The framework for Revenue Cycle Management is supported and established by claims billing, which provides cash flow for the practice. Errorless claims billing, among other things, sets the foundation for the revenue cycle management of dental healthcare. Therefore, poor billing and coding practices can result in denied claims, which holds down the collection and reimbursement and negatively impacts the overall revenue cycle. Proper claims billing ensures that the accurate amount for the services provided to the patients is reimbursed in a timely manner. Without a proper billing system, practices won’t have any way of generating revenue from their patients, and therefore it becomes a crucial step in the revenue cycle management.
So, what exactly is claims billing?
Claims billing is the process of generating insurance claims and patient bills using dental codes obtained via the dental coding procedures. After each patient visit, the provider assigns different diagnosis and procedure codes to the interactions and a bill is produced by adding the price of the treatments or services provided to the patient’s balance. The patient’s copayment and insurance coverage are also taken into consideration. The different codes help insurance companies in analyzing the claim and related coverages. Later, a clean claim is created and processed, and if the claim gets denied, then it needs to be properly addressed before the claim can be paid. The practice also needs to be well versed in the different billing and coding guidelines as well as the insurance policies, as ignorance of these may result in claim denials.
Common difficulties in dental billing
Missing tooth clause
The patient might be eligible for coverage for a fixed bridge, but only if the lost tooth was pulled while the patient was still covered by their insurance. There is no coverage for the replacement if the tooth was extracted while the patient was not covered under the specific plan. When confirming the benefits of the insurance plan, this is a crucial question to be considered. Ignoring the verification can result in the denial of claims.
Some policies do not cover certain procedures at all, even though it may be the same insurance company that has previously paid for the same procedure for someone else. This can be a real struggle for your billing team and can create a lot of confusion, which may disturb the entire revenue cycle.
Incorrect CDT coding
Every year, CDT codes undergo changes and adaptations, and if you are not aware of these code and nomenclature changes, you may send a claim without the required information for timely reimbursement or bill an insurance payer using a different code. This can become a roadblock to your billing process and can disturb your complete revenue cycle.
Age of patients
There may be age limitations for services based on the insurance plan. Not keeping up with these changes can cause havoc in your billing process and even revenue loss. Therefore, it becomes important that you check these limitations before beginning the billing process for a timely and complete reimbursement.
Unreadable or illegible documentation is another common mistake made during claims billing. In their hurry to get the billing process completed, practices do not pay much attention to the documentation and often overlook such errors without realizing that such small errors can lead to claim denials, disturbing the revenue cycle.
Insurance companies demand accurate, full patient information and any incomplete or insufficient information won’t provide them with the details that they need. This delays the claims processing and, thereby, the payment process. Therefore, make sure that you have all the necessary information before starting the billing process .
How can you improve your billing process?
Regular update on coding changes
The codes for dental procedures are frequently updated, therefore, the practice must always stay informed of any such changes to the existing codes, learn new codes, and be familiar with any codes that have been eliminated in order to avoid dental claim denials. A regular update on coding changes can save your practice time and energy needed for reworking denied claims.
Tracking Frequencies, Exclusions, and Limitations
Usually, frequencies, exclusions, and limitations vary according to different insurance plans, and the amount available actually depends on these factors. There are even policies with age group limitations for certain procedures. Therefore, it’s crucial to obtain a copy of the patient’s information as well as an insurance certificate that details exclusions, age limitations, and plan benefits before the claims billing process.
Collecting detailed information
The claim form needs to have complete patient information, including patient ID numbers and service dates, as well as information on dental procedures, as it helps in processing the claim further. Remember that a lot of denials return to the providers with a pending status and no revenue payments because of improper documentation and incomplete or inaccurate information.
Dental Care provider’s information
For error-free claims billing, you must collect information from the patients as well as the dental care provider. Prior to submitting the claim, double check to make sure you have included all the required information to prevent a denial.
Specific documentation for particular claims
For certain claims, insurance companies will need specific documentation in order to proceed with the processing. Insurance companies, for instance, would need X-rays and prior charting that demonstrates bone loss in the cases of scaling and root planing. Therefore, having information or documentation on the various treatments and procedures involved can prevent claim denials to a certain extent.
Deadlines are critical
Deadlines are very critical for the proper running of an RCM. Therefore, it is important that you keep track of and properly follow the deadlines without making a mistake. Make sure to complete the claims billing process within the given timeframe, as any delay can lead to claim denials and can delay the entire payment process, resulting in revenue loss.
Regular auditing is necessary to strengthen the claims billing process at your practice and wipe out any potential errors. These assessments and audits help your dental practice cut down on the maximum amount of unnecessary expenses.
Partnering with an RCM service provider
Partnering with an RCM service provider helps your practice complete their claims billing service without any interruption or errors. With an expert professional by your side, your claims billing process becomes more effective and also provides your practice with the time to focus more on patient care and treatment.
A proper and well organized claims billing process can greatly reduce the risk of denied or rejected claims. The revenue cycle management of any dental practice heavily depends on its claims billing. Therefore, make sure that you carry out the claims billing process without any delay and without any errors. Otherwise, the entire payment process would be at risk.