid misunderstandings, the practice should clearly define their payment terms, due dates etc., to their patients from the beginning.

Identifying and managing denials

Most of the revenue of a practice is lost in claim denials. Therefore, it becomes highly important for a practice to identify and avoid denials of claims. Even if a claim denial occurs, make sure that you rework and resubmit the claims as soon as possible to avoid further loss in revenue. Managing claim denials can be a demanding and exhausting task, but it is equally an important one that cannot be kept aside. Identifying and managing claim denials helps effectively collecting payments.

Final payment collection

This is the last step in the accounts receivable process as well as revenue management cycle. It is the process in which all the due payments are collected from the patients or the insurance providers. Offering your patients a simple and straightforward payment option This helps in increasing patient comfort and experience, thereby gaining their trust. Formulate the payment process as easily as possible for your patients to make the whole payment cycle a lot faster and smoother.

Why partner with an RCM service provider?

Managing the various steps involved in accounts receivable process along with the other processes involved in RCM can be a very stressful and hectic task, disturbing the entire working of your practice. Partnering with an experienced dental revenue cycle management service provider could be your perfect solution. As they help you with managing your RCM, including accounts receivable, with the help of their expert professionals, you can provide your undivided attention to other important aspects of your practice, like patient care and treatment. They help in handling all your complex RCM related worries and create a peaceful environment in your practice while lowering your lost revenue to a great extent and taking your practice on the path to success.

Payment Posting Doesn’t Have To Be Hard

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Almost all practices struggle with it payment posting 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 a process in dental revenue cycle management 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 of payment posting 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? 

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Payment posting is one of the significant yet confusing 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 in payment posting can cause a huge mishap that can disturb the entire revenue cycle process, 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 the 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

When a payment is posted in a patient’s system, it gives the practice a chance to analyze the revenue cycle, identifying the various errors 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. The various problems in your revenue cycle management can be resolved through a well-managed payment posting system, thus preventing the claims from getting denied.

Handles denials

Most claim denials occur because of errors in the submitted claims. 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 dental revenue cycle management. 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 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. 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 payments 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 its revenue by observing the daily trends within your dental practice. Beyond that, payment posting can act as a perfect opportunity to make the whole payment cycle efficient by speeding 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 dental revenue cycle management before they become critical and disturb your entire payment cycle, thus leading to an improvement in financial performance as well as faster claim reimbursement.

Why Should You Pay Attention To Your Accounts Receivable Days

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

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

  • To receive maximum reimbursement from insurance companies.

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

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

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

  • Proper AR management helps in tracking denied claims.

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

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

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

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

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

  • Helps in faster claims submissions.

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

  • Helps ensure the smooth functioning of the practice.

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

  • Helps improve the patient experience.

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

Accounts Receivable Management

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

Why consider an RCM service provider

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

Pay Attention To Your Dental Claim Billing Attachments

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One of the most frequent reasons for a dental claims billing denial is due to the lack of proper documentation or supporting documents and records. The more the number of missing supporting documents and records in your claims submission, the greater the chances of a denial. Additional documents, records and authorizations are necessary to “prove” that the patient’s treatments were indeed necessary. When a patient leaves your practice, they trust you to handle all their billing-related needs, including the necessary attachments of the various supporting documents. Even with many years of experience filing insurance claims for services and treatments rendered, practices may still overlook a required document or record. Having a final mental checklist can alleviate this risk.

Different types of Dental Claim Billing Attachments:

Narrative


This refers to the provider’s expert findings about the patient’s condition and the written documentation outlining the clinical need for the treatment that is to be provided.

Preoperative radiograph (x-ray)


This reference is made to the x-ray of the tooth or teeth or the area of treatment taken before the procedure. It illustrates the state of the treatment area, such as recurring decay, significant fractures, impacted teeth, missing teeth, and poor restoration.

Postoperative radiograph


The x-ray of the tooth or teeth or the area of treatment taken after the procedure is completed is known as postoperative radiograph. This offers clinical proof that the procedure was successfully completed and that it was an absolute requirement.

Intra-oral photo/caption (IOP/IOC)


Intra-Oral Photos (IOP) or Intra-Oral Captions (IOC) are the high-resolution pictures of the tooth or teeth which are being treated, taken with a small, handheld, pen-shaped camera placed into the mouth. This is essential for identifying details that cannot be seen on a radiograph, such as minor fractures in the teeth, the degree of decay, etc.

Additional supporting documents

Additional supporting data includes periodontal charting, referral reports, EOBs, etc.

Some reasons why the required supporting documents are not attached when submitting a claim are:

Forgetfulness


Caught up in the general melee of office work on a busy day, be it patient care or treatment, the dental staff just might forget to attach a critical supporting document when submitting a claim. Unfortunately, this oversight can result in a denial from the insurance.

Uninformed of the significance


Many practices are still unaware of the significance of attaching x-rays and other documents to demonstrate the necessity for dental claims billing services rendered. On the other hand, an x-ray may not always reveal what the human eye can see, which can lead to practices thinking it is not important to the same.

Proper documentation reduces denials and has many other advantages:

Speeds up and simplifies dental claim processing

With accurate and complete attachments, practices do not have to fear possible denials. It helps speed up the entire claims billing process. With all the necessary documents right from every document pertaining to the patient’s details to all the treatments and services rendered, at hand, the task for filing and submitting a claim would be simplified and the claims processing time would be considerably reduced.

Reduces follow-up time with patients

With the necessary data already in hand, practices can avoid or reduce the needless time that goes into patient follow-up. Also, correctly filed claims reduce backlogs at the providers’ offices and spares the insurance provider from having to deal with additional inquiries.

Increased clean claim rate

Lack of proper attachments is one of the common reasons for dental claim denials, and with that being managed and controlled, the number of claim denials can be reduced, in turn increasing the clean claim rate.

Get paid faster

With the increased claim acceptance rate and claims getting first off, claim billing becomes easier and faster, leading to claims getting paid faster. The time and effort spent in reworking and resubmitting the denied claims can thus, be reduced to a certain extent.

Failure to attach supporting documents can lead to:

  • Delayed payment by payer and a higher denial rate. 
  • Decrease in productivity and increase in labor costs as personnel will need to resubmit claims again.
  • Patients lose trust in your practice; they may feel they are being wrongly billed.

 Although many of the dental policies do not require attachments for preventative and diagnostic services such as examinations, cleanings, radiographs (x-rays), and fluoride treatments, many of the routine  procedures like anterior composite, root canals, extractions, and periodontal procedures may call for attachments. Since the insurance companies need supporting proofs to make sure the procedures and treatments rendered are successfully completed, and that they were medically necessary and not purely cosmetic in nature, all supporting documents and records pertaining to the procedure or treatment must be attached to any claims filed by a practice.

How to Successfully Bill Medical Insurance for Dental Treatment

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Medical insurance coverage for dental treatments can be a game-changer for patients, providing them with financial relief and improved access to comprehensive oral healthcare. However, navigating the complexities of billing medical insurance for dental services can be challenging for dental practitioners.         This blog aims to guide dental professionals on the best practices to successfully bill medical insurance for dental treatments, ensuring patients receive the benefits they deserve while maintaining a seamless reimbursement process.

1. Understanding Medical vs. Dental Insurance

Before delving into the billing process, it’s essential to understand the fundamental differences between medical and dental insurance. Dental insurance typically covers routine dental care, such as cleanings, fillings, and basic treatments. On the other hand, medical insurance primarily focuses on diagnosing, treating, and preventing medical conditions. However, there are instances where medical insurance may cover certain dental treatments that are medically necessary.

2. Identifying Medically Necessary Dental Procedures

One of the crucial steps in successfully billing medical insurance for dental treatment is determining whether a procedure qualifies as medically necessary. Medically necessary dental treatments are those that address a medical condition, such as facial trauma, oral infections, sleep apnea, and congenital anomalies affecting oral health. In contrast, dental insurance covers procedures that are considered routine or cosmetic, like teeth whitening or orthodontic treatments.

3. Collaboration with Medical Professionals

For successful medical insurance billing, it is essential to collaborate with medical professionals. Dental practitioners should communicate effectively with physicians and specialists to establish the medical necessity of certain dental treatments. This collaboration will enable both parties to provide necessary documentation and substantiate the medical requirement for specific dental procedures, increasing the chances of insurance approval.

4. Accurate and Detailed Documentation

Proper documentation is the backbone of a successful insurance billing process. Dental practitioners must maintain detailed records of patient evaluations, treatment plans, and procedures performed. Including all relevant medical history, X-rays, and other diagnostic reports will strengthen the case for medical necessity. Additionally, using standardized dental codes, such as Current Dental Terminology (CDT) codes, can help facilitate communication with medical insurance companies.

5. Verification of Medical Insurance Coverage

Before initiating any medically necessary dental treatment, it is crucial to verify the patient’s medical insurance coverage. Dental practitioners should thoroughly review the patient’s insurance policy, including the terms and conditions, limitations, and exclusions. Some medical insurance plans may have specific restrictions on dental coverage, making it imperative to be well-informed to avoid potential claim denials.

6. Prior Authorization Process

Many medical insurance plans require prior authorization for certain dental procedures. Dental practitioners should initiate the prior authorization process by submitting the necessary documentation, which typically includes treatment plans, clinical records, and any relevant medical history. Early initiation of this process can prevent delays in treatment and ensure timely insurance approval.

7. Coding and Billing Procedures

Accurate coding is essential to ensure that dental claims are processed smoothly. While dental procedures typically use CDT codes, medical insurance companies require Current Procedural Terminology (CPT) codes. Dental practitioners must understand how to convert CDT codes to appropriate CPT codes to align with medical insurance requirements.

Moreover, when submitting claims, dental practitioners should clearly indicate the medical necessity of the procedure in the claim form. Providing a comprehensive cover letter that outlines the patient’s medical condition, the treatment’s significance, and how it will impact the patient’s overall health can significantly improve the chances of claim approval.

8. Submitting Claims and Following Up

Once all necessary documentation is in order, dental practitioners can submit the medical insurance claims for dental treatment. Prompt submission is crucial to ensure timely reimbursement. After submitting the claim, it is essential to follow up with the insurance company regularly to check the status of the claim and address any potential issues promptly.

9. Appealing Denied Claims

Despite meticulous preparation, some claims may still get denied initially. In such cases, dental practitioners should be prepared to appeal the decision. Reviewing the reasons for denial, addressing any gaps in documentation, and providing additional supporting evidence can strengthen the appeal. It may be necessary to consult with medical professionals, insurance experts, or specialized dental billing companies to navigate the appeal process effectively.

10. Patient Communication

Throughout the billing process, clear and transparent communication with patients is essential. Patients should be informed about the procedures’ medical necessity, the potential coverage they can expect from their medical insurance, and any out-of-pocket expenses they may incur. Providing patients with estimated costs, pre-authorization information, and guidance on filing claims can help manage expectations and prevent surprises.

Conclusion

Billing medical insurance for dental treatment can be complex but highly rewarding for both dental practitioners and patients. By understanding the distinctions between medical and dental insurance, collaborating with medical professionals, maintaining accurate documentation, and following the correct coding and billing procedures, dental practitioners can increase the likelihood of successful reimbursement. Effective communication with patients throughout the process is crucial for managing expectations and ensuring a smooth experience. By mastering these best practices, dental professionals can optimize patient care while navigating the complexities of medical insurance billing for dental treatments.

Medical Billing for Dental Practices: 5 Common Errors to Avoid

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Medical billing plays a crucial role in the financial success of any dental practice. Properly navigating the complex world of medical billing for dental procedures can significantly impact a practice’s revenue and overall profitability. However, it’s not uncommon for general dentists to encounter various challenges and errors during the billing process. 

In this blog, we will explore five common errors to avoid when it comes to medical billing for dental procedures which is crucial for your revenue cycle management.

1. Inaccurate Coding

Accurate coding is vital for successful dental medical billing. One of the most common errors dentists make is using incorrect codes for dental procedures. Since dental procedures often fall under medical insurance coverage, it is essential to use appropriate Current Procedural Terminology (CPT) codes recognized by medical insurance companies. Failure to do so can result in claim denials, delays, or even loss of revenue. It’s crucial to stay updated with the latest coding guidelines and ensure proper documentation to support the codes used.

2. Insufficient Documentation

Insufficient documentation is another common pitfall in medical billing for dental procedures. Complete and comprehensive documentation is crucial for proper claim submission and reimbursement. Dentists should provide detailed treatment notes, including the diagnosis, procedure performed, and any supporting information. Inadequate documentation can lead to claim denials or delays, as it fails to demonstrate medical necessity and justify the treatment rendered. Implementing efficient documentation processes and training staff on proper record-keeping can help avoid this error.

3. Improper Coordination of Benefits

Coordination of benefits (COB) is essential when dealing with dual coverage patients or when dental procedures involve medical and dental insurance. Failing to coordinate benefits properly can result in incorrect billing, overpayments, or missed revenue opportunities. Dentists must understand the COB guidelines of the insurance companies involved and ensure accurate submission of claims. By coordinating benefits appropriately, dental practices can maximize reimbursements and minimize errors.

4. Failure to Verify Patient Eligibility

Verifying patient eligibility is crucial before rendering any dental procedure. Many billing errors occur when dentists fail to check patient eligibility, leading to denied claims and revenue loss. Dental practices should verify patients’ coverage, benefits, and policy restrictions before treatment begins. This step ensures that the patient’s insurance is active and covers the specific procedure. Regular communication with insurance providers and implementing an efficient eligibility verification process can prevent this error.

5. Neglecting Timely Filing

Timely filing is a critical aspect of medical billing service. Many insurance companies have strict deadlines for claim submission, and failing to meet these deadlines can result in claim denials. Dentists must be aware of the specific filing limits set by different insurance providers and adhere to them. Implementing a well-organized and efficient billing system, including timely submission of claims, can help avoid this error and ensure maximum reimbursement for dental procedures.

Conclusion 

Medical billing for dental procedures is a complex process that requires attention to detail and adherence to proper guidelines. Avoiding common errors in medical billing, such as inaccurate coding, insufficient documentation, improper coordination of benefits, failure to verify patient eligibility, and neglecting timely filing, is crucial for the financial success of general dentists. By implementing best practices for medical billing services, staying updated with the latest coding and billing guidelines, and training staff effectively, dental practices can enhance their revenue streams and provide quality care to their patients.

Making the Right Call: When to Bill Medical Insurance for Dental Procedures?

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In the world of dental practice, the distinction between medical and dental claims can sometimes be blurry. It is quite challenging to understand how medical billing for dental procedures work. As a dental practitioner, it is essential to understand the circumstances under which filing a medical claim might be more appropriate than a dental claim. 

The sophisticated claims payment and management systems do not help either. When is a treatment performed by a dentist covered by a medical insurance and what are the applicabilities? Understanding insurance claims is a perplexing task in itself and along with that, what kind of insurance claim needs to be  filed can be confusing as well, especially when it’s medical versus dental.

By navigating this nuanced decision-making process effectively, you can maximize reimbursement and ensure the best outcomes for your patients.

In this blog, we will explore key factors to consider when deciding whether to file a medical claim or a dental claim, ultimately helping you make informed decisions for your dental practice.

Understanding the Difference

Before diving into the decision-making process, let’s first clarify the fundamental distinction between medical and dental claims. Dental claims typically cover procedures directly related to oral health, such as cleanings, fillings, and extractions. These claims are filed with dental insurance providers.

On the other hand, medical claims pertain to treatments that address broader health issues that manifest in the oral cavity, such as sleep apnea, temporomandibular joint (TMJ) disorders, or oral cancer. These claims are submitted to medical insurance providers.

Factors Influencing the Decision

To determine whether to file a medical claim or a dental claim, several factors should be taken into account:

Diagnosis and Treatment: Consider the primary diagnosis for the patient’s condition. If the oral issue is a symptom or part of a broader medical condition, filing a medical claim might be more appropriate. For instance, if a patient with sleep apnea requires an oral appliance to manage their condition, a medical claim could be filed.

Insurance Coverage: Review the patient’s insurance policies and examine the specific coverage for both dental and medical procedures. Some dental insurances might offer limited coverage for certain medical treatments, while medical insurances may have provisions for dental-related procedures. Understanding the policies will guide your decision-making process.

Documentation: Accurate and comprehensive documentation is crucial. Maintain detailed records of patient examinations, diagnoses, treatment plans, and relevant medical history. Documentation should clearly establish the medical necessity and connection between the oral condition and the overall health issue being treated.

Reimbursement Rates: Compare the reimbursement rates between dental and medical insurance providers for similar procedures. In some cases, medical insurance may offer higher reimbursement rates, making it financially advantageous to file a medical claim. However, ensure that the medical billing process does not create unnecessary complexity or burdensome administrative tasks for your practice.

Case Examples

To illustrate the practical application of these considerations, let’s explore a couple of case examples:

Case 1: A patient with severe bruxism (teeth grinding) experiences chronic headaches and facial pain. After a comprehensive evaluation, it is determined that the bruxism is a result of stress and temporomandibular joint (TMJ) dysfunction. In this case, it would be appropriate to file a medical claim as the primary issue being addressed is TMJ dysfunction, which falls under medical insurance coverage.

Case 2: A patient presents with periodontal disease and requires extensive gum surgery. While periodontal disease is primarily dental in nature, if the patient has an underlying systemic condition, such as diabetes, that affects their periodontal health, filing a medical claim might be justified. The medical claim would focus on the treatment of the systemic condition, with periodontal surgery being an essential component.

Conclusion

By understanding the foundational differences medical billing for dental offices.

Determining whether to file a medical claim or a dental claim is a critical decision for dental practices. By considering factors such as diagnosis, insurance coverage, documentation, and reimbursement rates, you can make informed choices that benefits your dental practice.