Category: Blog

While running a practice, you may want to offer the finest patient care possible, and part of that may entail working with dental insurance companies. Dental Credentialing becomes important in this situation. It is the process of a dentist signing a contract with an insurance provider. Dental credentialing determines whether the practice is eligible for a contract as an in-network provider. Signing a contract agreement entails accepting the predetermined rates set by the insurance carrier so as to have access to a wider patient base.

Dental credentialing

After receiving a dental credentialing application, the insurance provider will examine and confirm the data. Once your application has been approved, you are bound by the contractual agreement with the insurance provider that stipulates you will adhere to their fee schedules, contractual constraints, and standards for patient copayments.

Credentialing your dental practice with dental insurance providers might seem challenging and complex. However, dental credentialing has become essential as it enables your patients to securely put their trust in the dental care provider of their choice. Dental credentialing additionally enables dental practices to connect with insurance providers so they can accept third-party payments. You can quickly become an in-network provider if you have established a relationship with an insurance carrier. The dental credentialing process can be a demanding task that needs to be approached with attention and organization, followed by constant and frequent follow-ups, in order to get it  processed on time.

Why is it so important?

Getting your practice credentialed is one of the first steps you need to take if you decide to accept insurance. Patients are 90% more likely to seek care from practices that are credentialed. This not only broadens your opportunities with potential patients, but it also helps promote your visibility online and in-network. It thus, gives your practice a better chance of attracting new patients. Also, it can be a mess if patients are under the assumption that a dentist is in-network with an insurance provider and that is not the case. Although dental credentialing initially takes up a lot of time, when done correctly, it saves a lot of time and helps reduce patient frustration.

Credentialing checklist

• To acquire a credentialing application and learn more about the process, get in touch with a network provider. The application and other additional information are usually available on the websites of insurance providers.
• Complete the application slowly and carefully, making sure to go through it thoroughly. Do not forget to include location information, copies of necessary papers, and other important information.
• A detailed description of your practice location and any required paperwork, such as a business license, insurance policy, board certificates, etc., need to be updated in your profile.
• Once you have submitted your application, keep a copy of it.
• Verify that the insurance company received your application. After that, until you are informed that credentialing is finished and a participating provider agreement has been signed, periodically follow up to inquire about its status.
• In order to speed up the process, respond quickly to requests for more information from the insurance company.
• Maintain records of your submissions, follow-ups, and any other actions you deem necessary.
• Keep track of all the contracts, applications, and submissions for credentialing, particularly the final version of the provider contract.

Common mistakes while credentialing

Sending claims with inaccurate provider data

Sending claims with the wrong provider information is a very serious error that could result in fraud charges.

Too late to begin the certification procedure

The procedure for obtaining credentials can take at least 90 days. This means you are not permitted to offer in-network services for three months. Since it can take several months, the application process should ideally begin earlier on.

Not conducting a prior analysis of your service area

Not doing any research into the most prevalent insurance payers in your service area is one of the most common mistakes. If you do not, patients may call to make an appointment, but go elsewhere for their treatment because you do not accept their insurance.

Failure to discuss the fee schedule

These are used to calculate the highest amount that can be charged to the patient and the highest amount their insurance will cover. As the highest dollar amount chargeable to the patient and to the insurance per service can be negotiated, do not blindly accept the first fee schedule you see.

Submitting applications to too many dental insurance providers at once

This can obviously bring in a lot of patients and money, but having too many applications open at the same time can be detrimental, as you may have to accept a lower fee schedule and your practice may have more work than your billing team can handle.

What happens when you have credentialed

You can start invoicing for in-network services after the credentialing process is finished. Confirm the patient’s insurance benefits prior to the visit and file claims within 24 hours after the treatment for prompt payment. Bill another insurance provider or the patient for any outstanding payments as soon as you get paid by the insurance provider.

Filing claims for orthodontic treatments can be a real pain if you don’t know what you are doing. Insurance providers have specific guidelines for the reimbursement of orthodontic claims as these treatments can span over multiple plan years. This makes processing these claims a complex task that requires some effort. Practices need to follow specific claim submission protocols to ensure that their claims get paid. If any of the information or documentation is incomplete or missing while submitting these claims, it can result in denials.

Steps involved in the submission of an orthodontic claim:

 Insurance eligibility and benefit verification

         The first stage in the process is to determine patient eligibility for orthodontic benefits. For dental insurance verification and coverage, get in touch with the patient or insurance provider, as orthodontic benefits vary greatly between different policies. The various pieces of information that need to be verified include details that are verified for regular dental services, like the name and date of birth of the patient, the name and contact information of the insurance provider, and also the insurance policy number. The practice also needs to get in touch with the insurance provider so as to learn the lifetime maximum, the percentage of the premium that the carrier is responsible for paying, the copayment and deductible, as well as any restrictions like age and dependency status. Keep in mind that all this needs to be carried out before the patient’s appointment.

 Coordination of benefits (COB)

         When a patient has dual coverage or is covered by multiple insurance plans, coordination of benefits becomes really crucial. Once the primary and secondary carriers are identified, claims need to be submitted in accordance with the rules that specify the sequence in which the dental practice must bill each health insurance plan.

 Claim submission

 While filing a reimbursement claim form that has been filled out completely, a statement outlining the treatment plan and the financial arrangements should be submitted. The documentation must include the estimated length of treatment, the payment plans, and the anticipated insurance payment, if any.

Information that needs to be included while submitting orthodontic claims:

●  The procedure code, together with a description of the appliance used and treatment.
●  The banding date.
●  The anticipated number of months during which the patient will undergo treatment.
●  The total amount you want to be paid for the services.

Points to be noted while reimbursing for orthodontic treatments:

 ●      The treatment expense needs to be related to the coverage duration. Reimbursing an entire orthodontic expense in one year usually violates the IRS requirement that the expense be spent during the coverage period because orthodontic expenses typically span two or more years. The cost of orthodontic treatment will be spread out over the duration of the treatment.

●   The patient should be receiving ongoing orthodontic treatment. Payments made after orthodontic treatment has ended are not eligible for reimbursement.

●      The entire expense of the orthodontic treatment cannot be fully reimbursed at the time of payment.

●      Payments may be made in monthly, quarterly, or annually over the duration of treatment, depending on the insurance provider.

●      If a patient is paying for an orthodontic treatment on a monthly basis, the monthly payments can be reimbursed as they are incurred.

●      Note that if adjustments or extractions are required to complete the orthodontic treatment, they will most likely be covered by the dental insurance. However, in rare instances, they will be billed from the orthodontic benefit.

Here are some tips on submitting orthodontic claims:

●  Diagnostic casts, photographs, or radiographic images need not be sent unless the insurance provider specifically requests them.
●  Make sure that claims are submitted with accurate, clean, and complete documentation.
●  Never submit orthodontic treatment along with general dentistry treatment on the same claim form.
●  Make sure to note down the start date–the date that braces are placed, appliances are fitted for the teeth, or aligners are delivered. This is a requirement for most insurance provider.
●  If the contract fee is less than the cost of orthodontic treatment, the insurance provider can be contacted to discuss options.
●  It is better to assign benefits to ensure that the insurance payments are received directly by the practice.

While these tips should generally help make the orthodontic claim preparation and submission easier and more streamlined, practices need to remember that each insurance provider could have specific requirements to accept orthodontic claims. Providers like Aetna and Delta Dental have their orthodontic claim submission requirements on their websites. Also consider that nothing can replace the eligibility and verifications process when ensuring that you prepare your claims accurately. 

There are several steps involved prior to providing dental services and the submission of claims. If not done accurately, these steps can lead to claim rejections and denials. The only way to prevent this is to verify that every aspect of preparing claims is accurate. Two processes that a lot of practices make errors in are verifications and pre-authorizations. Insurance verification and authorization belong to the initial, crucial stage of the RCM or dental claims billing process.

What exactly are insurance verification and authorization?

 Insurance verification

         Insurance verification is the process of confirming that a patient’s insurance policy or plan covers all the services that are scheduled to be provided. It involves confirming a patient’s insurance plan details and other information that will be required to submit the insurance claim. It is important to verify all the information, no matter how trivial it may seem, with the patient records so as to find any gaps or to determine the legitimacy of the claim. Even the smallest of mistakes, like a patient’s date of birth or a misspelt name can result in an immediate rejection.

 Insurance authorization

         Insurance or pre-authorization, on the other hand, is the process of getting approval from the insurance provider to perform specific services. The approval is to be sought before providing any treatment, as it determines whether or not you will get paid for the services provided. The chances of a claim being accepted or rejected are directly affected by this process. This is used by the insurance payer as an efficient means of ensuring quality and cost management while paying the claim.

 You will, most likely, need to submit a treatment plan to the insurance provider for review. This will include a detailed description of the proposed treatment as well as the estimated cost of services. They evaluate it according to predetermined criteria and carefully examine the request to determine whether the recommended treatment corresponds with the illness that the patient has complained about. If the insurance company approves of the treatment, they will issue an authorization letter, which confirms that they will pay for the services provided.

Difference between insurance verification and authorization

The pre-authorization process starts when the treatment for a patient needs pre-approval from the insurer, as opposed to insurance verification, which is carried out before submitting claims and before providing any of the service.

 Prior authorization is concerned with gaining prior approval for services, whereas insurance verification is concerned with the process of drafting and filing medical claims and receiving payment for patient care.

 Practice staff needs to be familiar with the CPT codes for the services for which pre-authorization is required for the process to run smoothly. Verification of insurance focuses on eligibility, active or inactive status, and coverage status.

Common challenges with insurance verification and authorization

Navigating insurance verification and authorization is an ongoing process and lapses can cause roadblocks in your RCM. The most common challenges with these are the inaccuracies in patient details and a lack of understanding of dental codes and coverage limitations. These challenges can often lead to patient dissatisfaction and uncollected payments.

Both processes can be time-consuming but once you have an effective system in place, the process becomes smooth and reduces glitches in your RCM. They can go a long way towards saving time, avoiding denials and delays, maximizing reimbursement, and improving patient care and satisfaction.

Patient retention rates at a practice should ideally be between 85% and 95%, and if your practice is nowhere near that range, it’s a sure sign that your recall mechanism needs to be refined. A lot of practices rarely realize the importance of a strong recall system and think it’s unnecessary. As a result, their patient retention rate falls unnecessarily low. It’s important to spend some time working on your recall system if you want to get the once-active patients back in your books. Neglecting the recall system will, most definitely, hurt your practice.

Here’s how ignoring recalls can hurt your practice:

Losing patients

While it’s important to attract new patients, it’s also very important to retain the already-existing ones. A lot of times, patients are never heard from again after their appointments. Without a perfect recall system, practices are most likely to lose these patients as you lose any chance of building a bond with your patients. 

Losing patient referrals

Patients who haven’t visited the practice in a while probably won’t recommend it to their friends and family either. That’s a missed opportunity, which can cost the practice a lot of money. 

Broken appointments

A couple of missed appointments may not seem like a problem. However, cancellations and no-shows tend to become a common occurrence if they go unchecked. This obviously leads to loss of revenue. 

Loss of revenue

Without a recall system, patients would most likely not prioritize overdue payments. This is sure to result in your practice suffering losses.

Here are some of the benefits of prioritizing recalls:

Increase in patient retention rates

Prioritizing your recalls can work wonders in increasing the patient retention rates at your practice. Having a strong recall system helps you give your patients the best service that is possible; whether they are current clients or new ones. Recalling your patients to inform them about their condition, reminding them about their pending payments, and educating them about the various payment options available helps improve the practice-patient relationship.

Increase in referrals

A loyal patient is most likely to refer their friends and family to a practitioner they trust. This is especially true if you are able to provide exceptional treatment and a great patient experience.

Reduced no-shows and broken appointments

No practice wants to deal with the hassles of last-minute cancellations and no-shows. However, it is only natural for patients to forget their appointments in the midst of their busy schedule and not show up for their treatments. With an effective recall system, such incidents can be avoided to a great extent, as it gives your patients constant reminders for their appointments and payment responsibilities.

Boost practice-patient relationships

Patients need to feel valued. Reaching out to your patients through recall, ensuring their oral health, and providing up-to-date information shows them how much they are valued at your practice. This helps in building a stronger bond and in building trust.  

Increase in revenue

The more patients your practice has, the more revenue it makes. By making recall a priority at your practice, you will put patients who were previously inactive back in your books. Your patients will also be reminded of their payment responsibilities. The improved on-time payments cycle will increase the overall cash flow at your practice.

In summary, patient recall helps a practice maintain ongoing patient care, increase patient retention, and reduce no-show rates.  Recalls give your practice the opportunity to talk to your patients about their dental health, remind them about their appointments, and also educate them on their payment responsibilities. This extra effort makes your patient feel special and valued, enhancing the trust that they have in your practice. Recall is important, and ignoring it is detrimental to a healthy revenue cycle.

A major part of having dental insurance is the cost sharing or out-of-pocket expenses that all insurance providers require patients to meet. Along with the premiums, members are also responsible for the copays, deductibles and coinsurance. Understanding how they are applied is vital for patients to plan their annual dental insurance costs. As a dental practitioner, one additional step that you can take to enhance patient experience is to educate them about their out-of-pocket expenses.

Deductible

Dental plans require that patients first pay for their dental services up to a fixed amount before the insurance provider starts paying for their covered services. This fixed amount resets annually and is called a deductible. Patients are completely responsible for their dental care expenses until they reach their deductible amount. However, preventive care, such as checkups, X-rays, and cleanings, are typically covered in full by the insurance plan. So, say your patient’s plan has an annual deductible of $100. If your patient comes in for a routine cleaning, the service may be covered in full by the insurance provider even if the deductible amount has not been met for that year. Some plans also have separate deductible amounts depending on whether you, as a dental rcm provider, are within network or out of network. 

Key points to note about deductibles:

• Deductibles may not apply to all services
• Separate deductibles apply to specific services under some plans.
• Family plans typically have both an individual deductible that is applicable to each member of the family and a family deductible. 

Copay

Simply put, a copay or copayment is a fixed fee that your patient pays for each visit of specific covered services. Copays may not apply to all covered services and may vary depending on what service the patient comes in for. The amount also remains the same regardless of the final bill that you as the dental provider raise. A patient could have a $10 copay for a routine check up, no copays for cleaning and a $150 copay for emergency visits. Let’s say your patient has had two dental emergency visits with you during a policy year. The cost for each visit may be different. However, your patient would have to pay $150 as the copay for each of the emergency visits. The remaining is paid by the insurance provider. Copays typically apply even if the patient has met their annual deductible. Copayment amounts could change depending on your network status with their insurance provider. 

Coinsurance

Coinsurance is a percentage that your patient pays for dental services once their annual deductible has been met. The remaining amount is paid by the insurance provider. If the coinsurance percentage for your patient’s plan is set at 20%, the remaining 80% would be paid by the insurance provider. Coinsurance percentages may vary depending on the services the patient receives. Amounts could also vary depending on whether you are within network or out of network with their insurance provider. 

How it works

Out-of-pocket expenses and other charges may vary depending on the dental insurance provider. Typically, patients pay their premiums to have dental insurance. Each time your patient visits, they may pay a copay, which may or may not add to their annual deductible amount. Once the deductible amount is met for that year, the coinsurance percentage that the patient needs to pay, kicks in. The copay and coinsurance amounts need to be paid till the out-of-pocket maximum for that particular year has been met. The insurance provider then typically pays 100% of all the charges till the annual maximum is met or till the policy year ends. 

The complex and crucial area of revenue cycle management takes a lot of effort and time in your practice. Submitting and following up on dental claims to get reimbursed for the services provided can indeed be exhausting. Additionally, the proper management of the revenue cycle helps make sure that the practices get paid for the services rendered. Therefore, it is crucial to have skilled billers who can improve revenue for the company. Which is why it is time for practices to consider an RCM partnership. When practices first consider RCM collaborations, terms like “outsourcing,” which most practitioners fear, often come to mind. These fears may prevent your practice from fully appreciating the advantages of outsourcing dental billing.

Here are some of the common worries that prevent practices from partnering with an RCM provider:

Fear of layoffs

The worry of losing their jobs once an external RCM provider is hired is very common among the staff at your practice. The concept of someone else handling the billing process can undermine their worth at the practice as they are so accustomed to handling it themselves. It makes them feel threatened about their job at the practice. Dental billing, as you already know, is a complex and tiring process, and an RCM provider only helps lessen the workload of your staff. The RCM service provider functions as an extension of the billing team; they work on your insurance claims behind the scenes while your practice staff remain front and center.

Loss of control over the revenue cycle

Another common fear present among most practices is the fear of losing control over their revenue cycle, which stops them from partnering with an Revenue Cycle Management provider. Practices often find it difficult to trust an RCM provider to complete the work in the desired manner and on time. However, the fear is not valid at all, as you are not really losing control when you let a professional handle your bills; instead, you are assigning the more time-consuming task to a third party while using your own time more effectively on more important tasks at your practice. By partnering with an RCM service provider, you get access to a skilled and knowledgeable billing team that helps you submit more accurate claims on time, boosting your collections.

Loss of revenue due to the cost of partnering with an RCM provider

The cost of partnering with an RCM provider is another facet / element that practices fear. Although it can seem like partnering with an RCM service provider will cost you more money, that is not true at all, as it only helps boost your practice revenue significantly. Expert RCM service providers often help practices save money by streamlining the revenue cycle. Furthermore, for most practices, the cost of salaries, benefits, and office expenses exceed(s) the cost of opting for a service provider. Therefore, the most cost-effective way to simplify your billing process and generate successful claims is to partner with a service provider.

Revealing confidential information to third-party service providers

Data security and regulatory compliance are top priorities at a practice, which is why practices may be hesitant to form partnerships. They may be concerned that the new third party will not be able to protect data in the same secure manner. As they are entrusted with securing such a huge volume of Patient Health Information (PHI), leading RCM outsourcing suppliers place high priority on data security and regulatory compliance.

Only large practices can partner with an RCM provider

There is a common stigma among practices that only big and well-established practices can partner with an RCM service provider. Although medical billing providers prefer larger clients, they do not exclude smaller or lesser-known practices from their services. The majority of revenue cycle management providers’ customers are small and medium-sized practices.

Partnering with an RCM provider is time-consuming

Many practices are under the misconception that partnering with an RCM service provider takes up a lot of time. In actuality, partnering with a service provider presents you with the opportunity to spend more time working on the other needs of your practice and less time worrying about the financial aspects. The service provider generally submits claims faster than your employees since their work is solely focused on billing and they don’t have to manage the other needs of your practice . They can also quickly locate denied or rejected claims, ensuring that you don’t miss any deadlines for filing appeals and thus, leading to faster dental billing, contrary to common belief.

Opting for a service provider may reduce patient satisfaction

Another aspect that restrains practices from partnering with a service provider is the fear that it would affect their patient satisfaction because the patients would prefer in-house billing, but this is far from the actual case / truth. Partnering with a service provider helps your staff devote more time to patient care. They can now focus more of their time and attention on improving patient care because they are no longer required to work on the time-consuming RCM processes. This in turn leads to strong levels of patient loyalty and satisfaction.

An RCM partnership is actually an added assistance that can lead to success for the company, its staff, and its patients. Understand that you can be losing out on a sizable portion of the practice’s income from unpaid claims if your fears prevent you from even attempting to partner with an RCM provider.

Dental codes and their power to accurately code various procedures for insurance reimbursements are a major source of worry for many dental practices. For the same reason, utilizing the proper dental procedure code is essential, yet quite puzzling. Accurate dental coding is vital to submitting clean claims for timely reimbursements. Practices need to make sure the appropriate dental codes are added to the bill when creating one. Also, they need to bill the claims accurately using the most recent CDT code sets so as to minimize problems, discrepancies, and other payment barriers.

CDT codes are a series of medical codes for procedures that deal with both oral health and dentistry. These procedural codes are alphanumeric codes that start with the letter “D” and are followed by four numbers. It contains the necessary codes required to code each dental procedure for submission to a particular dental insurance plan. It is important to understand that the CDT codes undergo changes every year, and a practice must be up-to-date on the changes to the CDT codes.

The CDT code set is divided into different service types, which include:

• Diagnostic
• Preventive
• Restorative
• Endodontics
• Periodontics
• Removable Prosthodontics
• Maxillofacial Prosthetics
• Implant Services
• Fixed Prosthodontics
• Oral and Maxillofacial Surgery
• Orthodontics
• Adjunctive General Services

Submitting claims with accurate dental procedural codes is not an easy task; it has a lot of difficulties, which are further exacerbated by  limited staff and time. Understand that your staff are not robots; they can make mistakes too. There are high chances for them to miss adding some of the dental codes to the bills, especially with their busy schedule. A lot of reasons, including time constraints, extra workload, etc., can lead to mistakes in dental coding.
Failure to use the appropriate procedure codes can complicate the entire process and result in negative patient outcomes. It is true that precise procedural coding is a legal necessity, and violators  have to face severe repercussions.

When process codes are misused intentionally or unintentionally, the practices have to face a lot of challenges, including:

Delayed or denied payments

Failure to provide correct coding can lead to improper billing, causing payments to be delayed, denied, or limited. A majority of claims get denied due to such errors in procedural coding. Such claim denials can be costly, as the buildup of these denied reimbursements can result in heavy loss of revenue at your practice.

Hinders patient satisfaction

Even a small error in dental coding, such as switching the order of two digits in a code, can indicate a completely different diagnosis. Patients may think there is a scam afoot if they receive a hefty fee for a procedure they did not have. This may result in claim denials or delays that negatively impact your patient experience.

Leads to fraud and abuse fines

Improper coding on claims may have legal repercussions in addition to regulatory liabilities if the insurance carrier challenges the accuracy of the procedures submitted. If an insurance provider finds out that a practice has routinely overcharged or overtreated a patient, the practice will be subjected to disciplinary action.

Your practice can’t afford to lose tens of thousands of dollars due to unnecessary errors or inefficiencies. However, that is exactly what happens if you are using inaccurate or outdated dental codes. Therefore, it’s your practice’s responsibility to make sure that the claims are correctly coded.

So, here are some ways in which you can reduce the inaccuracies in dental coding:

Perform regular coding audits

Regular coding audits are necessary for the proper and accurate coding of dental bills to make sure that your practice receives timely reimbursements. Performing regular coding audits helps you identify areas of inefficiency in your coding process, thus providing the opportunity to find solutions to rectify the most common mistakes in coding.

Stay up-to-date on the latest CDT codes

As mentioned earlier, CDT codes undergo changes every year, so it is important for your practice to stay updated on the latest changes as dental coding mistakes can have severe repercussions.

Always check for fraud

Make sure that you check for any kind of fraud in your dental billing before submitting the claims. If the insurance companies suspect any misuse or abuse of procedure codes, your practice can face disciplinary action. It is crucial to remember that your practice is legally responsible for the accuracy of all dental claims that leave it.

Clear communication

For the accurate coding of dental bills, practices must make sure that the necessary information is thoroughly communicated between the provider and the billing staff. For accurate and proper coding of dental bills, the provider must clearly communicate and explain the treatments performed on patients to the billing staff. The practice could suffer financial loss or even face legal repercussions for inaccurate coding due to a lack of proper communication between the provider and the office staff. Keep in mind that coding errors are more likely to occur in practices with poor communication, which can be quite problematic.

However, keep in mind that everyone at your practice must be aware of the updated CDT codes, not just the billing staff. It can be helpful to your staff in identifying scenarios where the codes may be applicable, recognizing when it is necessary to gather more information on a particular procedure, and fully documenting the procedures so that they are eligible for billing whenever possible.

Revenue Cycle management is an area that demands and receives frequent attention, but the surprising fact is that charge capture in RCM often goes unnoticed. Nevertheless, charge capture is a critical factor in the revenue cycle process, as dental practices risk losing millions of dollars in revenue if they do not accurately record data on the services rendered at their practice. “Revenue leakage” refers to situations where a healthcare provider has issued care and services to a patient, but does not receive payment.

Charge capture refers to the practice of documenting and recording the various services rendered to patients by the healthcare provider. These are then sent out to the insurance companies for reimbursement. It is one of the first steps in revenue cycle management, and any error at this stage can lead to claim denials.

Incomplete, un-billed or inaccurate claims submitted to the payer for treatments rendered to patients, result in the loss of more revenue than any other reason.

Challenges or Difficulties with charge capture :

Missing, Incomplete, or Inaccurate Documentation

While recording treatment details for a lot of patients, there is a huge chance for some details or information to go missing, be incomplete, or be inaccurate. This can become an obstacle to the effective functioning of your revenue cycle.

Not Documenting  All Services Rendered

Practices, in their hurry because of the tight schedules, may at times forget or skip documenting some of the services provided, which may result in claim denials and payments going unpaid.

Sudden Patient Visits or Inpatient Consultations

Unexpected patient visits or inpatient consultations can create disturbances in the charge capture process.

Typos in Documentation

Typos in the information documented may seem like a simple mistake, but they can have a huge impact on your revenue cycle as they result  in claim denials.

Long Documentation Gaps

While it is ideal to capture charges within 24 hours, coding staff frequently take too long to complete medical coding resulting in documentation gaps, in turn, prompting an increase in claim denials and redundant billing delays.

Benefits of having an effective charge capture system :

Identifying revenue leaks
An expert sharp eye can find any cracks in charge capture that would result in revenue leakage.

Timely submission of claims
Effective charge capture helps your practice submit a perfectly completed claim in the claims submission process well within the timely filing period.

Improved accuracy optimizes revenue
With an effective charge capture system helping your practice collect accurate and complete details of the services provided to patients, you can submit claims with the utmost accuracy.

Best practices involved in charge capture :

Eliminate legibility concerns

Place emphasis on accurate explanation of rendered services as they are provided to the patients and avoid any kind of legibility issues. This could be mistakes in the spelling and grammar.

Provide accuracy in coding

Emphasize coding accuracy so as to improve revenue and reduce the possibility of denials due to coding errors.

Set target goals

Make it your objective to collect payments within 24 hours, if not less, and strive to achieve the targeted goal. However, make sure that you collect the necessary data to identify if you have made any progress and make changes accordingly.

Conduct audits

A system audit can be valuable as it enables your practice staff to concentrate exclusively on identifying the source of inconsistencies. It helps in uncovering erroneous billing practices and coding problems, both of which can contribute to accurate patient billing. This eventually leads to higher patient satisfaction.

Align your teams

For accurate and effective charge capture, it is important for your practice staff to work together – right from the providers to the staff, everyone should align. This helps in avoiding any kind of confusion that may arise between the providers and staff, thus helping in accurate and correct charge capture.