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Why you Should Embrace Technology At A Dental Practice

Over the past decade, technology has taken the world by storm, bringing in flexibility and efficiency. The dental industry has not fallen far behind its impact. Advancements in the field of science and technology have convinced the dental practices of its relevance and how its integration into their business can increase efficiency and maximize productivity. 

The integration of modern technology at a dental practice can not only facilitate the dental professional in their tasks, but can enhance the patient experience as well. The more a dental practice can offer to their patient, the higher is the patient satisfaction and the greater is the appeal.  Even though the modern dental practice would constantly require improvements and updations, having a solid foundation in place is supremely important for the optimal functioning of any dental practice.

Benefits of technology at a Dental Practice:

  • Digitization increases efficiency:
    Digital platform in dentistry ensures that all patient information, imaging systems, and data work together effectively in a connected manner. The real-time flow of information allows practices with a digital platform the liberty of operating more efficiently along with quicker delivery of procedures and a significantly higher level of productivity.
  • Saves time:
    Incorporation of technology in the dental practice has proven to save time on a lot of aspects of providing patient care as well as practice management. With faster dental processes in place, dentists are now able to accommodate patients with time constraints or a busy schedule. Technology has also enabled same-day completion of treatments that would have otherwise taken multiple appointments without compromising on precision.
  • Providing a competitive advantage:

Technological advancements offer significant competitive advantage. Practices capable of delivering more efficient treatments, comfortable patient experience, same-day treatments, shorter appointments, and lesser invasive procedures tend to have a greater appeal to the patients. As the dental industry continues to embrace technology, it has seemingly become more and more important for practices to stay updated with recent developments, so as to ensure they don’t fall behind in this competition. With every practice having access to almost similar kinds of technology, the competition would rather be more about who makes the best use of it.

  • Improvement in patient experience:
    Dental treatments can sometimes be a bit overwhelming for patients. Dentists should therefore dedicate themselves to the comfort and positive experience of the patients. Focusing on the comfort of patients and ensuring that they are relaxed throughout the treatment as this makes a lasting impact on the patients and ensures that they return for regular check-ups.
  • Easier integration of RCM services:

It is only when a practice switches to digital charting and clinical note-taking, is when they will be able to outsource to RCM services more effectively. Most, if not all, dental practices across the US have now switched to outsourced RCM. Outsourcing your RCM services help the practice earn more revenue while still costing less than hiring a full-time billing/insurance coordinator.

  • Measurement of performance:
    The ability to quickly and easily measure staff and clinic performance is perhaps one of the key benefits of embracing technology. By implementing the necessary KPIs and frequently monitoring performance through reports extracted from dental management platforms, dental practices can ensure the efficiency of their staff and the practice thus improving their clinic’s profitability.


In comparison to previous times, patients nowadays have a better awareness of advanced technology, and expect the integration of a similar high-tech environment at the dental clinic. Advancements in dental equipments are bringing drastic changes and making high-tech practice a reality, with innovative equipment increasing efficiency in patient care and thus delivering better services to patients. Dentists can no longer afford to wait a decade to invest in and incorporate new pieces of equipments in their practice, as was in previous times. They are challenged every day to keep up with the pace of the ever improving technological advancements in order to remain productive, efficient, competitive and most importantly, relevant, among their competition.

A well-thought-out plan for the integration of  technology in a dental practice and following up on current trends to plan upgradation can help the practice be well positioned in the market and enjoy a greater success in the age of digitization in the field of dentistry.

What is EHR and Why is it Important?

The healthcare industry is complex. Its prime focus is always the safety of its patients and providing quality care, which is much more challenging today than ever before. Healthcare professionals and patients are therefore getting to use telemedicine technology, with electronic health record systems being an inherent part of it. In today’s healthcare picture, electronic patient records (EHR) are the commonly accepted norm. 

This brings us to the big question, What is EHR?

Electronic Health Record (EHR) is a systematized set of interconnected databases containing part or all of a patient’s electronic medical records and history. This is maintained by the healthcare provider over time and may include all of the critical administrative clinical data relevant to that patient’s care under the healthcare particular provider. A patient’s EHR may include demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports, along with even personal statistics like age and weight, and billing information. 

The EHR greatly reduces dependency by automating access to information and has the potential to streamline the clinician’s workflow. It is also capable of supporting other patient care-related activities directly or indirectly through various interfaces like quality management, and outcomes reporting. EHR provides the healthcare team, including family doctors, nurses, emergency room clinicians, and specialists, real-time access to the patient’s relevant medical information, so they can provide the best care in the most efficient manner.

Advantages of Electronic Health Records

EHRs and their ability to exchange health information via electronic means can help a practice provide higher quality and safer care for patients while creating tangible enhancements at the same time. EHRs can help providers better manage the care provided to patients and provide better health care by :

  • Providing accurate, current, and complete information about patients at the point of care.
  • Improving privacy and security of the patient data
  • Helping in the effective diagnosis of patients, reduction in medical errors, and providing safer patient care
  • Promoting health care convenience by encouraging patient and provider interaction and communication
  • Allowing for the secure sharing of electronic information with patients and other clinicians
  • Enabling safer, more reliable prescribing
  • Reducing costs through decreased paperwork, better safety standards, reduced duplication of testing, and improved health.
  • Facilitating quick and seamless access to patient records for efficiency in patient care
  • Helping promote comprehensive and complete documentation along with accurate and streamlined coding and billing process.
  • Helping providers improve productivity and work-life balance
  • Assisting providers to meet and exceed their business goals through improved efficiency

Electronic Health Records transformed health care in the following ways:

  • Better health care by improving all critical aspects of patient care, including safety, effectiveness, focus on patients, education, communication, timeliness, efficiency, and equity.
  • Better health by encouraging a sense of need for healthier lifestyles among the population, including increased physical activity, better food habits, avoidance of behavioral risks, and wider use of preventative care.
  • Improved efficiency and lower health care costs by encouraging preventative medicine and treatments along with improved coordination of health care services, as well as by reducing waste and redundant tests.
  • Better clinical decision-making by incorporating and integrating patient information from across multiple sources.

How does EHR boost efficiency:

  • Consists of built-in templates for physicians to refer to
  • AI assists physicians with the diagnosis and interpretation of reports
  • The E-prescribing feature saves physicians valuable time
  • Reduces the abuse of controlled substances that require a prescription
  • Checks automatically for any associated allergies or reactions to drugs

Integration of EHR with Revenue Cycle

In addition to the many advantages of EHR in the healthcare system, the most significant advantage is probably its capability of streamlining the revenue cycle and improving overall healthcare facilities. Medical practices providing diagnosis and treatment services need to be properly reimbursed to ensure financial stability.

Revenue cycle management, alongside its billing function, also plays a key role in assessing the financial health of the medical practice. A regular source of revenue is important to cover the cost of medical equipment, medications and other overheads.

Any errors in the medical information make the diagnosis and treatment of patients, a herculean task for doctors and surgeons, in addition to the evident difficulty in getting full payments and reimbursements for the treatments provided to the patients, in the later stages. Not to ignore the possible lawsuits and the prospect of paying expensive legal fees that a practice may face as a result of wrong diagnosis and treatment.  A purposeful EHR system helps avoid all these shortcomings and insufficiencies by ensuring that the patient information is accurate and up-to-date and correctly reflects on the medical bill.


Electronic health records are becoming an inevitable part of the modern healthcare scenario. EHRs are the next step in the constant progress of healthcare that has the potential to strengthen the relationship between patients and clinicians.  The data, the timeliness, and the ease of access are the factors of EHRs, that enable providers to make more informed decisions and provide improved patient care.  One of the best ways to ensure optimal utilization of the benefits of electronic health records is to achieve meaningful use. By achieving meaningful use of EHR, you can gain benefits that are beyond mere financial benefits.

What Is Accounts Receivable Management & How to Improve It

Accounts receivable is the money that is owed to a business after it has sold goods or services on credit. The status quo shows a rise in operating costs and an almost proportional increase in the number of patients with high-deductible health plans. Due to this, managing AR (Accounts Receivable) has become a herculean task leading to the mounting of the receivables, which is the leading cause of reduced cash flow in a practice. This is commonplace in most dental practices and their revenue cycle has been witnessing a steady decline due to it. It thus becomes very crucial to manage the accounts receivables efficiently to ensure the practice benefits from timely payments, happy client relationships, and high liquidity for your practice. There are multiple complexities involved with accounts receivable; including its management, the process of recording in financial statements, credit period, etc. Today we shall go over its management aspect and the ways in which the entire process can be improved. 

What Is Accounts Receivable Management and Why Is It Important?

Accounts receivable (AR) management is the process of obtaining customer payment within a given time period. Practices often make use of AR management to ensure the proper tracking and management of every step involved in collecting payment after the patient has undergone a procedure. It is a vital component for any practice for building liquidity and profitability and avoiding bad debts and there is much more to it than simply receiving payment on a bill. Accounts receivable management is not only about reminding the customers and collecting the money on time. It also involves the identification of the various reasons for any unforeseen delays and effectively finding a solution to those issues.

A successful accounts receivable management process helps practices maintain a healthy cash flow, which is essential for avoiding shortages or, in some cases, even bankruptcy. It is a known fact that a practice’s future revenue is based on incoming cash and hence avoiding delays in customer payments is paramount for the practice’s growth. Practices ought to put in time and effort to effectively manage their accounts to increase their working capital and, ultimately, pay their own bills. If in the worst-case scenario, a practice fails to provide proper, timely billing or collect patient payments, the subsequent limited cash flow can render them unable to cover their own operating costs.

It is also important to understand that the longer an account goes uncollected, the greater the loss of revenue, and the greater will be the amount of resources the practice would need to allocate for collection efforts. The best way to resolve this issue is by including accounts receivable timeline, with the days or months outstanding in a monthly report indicating the same. Keeping a lookout on the timeframe of the balances will give the practice a better idea about:

  • The age of the insurance claims
  • The number of times a statement gets sent to patients
  • Number of days gone by since the last payment was made
  • Days remaining for filing the claims within the timely filing limit.
  • Number of claims that did not go through

Tips To Improve Your Accounts Receivable Management

  1. Analysis of payer collections :
    It is very important to identify and list out the various insurance companies that are slower to pay the practice along with the ones that have a higher volume of denials.
  2. Assessment of patient collections :
    Practice must essentially collect all co-payments, advance payments, and outstanding payments at the time of service delivery. Patients should be made aware of the payment process prior to or at the time of service.
  3. Frequency calculation of errors that delay collections :
    Recurring errors in regard to patient data collection, coding, billing, or other processes should all be diligently noted. These are solid pointers to the areas that need change/ improvement.
  4. Leveraging the medical billing program :
    Suitable software should be made use of which would notify the practice staff when accounts are past their due so that appropriate follow-up steps can be taken.
  5. Staff Involvement :
    A team should be designated to track specific payers. In addition to that, regular meetings should be conducted to discuss Accounts Receivable status and problem areas, and identify effective collection techniques that work.

AR management essentially includes creating and following certain standards for your dental practice to facilitate efficient billing and payment for your clients. Following these allow your practice to get paid on time and avoid late payments. When done efficiently, you will not only receive timely payments but will also have happy client relationships and high liquidity for your business. Poor management, on the other hand, can lead to wasted staff time, accounting errors, lost revenue, and poor cash flow. The goal should be effective accounts receivable management in order to optimize billing, payments, and collections processes to minimize the time taken to get paid and eliminate any potential risk of bad debt.

Keys to Effective Communication in Dentistry

Despite the care and treatment provided to a patient being the most important aspect of running a dental clinic, it is also equally important to curate a well communicated experience for your patients, on every interaction. This is because patients are not only drawn to the care provided but also to the patient experience. Let us have a look at why effective communication between the patient and the dentist is so important and what are the best ways to improve them.

Why is effective communication so important in dentistry?

Effective communication is important in dentistry for several reasons. It is crucial, both for building trust with patients and for achieving successful outcomes. Here are a few reasons to implement effective communication in your dental clinic:

  1. Building Trust:
    Patients are more likely to trust their dentist if they feel heard and understood. Effective communication helps to establish a good rapport between the dentist and the patient, which can lead to greater patient satisfaction and loyalty.
  2. Clear Instructions:
    Dental procedures can be complicated, and patients may not always understand the instructions or expectations. Effective communication ensures that patients fully understand the procedure and how to care for their teeth post-treatment.
  3. Accurate Diagnosis:
    Good communication skills allow dentists to understand the patient’s symptoms and concerns, which helps in making an accurate diagnosis. Dentists who are skilled in effective communication are better able to gather information from patients about their dental problems, which enables them to develop a more accurate treatment plan.
  4. Improved Teamwork:
    Effective communication between dentists, assistants, and other members of the dental team is essential for a smooth and efficient workflow. Good communication can help to prevent errors, reduce stress, and improve patient outcomes.
  5. Increased Treatment Success:
    When patients understand the importance of oral health and how to care for their teeth, they are more likely to follow through with recommended treatments and maintain good oral hygiene. This can lead to better outcomes and a reduced risk of complications.
  6. Better Patient Outcomes:
    Dental treatments can be intimidating, and patients may experience anxiety or fear. Effective communication can help to alleviate these concerns and ensure that patients are comfortable throughout the procedure.

Ways to improve effective communication in a dental practice:

Effective communication is essential in all aspects of healthcare, including dentistry. Here are some key strategies for effective communication in dentistry:

  1. Listen actively:
    Listen carefully to your patient’s concerns and needs. Make eye contact, nod your head, and ask clarifying questions to show that you understand what they’re saying.
  1. Use plain language:
    Use clear and concise language to explain diagnoses, treatments, and procedures. Avoid using dental jargon or technical terms that patients may not understand. Instead, use simple language that your patient can easily understand. Or if you must use technical language, be sure to explain it in a way that patients can comprehend.
  1. Show empathy:
    Acknowledge your patient’s fears or concerns and show them that you understand how they feel. This can help build trust and rapport with your patients.
  1. Use visual aids:
    Use diagrams or models to help explain complex procedures or conditions. Visual aids can make it easier for patients to understand what will happen during their dental visit.
  1. Provide written instructions:
    Provide written instructions to your patients about their treatment plan, including any post-operative care instructions. This can help ensure that your patients understand what they need to do after their appointment.
  2. Collaborative Decision-Making:
    Involve your patients in the decision-making process regarding their dental treatment. Discuss different options and their risks and benefits, and work together to determine the best course of action.
  3. Use open-ended questions:
    Use open-ended questions to encourage your patients to share their concerns or questions. This can help you better understand their needs and provide more effective care.
  4. Provide feedback:
    Give your patients feedback on their oral health and hygiene habits. Positive feedback can reinforce good habits, while constructive feedback can help your patients improve their oral health.
  5. Timely Follow-Ups:
    Follow up with patients after their dental visit to ensure they understand their treatment plan and answer any questions they may have. This also helps to build trust and rapport with patients.

A crucial part of communicating involves setting proper expectations and standards that everyone should follow. This helps eliminate the guesswork from caring for a patient. It is important to remember that effective communication works best when it works both ways. Encourage your patients to ask questions and provide feedback to help improve their understanding and overall experience. With so much competition in the dental industry, retaining patients is difficult. But with clear communication and setting clear expectations, it is possible to achieve a better patient experience.

What are the major RCM challenges faced by the practices?

Efficient revenue cycle management plays a crucial role in ensuring profitability and sustenance in a practice. The ability to effectively collect revenue and utilize it to improve the quality of care provided as well as the infrastructure of the practice is perhaps one of the most significant aspects of financial management in any practice.

In today’s digital age, the healthcare industry isn’t far behind when it comes to the use of technology and automation to manage its revenue cycle. This change has proven to be quite effective for the practices in managing their revenue cycle. However, despite these advancements, we are often able to find insufficiencies in some of the RCM processes. These insufficiencies need to be identified and properly addressed and the most feasible solutions need to be provided in order to ensure an effective revenue cycle management process in place.

Here are the most common RCM challenges that practices face on a frequent basis:

  1. Timely collection of payments:
    This is one of the most common challenges faced by the practice. It is never easy to collect timely payments after providing treatments to patients. In fact, it is commonly agreed by most healthcare professionals that the collection of payments is the biggest challenge faced by their practice. Revenue not coming into the practice on a regular basis could adversely affect the overall operations of the practice and ultimately its efficiency.
  2. Futile amount of time spent on revenue cycle management:
    Alongside treating patients and helping them lead healthier lives, optimization of the revenue cycle is also a crucial process for a practice to fulfill its mission. But oftentimes, the practice may lack the tools and resources that they may need in order to optimize and manage their revenue cycle in an effective manner. As a result, they end up spending an excessive amount of time and manpower on their revenue cycle instead of managing other more relevant areas of operations.
  3. Pre – Authorizations for Treatment:
    The insurance eligibility of patients is highly unpredictable. Hence pre-authorization prior to providing any kind of care or treatment becomes very much necessary. But as important as this process is, it is also highly time-consuming. What makes it even more difficult is the delays and errors, if any, which would just end up further delaying/causing an inconvenience in the treatment or care being provided to the patient.
  4. Reinforcing regulatory compliance:
    Regulatory compliance is one of the more critical challenges that practices may face; especially when they are outsourcing their RCM service. It is very crucial that the practice as well as the RCM service providers comply with the rules and regulations of the industry. A practice’s RCM should comply with the guidelines laid down by the Healthcare Information Portability and Accountability Act 1996. HIPAA violations are an extremely common challenge in the healthcare industry today. Failure to comply could end up costing a fortune for the practice.
  5. Issues with Interoperability:
    Data and information are key elements to the effective management of a practice’s revenue cycle. The lack of communication and information exchange between departments can lead to tremendous amounts of revenue loss for a practice. The practice has abundant amounts of data and other resources which if used in a meaningful manner can boost the practice’s revenue. But on the other hand, the inability to share and exchange these can increase the risk of problems.
  6. Proper medical coding:
    This is a very complex RCM challenge that practices face because as crucial as it is,  accurate coding is also an extremely difficult and confusing task. Practitioners dealing with these codes are required to stay up to date with the ever-changing codes and guidelines of the industry. Leakage of revenue is inevitable if these code changes are not duly monitored and adopted, and the application of the same is not reflected in practice.
  7. Lack of a deeper insight into RCM:
    Most healthcare providers find it extremely challenging to get the deeper insights they require to ensure the most optimal approach to their revenue cycle management. Lack of the right tools in place, it’s next to impossible possible to get complete visibility into the revenue cycle and measure KPIs.


It is quite evident that these challenges are preventing the practice from functioning at its full potential and achieving its goals. Hence these challenges need to be addressed and tackled in the most efficient manner. In order to overcome these challenges, the practice must make available the tools to fill any existing gaps and clear any insufficiencies. On the other hand, outsourcing RCM services is in itself a great tool that can help take a major load off your practice by minimizing any errors or inaccuracies to a great extent. This helps you direct your focus on the more important aspects of operations in your practice. Once outsourced, the financial stability of your practice will directly depend on the quality and capabilities of the RCM service provider you are associated with. Partnering with an RCM service provider can help improve the overall financial picture of your practice.

What are Patient Engagement Services or Solutions?

Before probing the details surrounding patient engagement solutions, it is extremely important to understand and define what patient engagement is and why it holds so much importance to healthcare providers as well as the healthcare sector in general.

Patient engagement is a term often used to describe a patient’s participation in the healthcare services they use. It can also be considered a partnership between a patient and a healthcare services provider wherein it opens the door to discussion between the two parties. It also aims at providing a complete overview of a health condition, thus opening the door to further discussion. The term “patient engagement” is applicable to any patient and any healthcare setting, including inpatient care, emergency room visits, retail clinics, and outpatient care settings like doctors’ offices, outpatient imaging centers, and more. 

There exist multiple entry points to the patient experience. Some of these entry points are as follows: 

  • Scheduling 
  • Registration
  • Check-in
  • Appointments
  • Post-visit feedback 
  • Billing 
  • Patient recalls
  • Patient education

Is patient engagement worth digitizing?

The answer is yes. The simple logic behind this is that digitization is able to help healthcare providers to automate their communication with patients and in turn, makes it easy for patients to access their healthcare providers at times of need. It is also worth mentioning that the healthcare industry is flooded with massive amounts of data, with more and more data being created every second. Digitization helps with the storage and management of valuable patient information which serves as the foundation to patient engagement. All this data is transmitted dynamically to the healthcare service providers, allowing them to detect  the early signs of change in their patients’ physical condition and overall wellbeing. Personalized care is one of the most important aspects of patient engagement, and incorporation of patient data and marketing technology can allow healthcare providers to formulate personalized engagement plans. In total, digital patient engagement simplifies the healthcare process for the patients and brings substantial benefits to the practice from the business point of view. It is a win-win for all. 

What are patient engagement solutions?
Patient engagement solutions can be considered a platform or a tool that enables patients to get access  to their health condition data via digital medium. The patients are able to communicate with their care providers using electronic devices such as smartphones or laptops, thanks to which, a patient need not wait on call or visit the clinic to make an appointment or know about their health status.

Patient engagement solutions are rapidly gaining momentum as they have become a vital aspect of medical care and are a very important segment of the people-centric approach the insurance services have adopted. These patient engagement solutions are very responsive and transparent, and this approach is forecasted to aid the growth of the healthcare industry in the coming years. 

Basic features of patient engagement solutions:

  • Online registration of new patients and management of patient history
  • Hassle-free scheduling and rescheduling of appointments
  • Automated appointment reminders to patients via text or voice message
  • Digitized bill generation and online payment facilitation
  • Customized content for patient education

Types of patient engagement solutions:

  • Off-the-shelf:
    There exist a whole array of patient engagement solutions that are readily available to the healthcare service providers. Health centers now have the liberty to choose from a wide variety of features and pricing models. These solutions are offered to the practices on a predefined and monthly subscription basis. These patient engagement solutions are the fastest options and best suited to individual practitioners or the kinds of practices that small in size and have limited funds because requires significantly low initial investments. There is no ownership of the product and no requirement to procure any additional technology as it typically runs on cloud.
  • CMS-based:
    CMS-based patient engagement solutions are custom developed using pre-existing content management platforms, like Wix and WordPress. Platforms such as these, allow for building most of the basic functionality that a patient experience solutions could require, which includes patient registration, patient-provider communications, appointment scheduling and rescheduling, patient education etc. These patient engagement solutions are best suited to those practices that are looking for quick solutions without having to overpay and have no immediate plans of expansion as scaling CMS-based solutions can be quite difficult.
  • Custom built:
    These patient engagement solutions are uniquely built specifically for the purpose of fulfilling the needs of and catering to the internal processes of one particular practice. The practice has the full ownership of the final product and the support team helps the practice further customize and add in the relevant changes and features as and when necessary. Unlike the other two kinds of solutions, this one is built completely from scratch and are best suited to practices that provide a diverse set of services. Practices that can afford to pull of a significant initial investment and plan on eventual expansion also benefit from this type of patient engagement solutions. 

Benefits of having a patient engagement solutions:

  • Minimizes patient no-shows at appointments with assistance from appointment reminders and effortless rescheduling
  • Allowing for patients to fill in post-appointment surveys provides the doctors with valuable feedback and also get the chance to go through the surveys and adapt to individual patients’ requirements.
  • Patient involvement in the decision-making process helps improve patient compliance and loyalty.
  • Helps enhance the channel of communication between patients and their healthcare providers.
  • Patient engagement solutions also help attract new patients through marketing campaigns.

Patient engagement solutions give the patients the power to have a better knowledge and control over their own health as well as the care they receive. Giving this power to the patient while making them accountable for their own health helps them get actively involved in their health and decide the healthcare approach on their own. This significantly decreases the provider responsibility and makes it easier for them  to curate better healthcare decisions for the patient and thereby improving the patient-provider relationship which eventually leads to better health outcomes.

Understanding The Crucial Role Payment Posting Plays In RCM

Payment posting in medical billing has turned out to be one of the most obvious demanding situations that the network of healthcare service providers face on a rather common basis. Payment posting is often misunderstood as an afterthought after the more “enormous” a part of the revenue cycle process is accomplished. Contrary to popular misconception, accurate posting contributes to one of the most critical functions in the revenue cycle management of any practice.

What exactly is Payment Posting?

Payment posting, in layman’s terms, refers to the method of logging details of payments into the medical billing software program allowing us a view of the insurance payments in explanation of benefits (EOBs), payments from patients and insurance checks from electronic remittance advice (ERAs). In a nutshell, payment posting allows you to get a 360 degree view of the financial picture of your practice.

Payment posting is largely seen as the preliminary blockhouse against common payer issues and makes the whole process a lot more smoother for everyone involved; right from the front office to the back office workforce. Additionally, it allows you to effectively discover and control revenue leaks within the practice. It consequently becomes paramount that the payment posting process is performed with the highest level of accuracy. How the process of payment posting is performed has an extensive impact on efficiency, patient care, and overall financial growth of any practice. It is for this reason no surprise that payment posting is considered one of the most crucial elements of the revenue cycle management process.

Types of Payment Posting:

Depending upon the level of insurance coverage, payment posting in medical billing is mostly carried out in two ways:

Manual Posting:

Manual posting is performed by the administrative workforce in a practice and typically takes a longer time. Payment information is drawn and captured from scanned pictures of explanation of benefit (EOB) documents and each line item is posted to the respective patient accounts. Considering the fact that this is a manual task, there is an inflated risk of common errors, which causes an overall delay in the procedure.

Automated Posting:

Automated posting is considered more of a software-driven approach to the posting process, which is in sharp contrast to the traditional payment posting methods. In comparison to manual posting, automated posting helps speed up the medical billing process while allowing you to efficiently process payment information. This makes it a highly preferred approach to payment posting.

What is it that makes payment posting such a crucial process in RCM?

Quite simply, it is the fact that a well carried out payment posting process can help you identify and make the most of the opportunities that could potentially increase revenue by observing the daily trends within your practice. There is absolutely no denying the fact that payment posting is a very crucial process to revenue cycle management.

So here comes the big question: How critical is payment posting for your practice?

Payment posting is the most critical part of the medical billing process as it enables the practice to monitor its incoming revenue. When the process of payment posting is efficiently streamlined and properly organized, it essentially  helps in detecting all types of issues and resolving those issues quickly. 

A proper payment posting process in place can help you in the following ways:

Analysis of revenue cycle made easy

A proper payment posting process in place facilitates analysis of the revenue cycle in practices in a more seamless manner. This in turn, helps in maximization of revenue cycle by improving the profitability and the functions of the account receivable departments.

Reduced recurrent issues

The key to reducing recurring issues is by carefully observing and identifying the underlying pattern. It is when you identify recurring denials is when you can prevent future claims getting denied for the same reason.

Enhance your existing process

Resolution of concurrent issues is never sufficient. It is very crucial for the administration to circle back and provide more focus on solutions to enhance the precision and efficacy of the revenue cycle. This helps in strengthening the existing process.

Denial tracking and reduced denial resolution time

The most effective way to reduce denial resolution time is by preventing them. The longer the denials remain unresolved, the more it contributes to the overall accounts receivable days. Efficient denial tracking allows for efficient follow ups on the denied claims and helps quickly recognize the prime reason which has caused the denial. 

Accurate claims submissions

Accurate posting allows submission of correct claims to the secondary and tertiary payers by making sure primary payment is posted correctly. This in turn, reduces the margin of mistakes throughout billing, for secondary and tertiary payers, due to which, a reduction in the denial of claims is observed.

In an effort to sum all of it up, a proper payment posting system can elevate the overall efficiency and infrastructure of a practice. Streamlining the payment posting process is an effective way of enhancing the revenue cycle management (RCM) process especially as the process impacts many other A/R functions of the practice. Problems associated with billing may be addressed quicker, secondary payers are billed accurately and patients receive their statements promptly, increasing the overall medical billing cycle’s efficiency. In short, it is a win-win for all.

In-network or Out-of-network: Pros and Cons for your Dental Practice

Whether to opt to be an in-network practice or out-of-network with practice dental insurance is a dilemma faced by every dentist looking to start a brand new dental practice. Both options are different from each other and affect the claims and billing process of practices differently. So, whether to choose to be in an in-network practice or out-of-network is a matter of considering what is going to work the best for your practice and the people or service you plan to hire in order to handle that process.

Here we will walk you through the pros and cons of your practice being in-network versus out-of-network with insurance, while at the same time helping you understand the benefits and drawbacks of each option.

To start with, what is Dental Insurance Network?

A dental insurance network consists of a list of practices that have a contract with an insurance company. For instance, if a patient is covered under an HMO or DHMO insurance plan, they can only make use of their benefits stated at in-network practices. This option tends to be inconvenient and rigid and such plans are often disliked by many as such plans prevent patients from visiting an of their choice or one they trust and are comfortable getting treated by.

On the other hand, patients covered under PPO plans, are free to visit any dentist of their choice. Depending on the plan the patient is covered under and the plan’s network, the patient can expect to save on the price of their treatment. However, there certainly are some coverage differences between the in-network and out-of-network practices.

In-network practice

For dental practices, be in-network with insurance companies means they are entering into a contractual agreement with them. This makes the practice a “participating provider.” This contract defines the patients who come into your practice, your claims reimbursement process, and the rate of your fees.

For instance, a patient can only visit your dental practice only if they are covered by the insurance your practice is in-network with, to receive discounts on the services availed. Let us look at the benefits of being a  practice in-network with insurance companies.

Pros of being an in-network practice 

Dental practices often choose to be in-network with insurance because it provides them with more access to patients. Patients, on the other hand, prefer going to in-network dentists over out-of-network dentists because of the affordability factor and the ease of finding a dental practice that would accept their insurance.

Here are the advantages of being an in-network practice:

  • Marketing and advertising opportunities:
    Practices that are in-network with insurance are promoted free of cost by the insurance company. Thus the patients are easily able to find your practice in their insurance portal. This is a great opportunity for small practices that are trying to expand their patient base.
  • Access to more patients:
    The ease in accessibility in addition to being promoted free of cost by the insurance company the practice is in-network with ensures that the practice receives plenty of patients. This ensures a full schedule for the practice and constant revenue generation. If a practice seeks to increase in quantity, being in-network is the best choice for them.

Cons of being an in-network practice 

In all honesty, insurance companies are not really allies to practices especially when it comes to paying the practice. Once a practice signs a contractual agreement with a dental insurance company the practice is bound by the terms and conditions of the insurance company. When insurance has more input in how a practice is run and what patients it accepts, it may not always be in the best interest of the dental practice.

Here are the disadvantages of being an in-network practice:

  • Pre-established fees with the insurance company:
    When an insurance company enters goes in-network with a dental practice, the practice has to agree on the fee schedule for its service, as established by the insurance company. Negotiating these fees can be quite difficult and can be a drawback for dentists who want to charge more for their services.
  • Less time spent on patients:
    Sometimes quantity can take away from quality. When a practice has back-to-back patients, it is quite natural for the dentist or a front desk team member to feel pressed for time. This often leads a decrease in the quality of care provided to patients. 

Out-of-network practice

As the term suggests, the out-of-network practice are those that are not in any kind of contractual agreement with insurance companies. The practice still does accept insurance, but they can also charge the full fee to their patients. These practices also have the liberty of deciding the type of care they provide to patients without the input of the insurance company. There are plenty of benefits to being out-of-network as a dentist.

Pros of being an out-of-network practice 

One of the biggest advantages of being an out-of-network practice is that the practice retains control over every aspect of the practice. The insurance company does not have any opinions over any aspects of the practice or its patients. The practice still has to process insurance claims but not at the same rate as in-network dentists do. 

Here are the advantages of being an out-of-network practice:

  • Flexibility in rates determination:
    Controlling your own fees is a really liberating feeling for dentists. Being able to decide what your services are worth is a huge benefit to being out-of-network. This is especially appealing if the practice offer specialty services that aren’t widely available in that area.
  • Easier revenue collection:
    A lot of dentists find it very difficult to collect their revenue after administering treatment. Hence, becoming a fee-for-service dental practice is the most ideal option for them. This becomes possible if the practice is out-of-network and can seamlessly transition to this kind of a billing model. In this model the practice collects the full fee from the patient after their procedure after which a claim is sent out on their behalf. The patient then gets reimbursed their insurance.

Cons of being an out-of-network practice 

Being out-of-network can turn out to be a little overwhelming for some dental teams because there is an evident dilemma on where to start on their pricing. This also makes the practice harder for patients to find and reach out to, and oftentimes even too expensive for some patients.

Here are the disadvantages of being an out-of-network practice:

  • Decreased accessibility for some patients:
    If a practice aims at being more affordable and accessible to patients, then being out-of-network is not exactly the best choice for the practice. The practice can definitely choose to fix the price as low as they wish to but realistically speaking, that option is not very feasible especially if the practice chooses to be heavily equipped infrastructure-wise. The practice would also be required to spend a considerable amount of time marketing itself if it wishes to grow its patient base.

More time spent on patient billing:
Since the fees at out-of-network dental practices are higher in comparison to in-network practices, collecting the right amount from patients can get difficult. This results in having dental teams sit down with the patients to explain their benefits to them and why they are priced the way they are. In order to carry this out successfully, practice is required to have a streamlined patient billing process. This is a time-consuming process and the dental teams will end up spending more time fulfilling lesser important tasks.

Considerations Before Choosing An RCM Service Provider

Unsettled financial transactions due to a disorganized revenue cycle is perhaps one of the greatest challenges faced by dental practices today. Issues like heavy staff attritions and unproductive processes, leading to revenue loss, have further highlighted the importance of optimizing financial workflows in the dental practices. This has eventually led many dental practices organizations to realizing outsourcing revenue cycle management to be the best move for their long-term financial success.

An outsourced RCM service not only takes away the stress of day-to-day billing responsibilities, but also eliminates the need to hire dedicated billing and claims professionals, making it a very cost-efficient option and an attractive idea to even the most budget conscious practices.

Why is Choosing the RCM Partner Crucial?

Choosing the right partner for your RCM needs is an essential part of the process of establishing a successful and profitable business. An experienced RCM partner can provide you with the expertise, resources, and technology to maximize the efficiency of your practice. Having a knowledgeable and reliable partner on your side can help you to save time, money, and energy in the long-term when it comes to managing your RCM. In addition, a trusted partner can help you to ensure that your RCM processes are compliant with the applicable regulations and laws, as well as provide you with valuable insights and advice that can help to improve the overall efficiency and profitability of your dental practice. With the right partner in place, the dentists can rest assured that their financial operations are running smoothly and that they are getting the most out of their investments.

This brings us to the question: How to choose the best among the many RCM Service Providers in the Industry?

It helps considering the following factors while determining the best RCM solution for your organization:

  • Cost:
    Selecting a sensibly-priced RCM service provider is vital for a practice, especially if the practice is a small one with budget constraints. Investing in an expensive RCM service provider is not a wise option is the practice is trying to optimize its financial workflows. While choosing an RCM service Provider, it is crucial to assess the cost to collect which will regulate the returns on the investment. As long as the vendor is able to enhance collections and improve the revenue flow, the return on investment will cover the vendor cost.
  • Turn-around Time:
    The amount of time taken to deal with payers and stakeholders is very crucial to the success of any RCM or billing department. It only makes sense for a practice to partner with an RCM service provider that has demonstrated superiority in carrying out RCM functions with a fast turn-around time. The quicker an RCM service provider works, the faster a practice gets reimbursed for their services. The turn-around time significantly impacts the practice’s cash flow.
  • Reporting:
    Reporting is very vital to revenue cycle management. Hence, an RCM Service provider should provide the practice, reports on all aspects of the process, on a frequent basis. This helps in keeping the third-party vendor accountable for the work they’ve undertaken, in addition to providing valuable information for the practice to measure and evaluate its financial and billing progress.
  • Quality Customer Support:
    Just like one would expect from any vendor, quality customer support is very crucial for the overall satisfaction from the service provided. The best way to assess the quality of support provided by the vendor is to refer to the reviews left online by their existing users for an accurate feedback. It is also important to consider having a brief call with the prospects to discuss the options available and determine the  most effective way to manage the practice’s RCM so more time could be spent on more important aspects of the practice, such as providing better care to patients.
  • Overall Expertise:
    While looking to outsource a core function of the practice, such as revenue cycle management, it becomes crucial to finding an RCM service provider that holds expertise in handling a wide range of functions and the related issues. It is best recommended to hire an experienced RCM service provider that has a thorough knowledge of the service the practice is seeking. 

Once a practice is clear on its requirement from the RCM service provider and has its options narrowed down, it becomes easier to choose the right vendor. By partnering with the right RCM service provider, the dentists have the opportunity to optimize its practice and support the staff. The ideal vendor would help improve the practice’s profitability, reduce its administrative workload, and adapt seamlessly to the industry changes and facilitate growth.

Customer Success – Best Practices You Can Put Into Action

Increased sales is not the only way a practice can grow. Customer success and your ability to retain and renew your existing customers are some additional aspects that are crucial to your practice’s growth. Customer success strategies are proactive plans for guiding clients to outcomes that satisfy their needs. As customers enjoy more value, not only do customer retention rates go up, but your service adoption rates rise as well. This promotes the success of your practice as well as your customers.

Why invest in Customer Success?
Investing in customer success closely equates to investing in your own practice’s growth. This will in turn increase the lifetime of your customers’ association with your practice and develop a mutually beneficial future for both the practice as well as its customers. An investment in customer success can:

  • Decrease the churn rates and increase the retention rates of your customers, keeping them engaged.
  • Facilitate expansions and increase customer-centered growth.
  • Increase customer acquisitions and improve brand image through customer advocacy.
  • Help bring the necessary refinements and improvements in the internal processes for collecting, analyzing, and utilizing customer data, thus facilitating more effective strategies.

5 Principles of Customer Success
There are essentially five principles of customer success that are vital to understanding and orienting customer success strategies around.

  • Value:
    Customers are constantly seeking value out of the services they are receiving. It is very important to be consistent in providing value to customers. Value is what fuels customer satisfaction and customer retention.
  • Actions:
    A proactive approach is crucial to customer success. Warning signs as well as opportunities need to be identified well in advance in order to take the best action.
  • Real-time monitoring:
    A practice should keep a close watch on the customer particulars, in the moment; and not when the moment is over. Simply put, customer needs and issues should be monitored and addressed in real-time. This allows us to take actions that bring a high impact on custom success.
  • Engagement:
    Since practices have access to the customers’ particulars, it becomes quite easy to engage them with more relevant forms of communication. This allows the practice to trigger the right actions/tasks at the right time.
  • All Customers:
    For practices, there is an opportunity in every customer. Hence all customers should be treated as equals and should all be listened to with great attention. This will have a huge impact on the customer experience and will influence their decision of continuing their association with your practice.

So, what are the best practices that can be adopted for effective Customer Success?

  1. Devise an immaculate feedback loop:
    Feedback is the fundamental data for understanding your customers’ journey, experiences, requirements, and problems they face. Hence building responsive feedback loops is a necessity as far as matters relating to Customer Success are concerned. Feedback from your customers will help you understand why they are continuing with you and why they could potentially leave. There are various means of collecting this feedback. Here are a few most commonly used methods: 
  • Interviews:
    Interviews, be it face-to-face or virtual, are suitable for initial customer interaction and can help us get an in-depth understanding of what the customer’s needs are.
  • In-App Surveys:
    In-app surveys, such as Net-Promoter Score (NPS), Customer Satisfaction Score (CSAT), or Customer Effort Score (CES), are the perfect means of receiving customer feedback and can add great value to your Customer Success.
  • Online Reviews:
    Online reviews can be a great source of feedback for the practice. If it is positive, then it helps further expand the customer base and if unfortunately, it is negative, it can help discover parameters that can later serve as means of improvement.
  1. Have a retention strategy:
    Having a retention strategy will help you retain those customers who are on the verge of churn. This would also target those customers who are potentially considering the discontinuation of their association with the practice. Here are some methods that can be used to retain your existing customers:
  • Initiate communication with them to understand their reasons for discontinuing their association with your practice.
  • Reach out to them to offer assistance in the areas that they need.
  • Conduct frequent one-on-ones with them to understand if your service is meeting their expectations.
  • Keep a note of their valuable feedback.
  • Educate them on the new services that your practice has to offer them.
  1. Proactively promote the growth of your customers:
    Customers constantly depend on the practice for support. As a practice, you can ensure that your customers get the kind of support they expect by curating and delivering meaningful resource bundles, aimed at addressing the needs of customers at every stage of their journey with the practice. This is achieved with the help of:
  • FAQ guides to answer commonly arising queries
  • Demonstrations to raise awareness among customers
  • Blog posts with tips that address common concerns in the dental industry
  • Personalized emails
  1. Automate your customer success strategy:
    The strategies you lay down for customer success will function better with appropriate technology to back them up. An ideal customer success technology should consist of the following key features:
  • A platform for customer data platform connects all of the data in one place.
  • Real-time monitoring of customer progress.
  • A segmentation tool that allows for customized communications with each customer.
  • A tool to define and track measurable success goals aligned with your customer’s journey.

These customer success practices will help you improve your business in the following ways:

  1. Growing your practice revenue
  2. Maximizing chair-time utilization
  3. Increase average hourly earnings and new patient numbers
  4. Improve patient recall rates and treatment acceptance
  5. Reducing the number of failure to attend and short-notice cancellations
  6. Eliminate workflow inefficiencies


It is now quite evident that the ultimate goal of Customer Success is to increase customer satisfaction to improve customer retention and customer loyalty. To sum it all up, with the best Customer Success practices in place, not only will you be able to retain your customers but also turn them into active promoters of your service, thus ultimately improving your Customer Lifetime Value (LTV).

Customer Success: What It Means, Why It Matters, and More

Marketing and sales tactics play a pivotal role in the success of every business. But in an age where customers are provided with access to countless options, traditional methods are not sufficient to sustain growth. This is where the concept of customer success comes into play. Customer success refers to the practice of anticipating customer challenges or questions in advance and proactively providing solutions, ensuring customers get their desired outcome all throughout their time with practice. The customer success goals should be measurable, achievable, and time-bound. It should also have its primary focus on areas like how to increase customer retention, prevent turnover, build loyalty, and expand satisfaction with the service offered. 

Who needs a Customer Success strategy?

The answer is quite simple – if you have customers, you should invest in customer success. In recent times, it has become significantly more expensive for businesses to acquire new customers. That’s why their fundamental focus should be on retaining existing customers and keeping them happy — happy customers become your biggest assets. Some of today’s most successful emerging and growing dental practices are already investing in customer success.

Constantly growing practices are more likely to prioritize customer success in comparison to their stagnant counterparts. These growing practices fully understand that the most efficient way of running their practice is by ensuring their customers are happy and satisfied with the services provided. Hence their prime focus is on working proactively in partnership with customers throughout their time as a customer to help them get more value out of their purchases and share their feedback with you. Following the customer-first approach, drives the customer experience forward and ensures a successful path into the future.

Why does Customer Success Matter?

Customer success ultimately leads to the success of the practice. It improves customer happiness and loyalty; by genuinely helping your customers get their money’s worth ultimately turning them into the biggest promoters and advocates for your dental practice. Customer success helps you boost customer happiness and reduce churn rates, improve renewal and satisfaction, and, therefore, increase your revenue and customer loyalty. Customer success aims at helping users proactively and building long-term relationships with them.

How does customer success work?

There are three fundamental elements needed for customer success to be effective. These include a customer success solution (it could be a tool or software), a team and manager of customer success employees, and a customer success strategy.

Choose a customer success solution.

In order to proactively manage all interactions with the customers, it is necessary for your practice to choose a customer success software or tools.

Hire and train a customer success team.

Every practice needs a team of people working on customer success to proactively assist the practice’s customer base.

Create a customer success strategy.

The kind of strategy that you need to implement purely depends upon the service you sell and the customer’s expectations of your service.

Tips to Helping Customers Succeed

  1. Implement a customer success program:

    An effective customer success program to guide your team to efficiently and proactively assist your patients is very crucial. Customer success strategies are commonplace in every business. Hence while formulating a customer success strategy for your dental practice, ensure that it meets the needs and expectations of your customers. It is also very important to keep in mind to modify the existing strategy as the business grows — the needs of your customers change over time, especially as the dental services you provide evolves.
  1. Educate your customers:

    To best support your customers the best, you need to anticipate the questions that are bound to arise as they make use of your dental service. It is important to empower your customers through education about your dental service so as to avoid confusion on the patient’s end. For instance, with live chat functionality on your site, features and descriptions of what you offer can be listed and in case of any further confusion, the success reps are available to better support your customers in real time.
  1. Onboard Customers:

    Onboard your customers to support them throughout the initial parts of their journey with your dental service. Provide them with the resources and knowledge that they need to get started. Onboarding customers is a great way to get acquainted with your practice— and answer any questions proactively. By onboarding your customers, you set the expectations from your practice and the services you provide, during their time as your patients.
  2. Communicate With Other Teams:

    It is very important to keep a strong hold on communication among the various departments at your dental practice which will eventually help you help your customers. Work with the different teams in your practice, effectively creating resources that will further assist all teams collectively, and help your customers better. Communicate with different teams to better understand and target specific recurring issues that customers frequently approach you with. Communicate with the support team to align your practice’s proactive and reactive efforts so all interactions with your customers meet the requirements of professionalism and consistency. Remember, effective communication is key.
  3. Promote Customer Loyalty:

    A customer’s positive experience with your dental practice results in the customer’s loyalty toward your practice. The key to this is to get your customers to feel satisfied with the service being provided and a sense of certainty that they’re getting their money’s worth. Customer loyalty is, without any doubt, the best way to increase customer retention rates. 

You Succeed When Your Customers Do

It is quite easy to infer that most successful dental practices are those who ensure the continued happiness, growth and success of their customers. By creating an atmosphere where your customers feel supported throughout their time being associated with your dental service, they turn into loyal advocates of your practice. This will allow your practice to grow sustainably while at the same time, building long-term relationships with the people you depend on most: your customers.

Dental Billing Myths That May Be Holding Your Practice Back

Dental billing is a highly complex process. Knowing how to handle the dental billing process hence becomes a necessity when it comes to ensuring timely cash flow and avoiding errors. Failing to do so can lead to problems for the practice as well as its patients. But there exist quite a many myths around the dental billing process that lead to expensive mistakes on the part of dental practices. By busting these common myths, dental practices can empower themselves to use an efficient dental billing process to aid their dental practice in collecting more and bring a clean and efficient billing process into practice. Here is a curated list of common myths that might be preventing your practice from functioning at its full potential. 

  1. Dental billing merely involves the process of submitting claims.
    Submitting claims, without a doubt, is a large part of the dental billing process. But it is not limited to just that alone. There are many sub-functions in the billing process that are of equal importance. For instance, eligibility and benefits verification along with calculation and collection of copayments prior to administering treatments is a very important step in the dental billing process. This ensures a practice receives the collectibles from the patients, well in advance, as following up later for payments is a more tedious process.
  2. Dental billing is a simple job.
    This is a very popular misconception. But before jumping to any conclusions, one must always question why most patients find it difficult to understand their own insurance plans and why most dental practices opt to outsource their revenue cycle management. Dental billing is a very complicated and time-consuming job that calls for a lot of up-to-date knowledge and accountability while performing each process. There are a lot of rules, regulations, and updates that a practice needs to keep up with, which is very time-consuming for the dental practice.
  3. Dental practices cannot bill medical insurance providers.
    Patients generally have separate insurance plans to cover their dental and medical treatments. However, there are instances where certain dental procedures can be covered by a patient’s medical insurance. These are generally limited to treatments that are deemed medically necessary prior to performing a dental procedure. Although at first, procedures for accurately billing a medical insurance provider as a dentist may seem very different and complicated from billing a dental insurance provider. But in reality, no additional qualifications are required for this. The only prerequisite for performing such treatments is to be licensed and have a sufficient understanding of the medical billing and coding process. It is also a good idea to outsource the billing process from a third party that is experienced in both kinds of billing processes.
  4. Outsourcing dental billing does not go a long way.
    This is yet another popular misconception that is still persistent in many dental practices preventing them from opting for outsourcing as a long-term solution for their billing needs. While many still believe that outsourcing dental billing may not be the best solution for their practice, the truth is quite contrary to this. Fundamentally, outsourcing is hiring professionals whose sole job is to collect money for a practice, which can help a practice go a long way by taking a huge chunk of responsibilities off their shoulders. This allows a practice to focus on its primary responsibility; treating its patients.
  5. Outsourcing is more expensive than hiring new staff.
    While hiring a billing company to outsource your dental billing process may seem to be more expensive in comparison to simply hiring more staff to do the same, but in hindsight, hiring billing experts over amateurs who need to be trained for the specific task, makes more sense financially. It is wishful thinking to believe that an individual can be hired and trained to efficiently handle large volumes of insurance claims in a short time span. Moreover, errors in the process can increase overhead costs as fixing these is a time-consuming task for the practice. 
  6. Administration teams are left with zero responsibilities once dental billing is outsourced.
    It is quite important to understand that the billing company, hired by the practice, is not here to take over anyone’s job or responsibilities. It should be considered as an extension to rather than a replacement of any team in a practice. In fact, it is very important for billing companies to work with the administration team of the dental practice to carry out the process in a more seamless manner.
  7. Outsourcing dental billing is a short-term fix.
    While outsourcing a dental practice’s billing can yield quick results, outsourcing can also prove to be a healthy long-term solution for any practice. Most dental practices start outsourcing for their billing needs during times of heavy work volumes, shortage of staff, or simply because of not having access to the latest technology. They often fail to realize the prospects of outsourcing as a full-time solution. Outsourcing can help a dental practice in the following aspects:
  • Saving additional costs incurred on staffing, training, and technology
  • Saving time and resources on prospecting qualified billing staff.
  • Increasing the timely cash flow into the practice by cross-checking claims for accuracy before the final submission.
  1. It is acceptable to not be able to collect 100% of the insurance claims:
    It is a common misconception in dental practices that it is next to impossible to collect every single dental claim and there are going to be write-offs no matter what. But in reality, this is a question that must be raised among the practice staff. It is the dental’s team’s responsibility to collect what is owed to the practice. The only write-offs allowed should be correct PPO adjustments. An outsourced billing company can help a practice collect almost every single one of those claims, which the dental practice staff may not always have the time for.

While dental billing is a challenging job in itself, myths should not come in the way and make it worse. We have been able to see so many myths revolving around dental billing and come across many more on a frequent basis. Having a better understanding of these myths and debunking them, can help you get a better grip on the opportunities that you are otherwise missing out on, all for the benefit of your practice. Once this solid foundation based on facts is established and honest expectations are set – the practice is sure to observe positive results.

Dental Claims 101 – What you need to know

Dental claims are complex. But understanding the workflow involved can help dental practices identify areas to reduce costs and speed up turnaround time. Dental claims processing includes all processes involved in giving care to patients, right from the moment a patient is registered with a dental practice, up until the explanation of benefits (EOB) and payments are finished. There are two ways of submitting a dental insurance claim; one via paper and the other, electronically. Any inefficiencies in these insurance claim submissions end up being a source of additional cost to dental practices. This article will walk you through the dental insurance claims process and everything else you will need to know about dental claims.

After a patient has visited a dental service provider, claims have to go through multiple steps before the patients receive their final bill. The sequence noted below is what the entire process looks like: 


The insurance provider is sent a bill for charges for services rendered. This is not inclusive of any charges paid via co-pay upon check-in.


A certified claims processor will then review the claim, ensuring accuracy and comparing it against the insurance plan to validate whether the services rendered were covered by the insurance or not.


If the services received were covered under the benefits, the insurance company will pay the claim based on the allotted coverages. They may pay the entire claim in full depending on the patient’s plan. Otherwise, the remaining balance will be billed to the patient.


These amounts are then validated and applied to deductible and maximum out-of-pocket totals as they apply to an insurance plan. Those are updated immediately.

Explanation of Benefits:
An explanation of benefits details the list of services received by the patient, how much was covered by insurance, how much the patient has to pay, and what remains to be billed. An EOB is sent to the patient post-treatment.

Final Billing:

A final bill will be sent to the patient for payment if there are any additional payments that need to be made from the patient’s side apart from the co-pay that was paid upon check-in.


It is the patient’s sole responsibility to compare the EOB and final bill and ensure everything mentioned is accurate and billed correctly. Sometimes these numbers do not measure up because of a mismatched procedure code or other clerical error. Once detected, these mismatches can be fixed and claims can be updated without any penalty.

What are the necessities for filing a dental claim?

Given below is the standard set of information required for filing a dental claim. Each claim that you submit to payers needs to include the following:

  1. The Subscriber’s ID.
  2. The name of the patient, his/her date of birth, and relationship to the Subscriber.
  3. The name of the dentist or practice, Tax Identification Number or Social Security Number, National Provider Identifier (NPI), and phone number;
  4. The procedure code number as per the American Dental Association (CDT), the treatment date, tooth number, tooth surface(s), the doctor’s fees, and a narrative or description of services as deemed necessary;
  5. The Member’s signature for the release of information and/or assignment of benefits. The Dentist’s signature.

It is vital to do everything a practice can to avoid denials in order to protect the financial health of the practice, and its reputation as a preferred place to work and perform dental care procedures. Here are some measures that can be taken to avoid delays and denials while filing for dental claims:

  1. Map out your dental insurance claims process workflow in detail to streamline it.
  2. Identify the insufficiencies in your claims process, in order to fill in any gaps discovered.
  3. Reduce errors in data entry by double-checking the patient information.
  4. Choose electronic forms over traditional paper forms to collect patient information.
  5. Promote the use of templates to record clinical notes so as to ensure uniformity and clarity in data collection.
  6. Make sure claims are submitted including all the relevant imaging, else there is a risk of rejection.
  7. Carry out frequent evaluations of your process to ensure they are up to date.

There is no doubt that managing dental insurance claims is a distressing task for a lot of dental practices. However, staying on top of the collection game needs to be top priority for all dental practices alike. The better a practice gets at submitting claims successfully, the sooner its accounts receivables get converted into cash, and the healthier the cash flow of that practice becomes. Since a good claims process in place can affect the profitability of a dental practice to such an extent, it is crucial that all collection issues be addressed at the earliest.

How Big Data in Health Care Influences Patient Outcomes

Healthcare is a very complex system. All around the world, healthcare systems had been facing an astonishing amount of challenges due to the increase in the average life span of the world population and the related health problems and disabilities associated with it. This has led the system to shift from its current traditional approach to a more modern and technology-driven approach. The biggest challenge now is improving the quality of healthcare while keeping the related costs under control. This is where Big Data comes into use. Big Data can help healthcare providers achieve these targets in unparalleled ways. The potential of Big Data in healthcare relies on the ability to detect patterns and to turn high volumes of otherwise meaningless data into actionable knowledge for more efficient operations in the healthcare industry.

This brings us to the question, What is Big Data in healthcare?

In a more general context, Big data is an immense amount of information on any given topic. Big data includes any kind of information that is generated, stored, and analyzed on a large scale that is generally too vast and complex to be managed with traditional information storage systems.

In the context of healthcare, Big Data represents large volumes of data and information created through digital technologies that collect patients’ data and generate records, which are otherwise too large and complex for traditional technologies to process. These kinds of digitized records are extremely helpful in managing the performance of dental practices, hospitals, etc. It is generally characterized by the following 4 V’s:

  • Volume — which refers to the huge sizes of data
  • Velocity — which means that data generation is a continuous process happening in real time.
  • Variety — which points out to the broad range of sources and formats that data comes in.
  • Veracity — which emphasizes the quality of data and the value that it could potentially bring.

Sources of Big Data in healthcare

  1. Government Agencies:
    Governments and their agencies both generate and collect vast quantities of data through their everyday activities, such as pension management and allowance payments, collection of tax, national health systems, records of traffic data, and records of issuing official documents.
  2. Patient Portals:
    Patient portals allow for a more structured approach to collecting, storing and managing patient information as well as addressing and resolving patient concerns. The valuable patient information that they store  is accessible to both the patients as well as their healthcare providers.
  3. Research Studies:
    Researchers across various disciplines have contributed significantly to big data with their ability to link and cross-reference data from varying sources improving the accuracy of scientific findings that serve as platforms for the development of various disciplines.They ultimately help provide an appropriate starting point for further investigation.
  4. Generic Databases:
    Today,  an amalgamation of traditional and modern databases is used to acquire relevant big data. These databases are deployed for various purposes and can provide for the extraction of insights that are used to drive business profits. Some popular databases include MS Access, DB2, Oracle, SQL, and Amazon Simple, among others.
  5. Electronic Health Records (EHR):
    EHRs track and record patients’ health data eventually reducing the need for unnecessary tests and checkups and the associated costs. This data also helps healthcare providers treat patients more efficiently by reducing the time and effort invested in duplicate tests and ultimately improving patient care.
  6. Wearable Devices:
    These include modern-day wearable gadgets like fitness trackers, smart watches, smart clothes, biosensors, blood pressure monitors, glucose trackers, and other electronic devices that can be worn. These devices are designed to collect different kinds of health information. This data is generally transferred to the user’s smartphone and/or a remote/cloud server where it can be retrieved as and when required.
  7. Smart Phones and Apps:
    These are also useful for recording and retrieving kinds of health and activity-related data. They also track and keep a record of data that is manually entered by the user or transferred from connected devices. This data is also stored on a server that can be retrieved and shared as and when required. If used on a frequent basis, health and wellness-related apps can be of great help in tracking health conditions and diagnostic procedures.
  8. Payer Records:
    This is generally termed transactional data and as the term itself suggests, it refers to the data gathered both online and offline transactions during different points of sale. A unique characteristic of transactional data is that it is time printed, which makes it highly volatile. 

Why Collecting Data in Health Care Is Important

Big data collection and analysis enable doctors and health administrators to make more informed decisions in regard to the treatment and services offered to patients. In a simple instance, a doctor with access to big data of his/her patients has data samples to draw from, which is useful in identifying any warning signs of serious ailments well before it arises. Treating a disease at an early stage is simpler and more cost-effective in comparison to when it is treated once it has progressed significantly.

In other prominent areas of the healthcare industry, big data helps administrators make informed decisions on funding and resource allocation using key performance indicators and data analytics. Big data gathered from public health records and Google maps have been of significant use while creating critical health maps. With the help of big data, administrators and providers can make use of relevant information to determine where to deploy their resources.

Hospitals and other large care facilities use big data to capture a comprehensive picture of the patient experience. Big data tools allow healthcare staff to merge useful data that would otherwise only gather dust in the archives of clinics and hospitals.  Big data allows for the consolidation of patient data, which in turn facilitates a rapid and accurate mode of communication between patients and providers.

How big data can change the healthcare industry:

  • Reducing Cost
    Big data can serve as an incredible means to cut expenses for hospitals that are generally running on overhead costs or are understaffed. Appropriate research with the help of big data can help resolve this problem by foreseeing the confirmation rates and helping with appropriate staff allotment.
  • Advancement in the Healthcare Sector
    Big data is developing day by day as the amount of data being created is increasing exponentially. This will be a tremendous advantage for advancements in the field of science and technology. Thus big data, in a way, is also supporting the healthcare industry in improving.
  • Health Tracking
    Big data is assisting a lot in tracking the health record of the user. It helps in tracking many aspects of a patient’s health like sleep, exercise, and distance walked, alongside more important aspects like heart rate, blood pressure, blood oxygen levels, glucose monitors, and many more.
  • Assisting High-Risk Patients
    The biggest plus point of having a digitized form of data is having the assurance that all important files are stored in a safe and accessible manner and that they will never get misplaced. Similarly, in the case of all hospitals, digitization helps store records of data from numerous patients in a secure and accessible manner, which makes it the ideal data that can be gotten to comprehend the pattern of numerous patients at any given time. This method is particularly helpful to keep a check on high-risk patients and care for them in a more efficient manner.
  • Preventing Human Errors
    Human errors in a clinic or hospital can end up turning fatal for the patient. Hence this is one of those instances, where the scope for human errors cannot be accommodated at any cost. Big Data can greatly help prevent human errors in hospitals by helping with ready-to-access patient information like medical history and prescriptions at the snap of a finger. This tool is especially beneficial for doctors who meet with multiple patients in a day.

How Big Data Improves Patient Outcomes

Earlier amassing large volumes of data for clinical use was an expensive and time-consuming process. But now, innovative technologies have not only helped in the collection of large amounts of data electronically but have also helped in the seamless conversion of the same into easily readable forms. Health professionals can now come up healthcare solutions backed with solid data to improve patient outcomes in many ways:

  1. Predictive Analytics: Big data analytics can identify patterns and trends in patient data, enabling healthcare providers to predict disease progression, identify high-risk patients, and intervene earlier. Predictive models can help in identifying patients who are more likely to develop specific conditions, allowing for early interventions and personalized treatment plans.
  2. Personalized Medicine: Big data enables healthcare providers to analyze vast amounts of patient data to tailor treatments and interventions to individual patients. By considering factors such as genetic information, medical history, lifestyle, and environmental data, doctors can make more precise diagnoses and develop personalized treatment plans that are more effective and have fewer side effects.
  3. Clinical Decision Support: Big data can provide healthcare professionals with decision support tools that help them make informed decisions at the point of care. By integrating patient data, medical guidelines, and research findings, these tools can suggest treatment options, alert healthcare providers to potential drug interactions or allergies, and provide real-time clinical guidance, leading to better and safer patient care.
  4. Population Health Management: Big data can be used to identify trends and patterns in larger populations, allowing healthcare providers to implement preventive measures and interventions to improve public health outcomes. By analyzing data on disease prevalence, risk factors, and treatment outcomes, healthcare organizations can target resources to high-risk populations and develop strategies to reduce the overall burden of disease.
  5. Research and Development: Big data can accelerate medical research by providing researchers with access to large datasets for analysis. By analyzing diverse patient populations and combining different data sources, researchers can discover new insights, develop new treatment modalities, and improve patient outcomes.
  6. Real-time monitoring and early detection: Big data analytics can enable real-time monitoring of patients, especially those with chronic conditions or those in critical care settings. By collecting and analyzing data from wearable devices, sensors, and EHRs, healthcare providers can detect early warning signs of deterioration, intervene promptly, and prevent adverse events.
  7. Quality improvement: Big data analytics can help healthcare organizations identify areas for quality improvement. By analyzing patient data, outcomes, and performance metrics, organizations can identify inefficiencies, reduce medical errors, and implement evidence-based practices, ultimately leading to improved patient outcomes and safety.

In the end, it is important to note that while big data holds great potential for improving patient outcomes, challenges related to data privacy, data quality, interoperability, and ethical considerations need to be addressed for its effective implementation in healthcare.

Collect More Accurately with Eligibility and Benefits Verification

In this fast paced world, technological advancements have become an inevitable part of our professional lives. And to keep pace with this fast changing world, the medical billing industry has also adopted the relevant changes and become increasingly complex. With complexity, comes a greater need for process refinement. What this complex system now requires, more than ever before, is close attention to validating coverage, benefits, co-payments, and unpaid deductibles. The current status quo has seen proper eligibility verification become very important in the dental industry. Failing to perform proper eligibility verification can lead to unpaid and delayed claims. 

Eligibility and benefits verification is the first and most significant step in the medical billing process. Failing to effectively carry out a verification can end up in an unpaid claim by their insurance company. Insurance information keeps changing frequently. Failure to stay ahead of ever-changing regulatory requirements could lead to rejected claims, billing errors, and reimbursement delays, which in turn may affect the overall collection of a practice. 

What are the best ways of collecting more accurately?

The most efficient way of collecting is by streamlining the eligibility and benefits verification process. Decrease in delays and denials are also paramount to collecting more accurately. The following methods can be adopted to streamline the process, making it faster and more efficient. 

  1. Advance patient insurance verification :
    Verifying the patient’s insurance coverage well in advance allows the practice to have an approximate estimation of the total  patient responsibility for payment. This patient responsibility consists of the portion of the bill that should be paid by the patient themselves, which includes co-payments, unpaid deductibles, and co-insurances. Patients upon being informed of their responsibility prior to appointments, are far more likely to come to the appointment prepared to pay or make payment plans, making the overall collection process easier.
  2. Review, revisit, and reconfirm:
    Once the details of the insurance plan is collected, it is very important to review it carefully to identify errors, spot the gaps and check on the validity of data. This will help reduce delays and denials in the further steps.
  3. Record data for future references:
    The gathered and reviewed data should always be stored and maintained for future use. The data can serve as a ready-to-use reference in the future treatments to avoid miss-spellings and other errors while entering the data.
  4. Use of technology:
    There is no doubts onthe pivotal role of technology in streamlining and easing out a complex process. Technology-based platforms automate your eligibility verification process which, in turn, enhance efficiency and quality helping you collect better.
  5. Identification of pre-authorization needs:
    Pre-authorization is a primary requirement in several of the medical services. These authorizations need to be duly approved, entered in the system, and linked to the correct visits.
    Identifying such cases and obtaining authorization approvals can help ease the billing process, and reduce claim denials.
  6. Updation of Coordination of Benefits:
    Primary, secondary, and tertiary insurance should be thoroughly checked. When patients have multiple insurance plans, it is necessary to remind them to update their coordination of  benefits (COB) with each payer. This allows the elimination of  over-insurance or duplication of benefits.
  7. Benefit limitations:
    It is very important to note down any benefit limits whatsoever, if listed, and check how much of the benefit remains. Some plans may have limitations on the amount payable on each visit or the frequency and time frame in which the services must be delivered.
  8. Maintain data hygiene:
    Patients’ data should be updated  proactively rather than reactively, that is, the document wise requirements from the patients should be anticipated beforehand and collected as per the checklist instead of asking for data as and when required. This helps practices maintain a ready-to-use database and considerably reduce the risk of errors.
  9. Outsource to professionals:
    Professional medical billing services companies come equipped with all the relevant experience and skill sets that are paramount to streamlining the billing procedure and improving efficiency. If a practice faces challenges in regards to being unable to dedicate existing workforce or fall short of expert staff to manage this process, outsourcing the Eligibility Verification and Coverage identification process to professionals could be one of the best ideas.

In a nutshell, a smooth-sailing eligibility and benefits verification process is very essential to any practice. Working with patients, handling all the relevant paperwork, and verifying patient information with their respective insurance carriers facilitates revenue cycle improvement and maximizes reimbursement. During verification, it is key to keep in mind that the process must be carried out in efforts to reduce claims rejections. Filing for claims rejection is a very time-consuming procedure and can sometimes turn out to be very chaotic. This makes the overall collection process a tedious task which makes it imperative to verify a patient’s insurance plan before the patient gets admitted to any hospital, clinic or medical facility in order to avoid claim rejection. Streamlining the eligibility and benefits verification process would increase efficiency and help the practice collect their receivables more accurately.

Accounts Receivable Aging Reports And How to Prepare Them

An accounts receivable aging report organizes all unpaid customer invoices based on how long they have been outstanding. The report is generally divided into intervals that help practices in monitoring receivables in a timely manner which ultimately helps practice owners identify why their revenue may be going down. Accounts receivable aging reports also help track their outstanding payments from clients which helps them identify those clients who are becoming credit risks. Practices aim to provide treatments and other services and receive timely payments. Hence, they must always keep track of their receivables and stay on top of who owes them to maintain their financial health.

How to prepare accounts receivable aging reports

An AR aging report is generally prepared by listing the names of the patients, the amount of money they owe the practice at different time intervals, and the total of all the outstanding balances. It is also called an aging schedule because all the outstanding dues from clients are duly segregated and divided into different time intervals based on their due dates.

  1. Review open invoices

The best way to start preparing the report is by reviewing all the outstanding invoices of the practice to get a complete financial picture of the practice at the end of the report.

  1. Categorization based on the aging schedule

The next step is to sort all the invoices by patient name and subsequently itemize each client’s invoice. The invoices are then sorted out by invoice date or number.

  1. Customer list with outstanding invoices

Once the invoices have been sorted and categorized, the next step to follow is the creation of a list of clients with outstanding invoice balances. These client details are included in the final accounts receivable aging report.

  1. List customers based on the number of days outstanding

Finally, the clients are listed on the accounts receivable aging report based on the number of days due on their invoices. 

Importance of Accounts Receivable Aging Reports

  1. Stay on top of your billings
    Accounts receivable aging reports allow a practice to identify those patients who repeatedly fail to pay their invoices. The practice is then able to contact these patients to follow up on their dues, allowing the practice to stay in a tight loop with its billing and collection processes. With regular follow-up, late payments can be prevented and bad debt occurrences can be significantly reduced.
  2. Suspend ties with arduous clients
    Accounts receivable aging reports give you a clear picture of your good and bad clients and ultimately help you identify the clients the practice needs to sever ties with to prevent losses. It is always a good idea to let go of clients who constantly fail or struggle to pay their dues.
  3. Maintain healthy cash flow
    Delayed payments can be problematic for practices for several reasons, including causing a disruption in its cash flow. A healthy cash flow is essential for running a successful practice. Practice can incur tremendous losses and eventually fail when clients stop paying or due to mismanaged cash flows.
    An accounts receivable aging report allows the practice to identify issues in the accounts receivable. Based on these, the practice can then take steps to remedy those problems, such as getting clients to pay their dues faster or preventing issues in cash flow.
  4. Identify risks of bad credit
    The AR aging report method can help the practice estimate its uncollectible debts, be it for one reason or another. This figure can then be used as the end balance of allowance for all the doubtful accounts for the practice. It is observed that the longer accounts receivables remain outstanding, the lesser likely it is that the practice will be able to collect them. The adjusted journal entries for these bad debt expenses can later serve as a reference source to identify bad credit risks early and avoid them.
  5. Improve your collection process
    AR aging reports allow a practice to analyze its collection process. For instance, numerous old accounts receivables, mostly clocking over 60 or 90 days, may indicate that the practice may be weak in its collection process. Therefore taking note of such trends from the AR aging reports, can help remedy the situation by making changes and adjustments in the practice’s collection practices, making sure invoices are sent correctly, or hiring a debt collection agency.
  6. Alter your credit policies
    AR aging reports are helpful in identifying those clients who are lagging behind on payments. If these clients are few in number, then the appropriate actions are taken on a case-to-case basis. However, if repeated instances of a similar trend are observed in multiple clients, it clearly indicates an issue with the existing credit policy. In such a scenario, appropriate research needs to be done and the credit risk and policy of the practice need to be compared with the industry standards to check for the need to make adjustments.

A strong working relationship with your revenue cycle partner

A large majority of dental practices are struggling financially. Dental practices are largely dependent on RCM service providers to help them manage their revenue. Dental practices are leveraging outsourced revenue cycle functions in order to reduce labor costs and get a grip on the increased expenses in their practices. A strong working relationship with your RCM service provider is critical to achieving these goals.

Why is it  important to have a strong working relationship with your revenue cycle Service partner?

It is important to have a strong working relationship with your revenue cycle Service partner because they play a vital role in the financial success of your dental practice. Revenue cycle management involves various processes, such as patient registration, charge capture, claims submission, payment posting, and denial management, which can turn out to be an extremely time-consuming task for your dental practice and can . A revenue cycle partner is capable of understanding your organization’s operations and goals and can provide tailored solutions and strategies. When you work closely with your revenue cycle partner, you can ensure that these processes are optimized and aligned with your organization’s goals. A strong working relationship also facilitates effective communication, problem-solving, and collaboration, which can help to reduce errors, increase efficiency and collaboration between departments, and maximize revenue.

Having a strong working relationship with your revenue cycle partner is crucial for the success of your healthcare organization. Your revenue cycle service partner is responsible for managing your billing and collections processes, ensuring that your organization receives proper reimbursement for the services provided to patients. Therefore, a strong working relationship with your revenue cycle partner can enhance your organization’s financial health and improve patient care, ultimately contributing to its long-term success.

Here are some key factors that contribute to a strong working relationship with your revenue cycle service partner:

  1. Define clear expectations:
    Outcomes strongly depend on expectations. It is therefore very crucial to clearly define your practice’s expectations not only to your staff but also your revenue cycle service provider. This will help define what success means to your practice as well as provide clarity to your revenue cyle partners on how to assist you better.
  2. Clear communication:
    Open and transparent communication is essential for a strong working relationship. It is important to establish regular communication channels to discuss any issues, concerns, or changes that may affect the revenue cycle process. It is always advisable to maintain a two-way communication channel with your revenue cycle partner to convey your needs, while at the same time also listening to their inputs and concerns on matters to efficiently identify areas for process improvement.
  3. Common goals:
    It is very important that your revenue cycle service provider understand your needs and expectations and works towards fulfilling them in an efficient and timely manner. A good revenue cycle partner would collaborate with your practice to understand its long-term and short term financial goals and work with you to achieve them. This can include  streamlining workflows, reducing denials, reducing accounts receivable days, improving cash flow, and increasing revenue. It is therefore ideal to promote a culture of shared goals to ensure your practice as well as your revenue cycle partner are both moving forward in the same direction.
  1. Data transparency & regular feedback:
    Both parties should have access to accurate and timely data to make informed decisions. This includes financial reports, billing data, and other relevant information. It is also very crucial for the practice to provide regular feedback to RCM partner on their performance. This can include feedback on denials, collections, and other key metrics. Use this feedback to identify areas for improvement and to celebrate successes.
  2. Increased efficiency:
    When you have a strong working relationship with your revenue cycle partner, you can work together to streamline your revenue cycle processes. This can help reduce errors, increase accuracy, and ultimately improve your revenue cycle performance.
  3. Performance metrics:
    Establishing clear performance metrics and goals can help you track the success of your partnership. Regular performance reviews can help you identify areas for improvement and ensure that your revenue cycle service partner is meeting your expectations.
  1. Better financial outcomes:
    By working closely with your revenue cycle partner, you can ensure that your billing and collections processes are optimized. This can result in faster payment collections, reduced denials, and increased revenue for your business.
  1. Flexibility:
    Market conditions, regulations, and technologies are ever-changing. It is important to ensure that both the dental practice as well as the revenue cycle service providers should be able to adjust and adapt to this change. Flexibility goes a long way in securing a strong relationship between your practice and your revenue cycle service provider.
  1. Trust and accountability:
    Trust is essential for any successful business partnership. Your revenue cycle partner should be trustworthy and accountable for meeting performance metrics and delivering on their promises.
  2. Stronger partnership:
    A strong working relationship with your revenue cycle partner can lead to a long-lasting and mutually beneficial partnership. This can include recognizing their contributions, building trust, and maintaining open communication channels. This can help build trust and confidence in your business relationship, and ultimately lead to better financial outcomes for both parties.

In short, developing a strong working relationship with your revenue cycle partner is critical for the financial success of any your dental practice. By establishing channels for clear communication, defining expectations, having active involvement on the processes, providing regular feedback, and nurturing a positive working relationship, you can help ensure that your revenue cycle partner is a valued partner in your organization’s success.

Preferred Provider Organizations (PPOs)

Typically, dental insurance coverage in the US is either a PPO or HMO. Preferred Provider Organizations (PPOs) indicate that a network of dental professionals are employed by the patient’s plan at fixed, reduced prices. Although limiting in terms of  certain services, PPOs are the most common type of dental plan and account for 74% of the total maximum benefit.

What are PPO plans and how does it work?

In a PPO plan, patients can select a variety of dentists from a large professional network who have agreed to accept a set fee for treatments. This means that the practices charge a discounted rate that is paid in full rather than the standard fee. A portion of this reduced charge is paid by patients when they visit the practice, with the remaining amount being covered by their insurance. Depending on the treatment, the percentage that the patient pays is typically low and represents simply a portion of the discounted fee as opposed to being charged the whole cost of the service. Because of this, PPO dental insurance plans frequently have the lowest out-of-pocket costs if the patient chooses in-network providers.

Under a PPO plan, major and extensive procedures, including fillings, extractions, root canals, bridges, crowns, dentures, inlays, and treatment for gum disorders, offset at a discounted co-insurance fee, while preventive care services like x-rays, sealants, fluoride treatments, and annual visits are covered at 100%. Therefore, the practice staff need to be aware of these in order to make the most of the PPO plan. These requirements not only have the maximum overall benefit but also increase the possibility of receiving the entire amount due for the services provided.

What are covered under the PPO plans?

  • Preventative Care Services like annual cleanings, X-rays, sealants, fluoride treatments etc receive full coverage
  • Basic Procedures like treatment for gum disease, fillings, root canals, extractions etc receive Discounted Co-Insurance Fee
  • Major Procedures like crowns, bridges, inlays, dentures etc receive a discounted Co-Insurance Fee
  • Cosmetic procedures like teeth whitening, shaping, veneers or any gum contouring will not be covered
  • The patient is required to pay the full cost of anything that is not absolutely necessary for maintaining their dental health

Benefits of PPOs

  • PPO participation acts as one of the main reasons for the greater visibility and new patient flow at your practice
  • Dentists must effectively manage PPO participation if they want to generate profits year after year.
  • Dealing with PPOs can help you attract patients you don’t want to lose and also helps slow down any patient loss.
  • PPO insurance offers flexibility to both patients and dental professionals.
  • Regardless of in-network or out-of-network dentists, 82% of dental insurance policies in use today are PPOs.
  • As opposed to percentages determined based on the allowed fees of the plan, a PPO plan guarantees 100% coverage for diagnostic and preventative treatments.

Things to be careful of while participating with PPO plans

  • Several dental insurance providers check submitted fees on claims to determine the UCR, or ordinary, customary, and reasonable fees. The average fee for the demographic region will decrease if the PPO fees are billed out, which will result in lower pay for everyone.
  • Even if the claim is out of network, if you accept the assignment of benefits from secondary insurers, they will never coordinate up to a larger sum when compared to the amount you charge on the primary claim.
  • If you charge your usual rate on all insurance claims, the practice will receive a higher reimbursement because the payment will come from the patient’s specific group under the insurance company and not the PPO network cost.

Make Use Of EFTs For Faster And Secure Claims Payment

A claim is deposited into a dental provider’s bank account directly using  the electronic funds transfer (EFT) option. This reduces the amount of time and effort required to process claim payouts and does away with the requirement to take anything to the bank to be deposited. With Electronic Funds Transfer (EFT) payments as an alternative payment method, practices can accept payments more swiftly and securely. This makes your patient transaction quick and uncomplicated leading to increased claims payment and a smoother revenue cycle management. The American Dental Association has established a checklist for providers to start receiving electronic funds transfers (EFTs), which almost all insurance plans offer as a means of collecting more claim payments. It includes a number of resources to assist dental professionals in accepting EFTs for claim payments.

These are examples of an Electronic Funds Transfer:

  • Direct Deposits
  • Electronic Bill Payment through online banking
  • Debit Card Transactions
  • Phone Payments
  • ATM Transfers

Benefits of EFTs

  • Faster payments.
  • Elimination of risks such as lost, stolen or misdirected claim deposits.
  • Reduced amount of time and work for your staff.
  • Payments can be posted while you are away from the office.
  • Direct bank account transfers increase cash flow.
  • Easier to view Explanation of Payments (EOP), patient Explanation of Benefits (EOB), and Predeterminations as the providers have access to a protected portal.
  • Deposits of claim payments are made in a secure and private manner, and access is rigorously limited for each patient with a number of security elements.
  • Easier to verify payments by comparing them to ERAs.
  • If necessary, multiple bank accounts can be used.
  • It becomes simpler to organize payments from more than one insurance provider.
  • Accounting and Reconciliation are made simpler.

Here are some tips to handling EFTs

Always wait for a trace number and deposit date prior to posting

The trace number is a unique number associated with a specific deposit amount and the EFT’s deposit date is the day it arrived in your bank account. This helps your practice confirm that the funds from the claim that insurance owes you have, in fact, been put into your bank account, and also identify the precise time it was deposited. Before you designate the claim as paid, check to make sure that the payment is processed to your account. Meanwhile, posting the incorrect amount can make it extremely difficult and confusing to balance your books later.

Weekly EFT balances are far more effective than daily ones

The idea of balancing your EFTs is rather straightforward. It simply implies that the amount in your bank account, insurance site, and dental software all add up to the same number. Although balancing your EFTs is simple, it is still laborious and you can easily get distracted. An excellent way to keep your payments organized is to designate a specific day for  balancing your EFTs without any interruption. Plan a day to review all of the payments from the previous week rather than logging into web portals every day to find a few little random payments.

Post dental insurance payments and balance your EFTs separately each day

Some dental practices choose to balance their EFTs in their bank accounts and also send insurance payments to their software at the same time. When you have to enter numbers  while you navigate between various web portals, it can become perplexing. Errors could arise easily, especially if the insurance provider is depositing your EFTs into various bank accounts. Therefore, it is better to post the dental insurance payments and balance the EFTs on separate days.

So, another important question that arises is- “why is it so important to balance the EFT payments?”

It is important  to make sure  you get every penny owed to you by the insurance providers. Each payment entered in your practice system should be accounted for in the bank. You  cannot be too sure that  you are posting the right payments to your patients’ accounts if you  are not balancing the payments periodically.
There is a  common misperception is that setting up an EFT is excessively challenging or time-consuming. However,  this is definitely not the case. As a matter of fact, it can be pretty easy. EFTs  are not only simple and effective, but it also enhances patient care while eventually saving you time  at the practice.

COB: What Is It and How Does It work?

What happens when a patient shows up with dental benefits from multiple insurance plans? How are claims supposed to be filed in such cases? Which insurance company gets billed first? How do they decide on what amount is to be covered? Coordination of benefits or the COB provides a framework that helps answer these questions.

 So, what is coordination of benefits?

COB is a method for insurance companies to coordinate benefits for patients who have insurance coverage through multiple insurance providers. When a patient has dual or even multiple coverage, COB enables them to take advantage of all benefits while helping insurance providers to ensure that their payments do not surpass 100% of the overall cost.

 Coordination of Benefits regulations are intricate, and many practices don’t even take secondary insurance benefits from patients because these rules can create a lot of complications. Understanding the COB rules will enable you to submit accurate claims that will result in higher payouts. With accurate information about COB regulations, you can easily identify which plan is primary or secondary or even tertiary, file insurance claims confidently, and ensure compliance of insurance regulations.

Here are some important COB rules to keep in mind:

 Main Policyholder coverage

This rule is applicable when a patient is enrolled in more than one insurance plan, one as the main policy holder and the other as a dependent. In such cases, the primary plan is the one in which the patient is enrolled as the principal or main policyholder and the patient’s enrollment in the dependent plan would be secondary.

Current employment coverage

This applies to patients who have retired or been laid off. The primary plan would be the one they were covered by before the retirement or layoff, provided their benefits are still in effect at the time of receiving the dental service. This plan would take precedence over any current coverage they may have as an inactive employee. The current coverage would become the secondary insurance provider.

More than One Employer Plan

         When a patient has dental insurance plans from more than one job, the primary plan is the one that has been covering them for the longest. To be precise, the primary insurance is the plan they enrolled in first.

Dependent Children

         This happens when a child is covered by the insurance policies of both of their parents. In such cases, the policy of the parent with the earliest birthdate within a calendar year is considered primary. This is called the ‘birthday rule’. As for parents who are divorced or separated, the court’s decree would take precedence. Which means, the parent with the primary insurance will be the one who has the legal custody of the child.

 In cases where there is no divorce decree, the primary coverage and the responsible parent is decided first by the birthday rule and then the policy which commenced at an earlier date.

 Dental or medical plan

         If the patient has both a dental and a medical plan that offers coverage for a particular procedure, the medical plan will be considered the primary.

 Types of coordination of benefits


         The patient may receive up to 100% of costs under the primary and secondary plans with traditional coordination of benefits.

 Maintenance of Benefits

         Maintenance of benefits (MOB) applies the plan deductible and coinsurance criteria after reducing the covered charges by the amount the primary plan has already paid. Consequently, the beneficiary usually bears some cost sharing, and the plan pays less than it would under a conventional COB arrangement.

 Carve out

         Carve out is a coordinating method which first determines the usual plan benefits that would be paid, then subtracts the amount paid by the primary plan from this total.

Non-duplication COB

         Nonduplication is typically employed in self-funded dental plans. In a non-duplication COB, the secondary carrier is not liable for any payments at all if the primary carrier paid the same as or more than what the secondary carrier would have paid if it had been the primary.  Remember that if the dental insurance plans are not properly coordinated, either your patients or the insurance provider may be forced to pay expenses that they did not have to which can have a negative impact on the overall working of your practice. A lack of coordination in your patient’s plans may block payment of the claim until the COB has been verified.