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Why Should You Pay Attention To Your Accounts Receivable Days

by [email protected]

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

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

  • To receive maximum reimbursement from insurance companies.

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

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

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

  • Proper AR management helps in tracking denied claims.

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

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

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

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

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

  • Helps in faster claims submissions.

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

  • Helps ensure the smooth functioning of the practice.

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

  • Helps improve the patient experience.

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

Accounts Receivable Management

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

Why consider an RCM service provider

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

How to Successfully Bill Medical Insurance for Dental Treatment

by [email protected]

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

1. Understanding Medical vs. Dental Insurance

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

2. Identifying Medically Necessary Dental Procedures

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

3. Collaboration with Medical Professionals

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

4. Accurate and Detailed Documentation

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

5. Verification of Medical Insurance Coverage

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

6. Prior Authorization Process

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

7. Coding and Billing Procedures

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

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

8. Submitting Claims and Following Up

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

9. Appealing Denied Claims

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

10. Patient Communication

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

Conclusion

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

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

by [email protected]

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

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

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

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

Understanding the Difference

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

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

Factors Influencing the Decision

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

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

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

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

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

Case Examples

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

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

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

Conclusion

By understanding the foundational differences medical billing for dental offices.

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

How to Calculate Accounts Receivable Collection Period.

by carerevenue

The Accounts receivable collection period refers to the amount of time it takes for a dental practice to collect payments owed by its patients and insurance providers. It can be used to make sure that your practice has enough revenue to meet its financial obligations, thus improving the proper working of your practice. It serves as an indicator of how well your practice handles its accounts receivable, thereby making it a crucial factor for practices that depend largely on their revenue or cash flow for its smooth functioning. A practice should always be able to maintain its accounts receivable collection period to the minimum if they want the practice to be successful and their revenue to be high. Remember, the lower the accounts receivable collection period, the faster the payment would be and the higher the revenue would be. Knowing how to calculate and analyze your collection period will ultimately help you increase the effectiveness of your accounts receivable management.

How can you calculate the accounts receivable collection process?

In order to calculate the average accounts receivable collection period, first, divide the company’s net credit sales for the year by 360 or 365 days. This gives you the average credit sales per day. Now divide the average balance in accounts receivable during the year with this result. 

Some of the processes involved in the calculation of the accounts receivable collection process are:

Gathering the data

Keep a tab on the data you need for calculating accurate account receivable collections. The various requirements for calculation need to be identified and collected without any errors or mistakes. The important data that needs to be collected include net credit sales, average accounts receivable balance, and accounts receivable turnover ratio. 

Calculating the collection period for accounts receivable

The formula for calculation needs to be clearly understood for an accurate accounts receivable collection period, and the data collected should be appropriately used in the formula. Once all the collected data is put into the equation, you can easily solve it to get the required result easier and faster.

Why should you calculate the accounts receivable collection period?

A practice can use its accounts receivable collection period to identify trends in its own insurance claim processing. It can be used to compare your practice’s revenue cycle with that of your competitors. So that you can identify your practices’ shortcomings and work towards improving them. Doing a proper calculation of the accounts receivable collection period can help your practice identify any mistakes in claim submission and take steps to prevent the same from happening again. This helps in reducing the number of claim denials and unpaid claims, thus improving the overall functioning of the practice. The main goal of your practice should always be to reduce the accounts receivable collection period to the least and get the payments from your patients and insurance providers as soon as possible without any delay so as to help your practice in its growth and development. But just identifying and analyzing the areas of improvement won’t help your practice. Instead, you need to take steps for improvement from the data calculated. Remember, the revenue flow of your practice depends highly on its accounts receivable collection period and knowing it would help your practice to take measures to collect the payment without any delay within the given time frame.

Role of AR management

It is the responsibility of a practice’s AR management to keep track of their AR collection period and to make sure that the payments are collected within the given time frame. Make sure you keep an eye on your practice’s accounts receivable collection period so as to monitor its performance and growth at every point without making any mistakes. It also helps your practice in implementing strict rules or policies for collecting timely payment from your patients without any difficulties by tracking trends that may show continued payment delays or unpaid claims by certain patients. 

How does it affect your practice

It’s important to understand that claims with accounts receivable collection periods of more than 60 or 90 days are at a high risk of going unpaid, which can greatly hit the overall revenue of the practice. Therefore, it becomes important to limit your accounts receivable collection period to below 50 days. If claims take more than 50 days to process, then strict measures need to be taken to collect the payments on time so to reduce unpaid claims and ensure that the functioning of the practice is not affected. 

Do not forget that as the revenue of the practice gets hit, the quality of facilities in your dental practice also gets affected. Complete payment of receivables translates to increased cash flow, leading to better quality of patient care. Have your accounts receivable collection period minimized to the lowest so as to prevent revenue leakage.

It can also help you determine the effectiveness of your RCM and work on the areas that need improvement. It shows how well your collection policies are working out, whether they are helping your practice or not, so that you can work accordingly. You can continuously monitor your accounts receivable collection period and compare it with your previous years to check the performance status of your practice for points of improvement.

Make sure you know the accounts receivable for all payers individually, so you can easily identify patients with high accounts receivable collection periods and take measures to get the payment faster. Practices often overlook the need for the proper calculation of accounts receivable among the other complex processes of RCM, without realizing that it is one of the most crucial and important steps in RCM, which can determine the success of a practice. Ignoring or paying less attention to the calculation of the AR collection period can harm your practice in many ways.

Conclusion 

The Accounts receivable collection period can be a really powerful tool for measuring the success of your practice. Calculating our practice’s receivables  and all the other related tasks can be really stressful for your practice. Partnering with a dental RCM service provider can be the perfect solution as they guide you through the complex process of revenue cycle management so that you can concentrate on the more important needs of your practice, like patient care. They help you calculate the accounts receivable collection period and determine the growth of your practice without you having to worry about it in any way.