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Managing Dental Practice Overheads

The aim of most practices is to be successful while providing the highest caliber dental care. A practice that is struggling to organize its costs and expenses, can find it quite difficult to determine which practice expenses should be prioritized and which should be reduced, and which areas of the dental office should be given top priority when it comes to controlling operating expenses. The easiest way to reduce overheads is to increase efficiency while also lowering the total expenses at your practice. Practices need to strategize and implement methods to review and reduce overhead costs, raise profit margins, and prevent serious cash flow issues even if many of the expenses cannot be avoided.

What are some of the reasons that lead to overheads at your practice?

Overlooking practice numbers

         Most practices typically pay attention to some but not all of their crucial practice numbers. Practices sometimes tend to focus solely on cash in the bank, production, as well as the collections and often overlook the effect of overhead on their net income. It’s true that increasing revenue can help a practice develop consistently, but rising overhead costs can quickly consume all that extra cash. Remember that a practice’s net income can increase by thousands of dollars with just a 1% drop in overheads.

Too many appointment cancellations and no-shows

         When a practice reserves time for a patient and that patient is late for the appointment, or misses the appointment, the production time is permanently lost. More crucially, money is lost. In addition to losing revenue, a significant portion of the overhead connected with the time is still incurred when patients fail to show up for appointments. When there is a decrease in production, larger overhead percentages are created by rent, utilities, and other fixed expenditures. A list of patients with flexible schedules and short notice availability might be helpful for covering such cancellations.

Insurance billing difficulties

Insurance billing difficulties include claims unpaid even after 30 days, low insurance coverage percentage, and claims that reach timely filing limits. All these can lead to your practice losing a considerable amount of revenue. It, therefore, becomes important that the insurance billing needs of the practice be handled with diligence.  

What can be done to reduce overheads?

Evaluate the data of your practice

         Finding out where the practice stands and how the numbers compare with industry benchmarks is the first step to overheads at your dental practice. Utilize key performance indicators (KPIs) and other solid data to oversee and measure performance. It’s crucial to delve deeper into the data once you understand your current situation in order to comprehend how your numbers affect your practice. This data includes production per day, the number of active patients, the number of new patients each month, and the treatment plan acceptance rate. Once you are aware of the practice expenses, you can easily create a plan to control them and put it into action. Examine your workflows and tools in detail and find areas to increase your practice efficiency.

 Reducing expenses

Cutting costs is a simple approach to lower overheads, but doing so may involve making unpleasant choices. Negotiating your lease terms, verifying your insurance coverage, and assessing your utility expenses, reduced staffing are all such unpleasant cost-cutting measures. It’s vital to keep in mind that every practice is different, so the earnings and expenses may not align. Any cost-cutting tactics that have a negative impact on efficiency are simply not worth it. Instead, your aim should be to optimize profitability while placing good patient care ahead of everything else. You may be able to avoid eventual replacements down the road and make the optimal decision for your practice by weighing upfront savings against quality. Many practices struggle with shocking overhead proportions, but investing the time to analyze its data is the first step to success and growth.

Make the most of technology

Technology plays a significant role in the growth and management of a practice and isn’t likely to disappear any time soon. However, what you decide to use and pay for should be thought through as you cannot waste your revenue on the ones that are not a necessity. Workflows and digital technologies have considerably improved. These resources support dental practices in maximizing patient care and revenue. Choose a technology that not only fits your budget but also supports the efficiency and profitability of your dental team. 

Make your dental billing process efficient

         Take some time to assess the performance of the dental billing system you have in place, whether it’s in-house billing or partnership with a service provider. A lot of revenue can be lost through inefficient handling of patient payments. For practices wishing to manage its overhead costs, partnering with an RCM service provider may be the most cost-effective option as they help employ dental billing expertise to collect the cash you’ve earned. This helps your practice increase its revenue while gaining clean, accurate, and compliant billing services. Since the insurance billing is no longer taking up all your time and energy, you can focus on providing exceptional dental experiences to your patients.

Other important tips to avoid overheads include:

●  Comparing lab costs while placing quality ahead, at all times.
●  Preventing loss in revenue by collecting your patient payments on time.
● Maintaining consistent cash flow with a strong collection strategy and credit options for patients who have trouble making payments.
● It may also be a good investment to hire a dental CPA to go through your numbers annually.

Understanding The Missing Tooth Clause

Most people who have dental insurance think that all essential procedures will be covered under their insurance. This myth gets busted when they receive rejections from insurance companies for services, for what they might consider trivial reasons. One such reason or clause that confuses the dental industry is the missing tooth clause. This clause, which is included in a lot of policies, states that any dental procedure to replace a tooth that was pulled or lost before the insurance coverage began would not be covered. Therefore, if your patient has a tooth pulled out or lost before their insurance coverage began, such policies typically would not pay for any procedure to replace the missing tooth. This could include services like implants, fixed partial dentures, or removable partials. This clause results in the patient having to spend significantly more than anticipated. This makes it necessary to check your patient’s coverage thoroughly for missing tooth clauses.

 Key points to note while looking for a missing tooth clause:

In some instances, after a waiting period, the insurance coverage may pay for tooth replacement expenses. However, the plan may not pay for the tooth replacement if the tooth was lost within the waiting period specified in the missing tooth clause. Remember, insurance companies have different waiting periods, which typically range from a few months to a year. Some insurance plans may also include waiting periods of up to five years.

 What can your practice do about missing tooth clauses?


         Insurance companies may reject claims based on a missing tooth clause when your practice least expects it. In such cases, a predetermination can help guarantee that your patient receives the information they need to make an economically sensible decision on their treatment. It can be a useful strategy for your practice when working with patients, to secure their consent for desired treatment plans. This helps them gain a better understanding of their out-of-pocket expenses following any coinsurance, deductibles, and policy maximums. Dental practices may have to perform predeterminations for several reasons, including potential missing tooth clause-related rejections.

 Detailed treatment plan

         Giving your patients a treatment plan following the diagnostic appointment is another step your practice can take. This will encourage your patient to open a dialogue their insurance company and help them better understand their course of treatment and the clauses included in their coverage.

Send appeals

         Make sure that you send appeals for rejected claims due to missing tooth clauses, for which you have necessary documentation as proof or support. Sometimes the first decision is reversed by the first appeal, and benefits are paid out. There are times a second appeal is required, or a peer review is asked for. Having an appeal template for the missing tooth clause can be a good idea. The appeal also helps inform your insurance provider that the patient would not have accepted the service if payment was not going to be provided. Your documentation can serve as evidence that shows your practice has conducted the required research on reimbursement for the procedure.

 Educate your patients

         The most important thing to remember is to inform and educate your patients about missing tooth provisions in their insurance coverage before starting a treatment. Make sure you have completed a pretreatment estimate and have the necessary documentation on the policy on-hand in case you need to file an appeal. By taking these actions, your practice will at least be able to keep your patients from being taken by surprise by huge out-of-pocket expenses. Building a financially sustainable dental care plan for your patient’s dental care and gaining patients who trust you and your team can depend on this step.

 How does ignoring missing tooth clauses affect the practice?

Ignoring missing tooth clauses can lead to your patients losing trust in our practice and can also result in revenue loss. If the claim is rejected after replacing a patient’s missing tooth, you lose money. Furthermore, the practice’s reputation may suffer if the claims get denied. It is natural for a patient to expect that your practice has done the necessary verifications with the insurance company. Not doing so will result in the patient inconvenienced with a sizable amount that will have to come out of their pocket. Remember, a practice’s value is greatly enhanced by their patients’ trust. The development and success of a practice depends on its reputation. Understanding the missing tooth clause and assisting patients in using their insurance benefits helps your practice avoid denials due to a missing tooth clause.

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Dental Billing Mistakes That Lead To Fraud

Any situation where the practice receives insurance money for filing a false claim, inflating a claim or billing for services not rendered, can be considered a crime. Even an accidental insurance mistake can lead to accusations of fraud and, guess what, such instances are more common than you think!. Fraud can take many different forms, but it most often involves illegitimate gain, deception, and intent. It is possible to land in trouble accidentally, but the intent behind fraud is what sets it apart from negligence. Therefore, your practice and its staff must be fully aware of both coding and the rules and regulations governing claim submissions. Always record and report your actions. However, ignorance is no excuse when it comes to fraud and it  will not save you from going to prison or losing your license.

Here are some of the common billing mistakes that can lead to fraud:

Billing for services not performed or not completed

Although it looks self explanatory,  there are more  complexities to it. It is obvious that billing for a procedure that has not been carried out would be fraudulent. This makes it crucial to confirm the performance or completion of all services before making a claim. Also remember, basic extraction should not be upgraded to a more difficult surgical extraction, and the same goes for reporting a normal cleaning as a periodontal deep cleaning, which is more expensive. All this can lead to fraud, damaging the reputation of your practice and  rupturing its overall functioning.

Waiving deductibles or copayments

When a copayment or deductible is waived, the practices will charge different rates than what the insurance provider believes should be charged. Practices are not permitted to waive their patients’ deductibles or copayments as set by insurance providers. Copayments and deductibles are the responsibility of the patient. Since it leads to false claims and excessive usage of services paid for by the insurance provider, waiving of deductibles or copayments is often regarded as fraud.

Altering dates of service

When a claim is presented with the wrong date of service, it can be considered a fraud. While initially appearing harmless, the date of service may have an impact on a patient’s ability to receive coverage if the treatment was rendered prior to the effective date of their insurance plan or before the conclusion of the plan’s waiting period. Make sure that the date of treatment coincides with appointment scheduling and clinical notations. It should also be related to patient eligibility and any applicable waiting period criteria.


Upcoding refers to the submission of insurance claims for procedures that were more difficult than what was actually performed. This is regarded as a major fraud. Utilizing codes for services the patient did not receive or for more complex treatments than the practitioner actually carried out can create a lot of mishaps at your practice. Insurance providers and regulatory bodies closely monitor upcoding as it can be used by practices as a means of evading insurance regulations and obtaining extra money from the payer. Practices must make sure that they only code for the actual services provided in order to prevent such dental billing issues.

Misrepresenting patient identities

Submitting claims for treatments using another patient’s data can be considered as another major fraud. Make sure  you are filing claims for the actual patients. It is a fraud to treat one patient while intentionally or unintentionally filing the claim under the name of another in order to have the procedure covered. Also, misuse or disclosure of the patient’s specific dental care information in order to obtain payments from insurance providers is again a fraud. Ensure that patient data in your custody will always be safe and not be misused in any way.

Improper use of additional codes.

Always use the most appropriate code when submitting codes for treatments. Using multiple codes to indicate a service on a claim when one code is adequate is considered fraud. Do not break up a process into codes for local anesthetic, incisions, drainage, and sutures if there is already a code for a single service, such as an extraction, that covers the entire treatment. The process of breaking up codes is known as unbundling, which is not permitted.

Tips to prevent frauds

  • Provide formal billing and coding training for your practice staff.
  • Make sure your team is well informed of any changes to coding or insurance regulations.
  • Submit claims that are fully accurate.
  • Partner with a trustworthy dental billing partner to handle your claims

Why should you prevent frauds?

All involved in the dental sector can be harmed by acts of fraud. It can have an immediate impact on your practice in addition to raising the cost of insurance for both patients and employers. If your practice is found guilty of committing a fraud, you may have to pay fines, lose your professional license and access to networks, or perhaps you may even be sent to jail. Therefore, make sure that the claims that are submitted are accurate and are free of any mistakes that could end up landing you in jail.

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Dental Treatment Plan Acceptance – Key To A Successful Practice

A successful dental practice depends on patients accepting the recommended course of treatment. If a practice is unable to persuade their patients to adhere to the recommended treatment plans, they have no chance of surviving. However, it can be tricky to encourage a patient to adhere to their treatment plans. Even though regular dental care is essential, a significant  number of people actively avoid dental treatment as these treatment plans can be pricey, and many  find the treatments to be uncomfortable or frightening. Therefore, giving your patients all the information and specifics they require to understand what their plan entails helps them select which treatment plans they are willing to start right away and which ones will need to wait.

Why do people reject dental treatment plans?

One of the main reasons is the lack of insurance. As per  statistics, almost 76 million Americans are without dental insurance – most of them  above the age of 60. Which means they simply lack the resources to pay for dental treatment. Money can still be a concern for patients even if they have dental insurance, especially if they need a major treatment.  In the end, the cost of treatment may result in treatment refusal. Fear of pain and of dental procedures are also contributing factors. Although dentistry has advanced significantly, patients still dread getting dental treatments, especially if they have had  unpleasant past experiences.

By fostering a relaxed atmosphere and being open and honest with patients about their worries and concerns, your practice can significantly reduce the fears and anxiety of your patients. It is the responsibility of the practice to make sure that the patient is as comfortable as possible because patient acceptance is crucial to preventing the occurrence of serious issues in the future.

So, what are the ways to increase your acceptance rate for treatment plans?

Get to know your patients

Developing a treatment plan with the patient’s dental needs in mind makes it much simpler to convince them to follow through with it. Getting to know your patient is the only way to determine what these dental needs are. Rather than just discussing the patients dental health, ask about their lives, talk to them openly and compassionately about any dental problems they may have and how those problems have affected them. You could find it useful, understanding why they had not visited a dentist. Thus, being aware of their dental needs helps you tailor a treatment plan that meets those needs, thereby, increasing the likelihood of the plan being accepted. Oftentimes, being fully informed is all that it takes to get your patients to change their minds and agree to their treatments.

Educate your patients on the treatment plan

A patient is more likely to accept a proposed plan of treatment if they are better informed, as it increases their trust in you. Make sure that you take the necessary time to discuss each suggested treatment with your patient. Also, provide open and honest responses to all of their queries. Inform them of the value of maintaining their dental health and offer information on their condition, available treatments, and associated expenses. Your patient will understand that you care if you take the time to explain the details to them. Also, they are more likely to accept the recommended course of treatment if they feel more connected to your practice.

Emphasize the need for treatment

Be sure to carefully emphasize the advantages of good oral health and hygiene to your patients. Avoid starting the discussion with the cost of treatments because the moment you do, your patient will only hear about the money involved and not the need for the treatment. Additionally, it will give the impression that you only care about their dental health in order to sell them dentistry. /  Additionally, it will give the impression that you only care to sell them your dentistry and not so much their dental health. You need to make them realize that you truly care about giving them the best dental care possible. You need to instill in them that good oral health contributes to better overall health. Make them aware of the fact that the treatment plan you suggested will only enhance their overall dental health.

Make sure to do proper follow-up

Before making a decision, patients typically need to think over the proposed treatment plan. Therefore, once they leave your office, it is crucial to get in touch with them again in a week’s time or so. This gives them ample time to consider it, conduct independent research, and arrive at a decision. Also, if they still have unanswered questions or are simply afraid of what needs to be done, following up with them can help reassure them.

Schedule the appointment

Your practice should try its best to schedule appointments on the same day the patients accept the treatment plan by giving them a solid presentation of their dental condition. When patients take time to consider when they want to schedule their treatments, they frequently start debating whether they really want the treatment in the first place. In such cases, it will be challenging to convince patients to return to your office for treatment. If the patient requests extra time to consider the suggested course of treatment, make sure that your practice staff does proper follow-up to find out when the patient would prefer to have it done and fix the date for the treatment.

Eliminate patients fear

It has already been established that a patient’s decision to proceed with the care they require is significantly influenced by their feelings of fear and worry. Working to eliminate a patient’s fear is one strategy to boost the likelihood of them proceeding with the required dental treatment. Also keep in mind that reassuring a worried patient that you will explain what is happening at each stage of the treatment and that you will stop if they experience any kind of pain may help them feel better about going ahead with the proposed treatment plan.

Analyze the figures and monitor any alterations in your dental case acceptance rates over time. If you notice any significant rise or falls in your figures, consider reviewing your approach to see what you are doing right or wrong. Exhibit your interest in each patient by getting to know them, educating them, sharing the advantages of good dental health with them, and following up which would, without doubt, boost your treatment plan acceptance rate, leading to a more successful practice.

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Get Started With Dental Credentialing

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.

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Filing Claims for Orthodontic Treatments

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. 

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Managing Overpayments – Stabilizing your RCM

Most dental practitioners spend a lot of time ensuring that they receive overdue payments as soon as possible. While this is obviously a necessary step to take, overpayments have also become a growing problem in the dental industry. Patients are often charged more than they should be for services and visits. Although overpayments can be made due to patient error, it is usually the insurance company that overpays. In both scenarios, overpayments need to be reimbursed without delays. How your practice manages the refund process will affect a patient’s overall impression of their dental practitioner.

 Some of the most common reasons for overpayment include:

●   Out of date patient eligibility and benefit information.
●   Incorrect billing due to changes in coding not being tracked.
●   Incorrect estimation of copays and coinsurance amounts at the time of service.
●   Changes in policy between the time of the dental visit and the billing process.
●   Errors in billing.
●   Overpayment by the patient.

  Avoiding overpayments

  Considering that prevention is better than cure, it is always advisable to avoid situations that could result in overpayment. One solution is for your practice to ensure that their coding is up-to-date and accurate. This can be done by regularly checking for coding updates and making sure that all claims are submitted with the right codes. Additionally, it is important to double check insurance information before submitting claims to ensure that the patient is not being charged more than they should. Other important ways include:

 Estimating your patient’s responsibility

Create a payment schedule for patients with larger balances so that the money can be collected over time. This will help your practice to track payments as they are made, which helps minimize overcollection. Establishing patient expectations and creating payment mechanisms to collect the payments or recurring balances, guarantees that your practice gets paid exactly what it is owed, nothing more and nothing less.

Checking for patient responsibility in real time

Before beginning the billing process, make sure the patient’s benefit details are up-to-date and accurately documented in your system. To ensure you have the most recent information possible, check the patient’s eligibility before each visit and dental appointment. Using outdated benefit information can result in incorrect billing, which can lead to patient overpayments.

Improving patient engagement

Patients are more likely to pay close attention to how much they owe when you involve them in the payment mechanism. Provide your patients with various payment options, as this helps increase their convenience. Patients are less likely to make payment mistakes and more likely to keep track of what they owe when they have control over their dental care payment process. 

What to do when overpayment occurs?

  Notify your patient about the overpayment. If the patient plans to return, check with them about crediting the excess amount towards their future visits or services. However, the excess payment must be returned if the patient doesn’t wish to use it for a future appointment. The next step is to quickly send the patient a check for the amount overpaid, along with a note explaining the situation of the overpayment.  Dental providers find themselves issuing refunds when there is a situation of overpayment. The manner in which a practice manages its refund procedure will affect the patient’s overall dental care experience. In order to provide their patients with ease and convenience, practices need to view the refund process as a crucial part of the patient’s dental care experience. In conclusion, overpayments are a growing problem in the dental care industry. Though there may be multiple reasons, identifying overpayment scenarios and addressing the issues on time can go a long way in reducing the number of occurrences.

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What You Need To Know About Insurance Verification And Authorization For Better Reimbursements

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.

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It is time to clean up your old Accounts Receivable

Collecting patients’ payments on time can be one of the most difficult parts of running a dental practice. Having old or aging accounts can indeed become a headache for your practice’s payment collections and management. Your practice needs to make sure that it is getting paid for the services provided and that the payment is collected from both the patients and the insurance provider. But often you see practices struggling to collect payments on time.

There are various explanations for why dental practices do not receive full payment. 

This includes:

  • The patient leaves a balance.
  • Insurance does not provide the expected coverage.
  • The patient discontinues payments under the established payment plan.

Now, why do you need to clean up your old accounts?

Accounts receivable is a major expense for dental practices which can easily go out of control. If accounts receivable get too high, it can even result in your practice being closed down. However, the good news is that regular cleaning up of accounts over the next 90 days will help your practice collect outstanding balances and limit bad debts, thereby preventing the accounts receivable from getting too high. Clearing old accounts on a regular basis also helps to make sure that not much time or money is spent chasing past-due patients’ balances and insurance balances. The goal of your practice should be to clear all accounts in accounts receivable that are older than 30 days.

Steps to cleaning up old accounts

Create a report

The first step to cleaning your old accounts is to create a report of accounts over the past 90 days. The likelihood of your practice collecting on overdue accounts decreases dramatically once they remain unpaid for such  long periods of time. This makes it important for practices to create a report of all the old accounts before they get written off.

Clean up patient data

Making sure that your patient data is clean and accurate is highly important for ensuring that your claims get paid on time. Any mistakes or inaccuracies in it can lead to payments getting delayed or worse, claims getting denied altogether.


  • Check for any duplicates
  • Check for missing information
  • Check for inaccuracies or errors
  • Check for inaccurate patient demographics
  • Check if the patient data are up-to-date

Review pending patient payments

Reviewing pending payments helps your practice get an idea of what went wrong, whether it is a mistake from your part or the insurance provider or the patient. Reviewing payments within the last 30 days will help you know if any payments have been forgotten or if there is some kind of problem with one of the insurance providers.

Send friendly reminders

The best way to stay organized and on top of the numerous patient payments is to send timely reminders via text messages, emails or phone calls. This helps your practice make sure that none of the payments go unpaid. It can be the best means to remind your patients of their payments, as there are high chances that they might forget about the payment.

Make follow-up calls

This is the last step in cleaning up the old accounts. It is the part where you call the patients to remind them of the payments and convince them to pay the due amount. There may be a lot of reasons that keep your patients from making the payments. This is your chance to talk to them and understand what is stopping them from making the payments so as to make the necessary changes to make payments easier for your patients, if possible.

Here are a few tips to clean up your unhealthy accounts receivable:

Collect payments on or before the day of treatment

Make sure to collect patient payments before providing the services so as to make sure that none of it goes unpaid. Collecting payments prior to providing services also helps reduce no-shows and cancellations. If you are not able to collect it at the time of scheduling, do so before the patient returns for treatment, especially if their appointment is long or challenging.

Avoid surprises

Before beginning treatment, explain the treatment plan and the anticipated cost to your patients. Have current eligibility information, a summary of benefits, and the insurance fee schedule on hand for the patient. Avoid surprises as it may ruin their experience, making them lose trust in your practice and not want to visit again.

Provide constant reminders

Provide constant reminders to your patient so as to make sure that they do not forget about their payments that are due. Make sure to call the patient if payment is not made by the due date. Even better, send them a text or email with a link to a payment page so they may pay the remainder online quickly and conveniently.

Offer various payment options

Make sure that it is easier for the patients to make the payment by offering them various payment options. In addition to accepting cash, checks, and charge cards, allow your patients the convenience of making payments online. Thus helping your practice collect payments faster and easier.

Cleaning up old accounts can be a great way for your practice to collect on outstanding balances and reducing bad debts. The key is to do it regularly and make sure you have a plan in place before starting.

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Dental Insurance Waiting Period – What You Need To Know

Dental billing is an important part of maintaining the steady health of your dental practice, but it can also be confusing and tiring. Understanding your patients’ insurance coverage and waiting period is essential to ensuring that you get the most out of their policy. Knowing what to expect during the waiting period and what services are covered can help your practice make the most of the patient’s dental insurance. Therefore, it becomes highly important to understand and take into account your patient’s insurance waiting period.

So, what exactly is a dental insurance waiting period?

The waiting period is the amount of time your practice or the patient needs to wait between the purchase of the insurance plan and the date the services are completely covered. This period varies from plan to plan. The length of a waiting period for dental benefits might range from a few months to a full year, depending on the type of plan you’ve chosen and the details of your insurance policy. So it is important to understand the specifics of the policy. There are chances that the dental insurance may not cover certain procedures while the waiting period for the dental plan is in effect. Also, not all dental insurance companies have a waiting period. Waiting periods for dental insurance aid in containing your patient’s overall dental insurance expenses. They stop your patients from getting expensive dental work done and then canceling their coverage soon after, which raises everyone’s costs. In essence, waiting periods assist in keeping the cost of dental insurance reasonable for all your patients.

Services covered during the waiting period

Understanding which procedures require a waiting period before providing the services can help your practice in the long run. Therefore, it is important to contact the insurance provider if you have any doubts regarding the services covered under the waiting period. Keep in mind that some plans have longer waiting periods than others. Here are some of the treatment categories for waiting periods:


Preventive care is usually not subject to a waiting period under most dental insurance policies. These include checkups, cleanings, x-rays, etc.


Basic procedures like non-surgical extractions or fillings may have a three to six months’ waiting period.

Major dental works

Major dental work like dentures, bridges, and crowns may have a three months to one year’s waiting period.

How is the dental insurance waiting period a limitation?

Most patients only need the insurance for a limited period of time. Since insurance firms are aware of this. Waiting periods protect them against such circumstances. There are waiting periods in some insurance plans, but not in all of them. Waiting periods are a way to limit how much insurance money a patient can get in reimbursement over the course of the plan’s implementation. As a result, insurance costs are reduced for both your patients and your practice. However, during insurance verification, it is crucial to inquire if a patient has a waiting period as waiting periods can delay patient treatment payment collection, thus affecting the overall revenue collection at your practice. The patient will be required to pay out of pocket for the procedure if neither the patient nor the dentist are aware of the waiting period and the insurance does not cover the cost. We can almost certainly predict that the patient  will not be thrilled by such surprises that they  are not prepared for. This can negatively impact their experience at your practice. As a result, unexpected waiting periods in dental insurance plans can prevent your practice from receiving payment for services rendered.

Common mistakes when it comes to waiting periods.

The most common mistake that the practice as well as the patients make when it comes to waiting periods is not being prepared for them. Another important mistake they make is assuming that waiting periods are the same for all plans.

What should you do about the waiting periods of patients’ insurance plans?

Make it a priority at your practice to ask the insurance provider if the patient has a waiting period in their plan during the time of verification. Also, make sure to collect information or details regarding the waiting periods as you need to inform your patients regarding their waiting period before providing any services. If you do not, the patient is likely to hold you responsible if the insurance company does not cover for the procedure. Upset patients and possible financial loss could be the result of this.

Your practice needs to be aware of the different types of waiting periods, what they are, and how they work. It is also critical to understand what services are covered during the waiting period in order to plan accordingly so that the revenue cycle of your practice does not get affected and the practice runs smoothly.

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Tracking Your Claim Status

Nothing in a dental practice is more upsetting than learning that your dental insurance claim was rejected or wasn’t reimbursed fully. Which means you have to go back and figure out what went wrong. However, the majority of medical practices rely heavily on insurance payments, so it’s crucial to monitor claims and look into the causes of rejections, even if it is time consuming. In most cases, practices have to wait for EOBs (Explanation of Benefits) before identifying the errors or mistakes in claims. However, with proper tracking practices, we can detect errors in claims early on and take the required action to ensure that claims are processed promptly.

The claims billing process at your practice doesn’t end with successfully submitting the claims. To handle challenges like the payment of smaller claim amounts, erroneous fund redirection, rejection of the ID you have provided, and to answer any inquiries from the insurance provider, your practice needs to be actively involved in the dental insurance claim process. It is really important to keep tabs on the progress of your insurance claim, as it enables your practice to stay informed about the claim’s status and learn about any delays or obstacles that may have occurred during the claim’s processing. When checking for the status of your claims, you may come across different claim status types, and each may require different action.

Here are some of the claim statuses you can come across:


This means that the claim has been approved by the insurance provider, and all you have to do now is to wait for the payment of your claim.

Under process

This means that your claim has not yet been processed, and you need to keep a continuous check on it to make sure that it gets approved.

Details required / Issues

This means that you have to contact your insurance provider and submit the necessary additional documents so that the insurance provider can continue with the claim processing.


This means that your claim has been rejected, and you now need to contact the insurance provider and find out the reason for the denial. You can file an appeal if you think that there was an error while processing the claim. 

What are the benefits of tracking your dental claims?

Helps prioritize denials

With continuous tracking of claims, your practice does not have to wait for the explanation of benefits to take action against denials. Tracking your unpaid claims helps identify the reasons for denial, thus helping you correct the mistakes or errors and appeal claims without much delay. Tracking unpaid claims gives your practice the chance to work on them early on and prevent the claims from going unpaid.

Helps identify red flags

Continuous and thorough tracking of claims helps in identifying patterns in claim underpayments or denials. It is crucial for practices to identify internal issues or trends that might be contributing to these denials. These can be considered learning opportunities that will help avoid repeating the same mistakes that lead to claim denials.

Helps pursue appeals

Since tracking claims helps you identify unpaid claims and reasons for denials early on, it thereby helps practices submit appeals faster and much easier. Your claim appeals can be accurate and efficient with claims tracking, as it helps you identify the errors early on and fix them quickly.

Increase in revenue

Proper tracking of claims helps your practice submit claims efficiently and on time, increasing the clean claim rate and thereby increasing the overall income at your practice. It also helps in making sure that no claim goes unpaid or unnoticed. Even the ones that get denied are appealed for on time.

Here are some tips to improve the tracking of claims at your practice:

  • Obtain the most up-to-date claim status.
  • Work on your dental insurance aging report at least once a week.
  • Keep an eye on your average monthly production and your total accounts receivable.
  • Follow-up on all dental claims that are more than 30 days old.

The main aim of submitting a claim is to get reimbursed for the services provided. While promptly filing a claim with your insurance provider is essential, it’s also critical to monitor the status of your claim. This ensures that action is taken on time, regardless of the issues with your claims.

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Leveraging Recalls for better practice management

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.

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Understand How Copays, Deductibles, And Coinsurance Work

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.


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. 


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 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. 

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Why Do Practices Hesitate In Partnering With an RCM Service Provider ?

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.

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Stop Letting Poor Dental Coding Ruin Your Practice’s Revenue Cycle

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.

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Transparency In Patient Payments: Improve Your Practice Performance

Dental practices charge different patients varying amounts for the same services. Because of this, patients rarely know what the payment for the services are until after they have received the treatment. Lack of transparency in the costs of treatments and the resultant fluctuation of prices within the same city or state has led to some practices charging more for certain services than others, thereby, increasing the overall cost of dental care, and the amount paid by the patients.

Since patients and doctors alike, cannot predict what treatment is required until after consultation, there is no scope for informing patients what their payment amount would be at the end of their visit. So, if there are any out-of-pocket payments to be made, it would come as an unwelcome surprise to the patient, leaving him / her in distress. Such situations negatively impact the overall experience the patient has at your practice. This could make them never want to visit your facility again and look for an alternative one instead. Most practices are often overly cautious about revealing the costs or high costs of their services and treatments as they worry that they may lose patients to practices that charge less for the same services or treatments. However, this is far from the truth as the cost of the treatments and the quality of the services or treatments are not always related. Patients choose more expensive treatments because they believe that more expensive treatments are of higher quality.

Transparency in patient’s payment details has its own challenges. Some of them being:

Determining the services needed in advance

It is almost impossible for a practice to determine exactly what services all of its patients may need. This makes it hard for the practice to come up with an accurate payment amount in advance. Sudden and unexpected treatments or procedures can disturb this and complicate things further for the patients, disrupting their entire patient experience.

Difficulties with patients’ insurance policies

Attempts to make patient payment details transparent can be difficult because of the complex insurance rules and regulations. This is made particularly difficult by the vast range of insurance benefit structures and the challenge of estimating the payment when charges come from several suppliers.

Legal hurdles

Legal obstacles to reporting payments, such as contractual obligations that, in some cases, prevent health plans from disclosing their negotiated rates with providers, are also factors that prevent practices from disclosing patient payment details ahead of treatment.

Even though there are a lot of challenges in making transparency in payment details a routine, it is essential for the improved functioning of your practice and creating a better experience for your patients.

Benefits that come with providing transparency in patient billing:

Better patient experience

Patients have long been burdened with unforeseen payments that they had not budgeted for before receiving the treatment. This has always been the norm in the world of dental payments – leaving the patients frustrated and perplexed when the time comes for them to pay the dental bills. With transparency in billing, the frustration and worry that patients are faced with can be limited to a certain extent. In turn, this gives rise to a better patient experience at your practice.

Encourages patient payments

Better payment transparency results in greater patient education and comprehension of their treatments and associated expenses. Instead of being caught off guard and anxious when their dental bill arrives, the patients would have time to plan and budget for the cost of services. Your patients are more likely to make the payment if you employ price transparency tactics at your facility.

Enhances patient relationships

Payment transparency can actually help your practice build a strong relationship with your patients. With better price transparency, your patients will feel more calm and less worried about their payments. Patients feel a sense of empowerment and relief with increased transparency into the cost of their dental care. This helps to build a strong relationship with your patients and deepen their trust in you, which in turn enhances your patient relationships.

Boosts revenue

Being clear about billing helps your practice make more money. It shows patients how much they owe and encourages them to pay quickly for their treatments. Knowing the payments will only help your practice boost its revenue. Transparency in billing involves informing patients beforehand about the services or treatments they will receive and the corresponding costs. This ensures that patients are aware of what they will be receiving and how much they will need to pay.

Dental care can be costly, complex, and personal, and it involves choices that can have a lasting impact. What is more, most patients lack sufficient knowledge of the dental care system to make informed decisions about their use of healthcare benefits and services. Educating them on the best courses of treatment for their dental health and explaining to them the possible costs for the treatments will make your patients feel more valued and cared for by your practice.

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Enhance Accuracy and Consistency With Charge Capture

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.

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

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.

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Pump up your Eligibility and Verification Strategy

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

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.