Insurance companies hugely contribute to the total revenue of the healthcare industry in the US. Total spending by private companies amounted to $1.4646 trillion, while public insurance programs, Medicaid and Medicare, cumulatively spent $1.9017 trillion.
This means it’s a huge revenue stream for your dental practice, and you can’t just miss out on it!
You can maximize your earnings from insurance companies if you carefully process the claims submission. And achieving that successfully is only possible with effective RCM in dental billing.
Want to know how it transforms your billing workflows into flowing cash? Let’s discuss the entire process with its benefits and the right strategy to achieve desired outcomes.
What is Dental RCM?
Dental revenue cycle management is the entire process of tracking all the financial aspects and cash flow of your dental practice. The process begins with patient registration and eligibility verification. It continues with the insurance claim submission and concludes with claim settlements, denial management, and follow-up on outstanding balances.
These are just the key steps in a dental RCM, and to make it effective, you need to understand the entire process in detail.
So, let’s follow the entire dental RCM process step-by-step and see how it’s vital in claim recoveries and eventual financial growth for your dental practice.
Step-by-Step Dental RCM Process
Patient Registration
Your dental RCM begins right when a patient registers with your practice for a dental treatment. In fact, if you partner with an RCM outsourcing company, it also manages appointment scheduling, reducing workload for your staff, leading to improved patient care.
Eligibility Verification
When a patient’s treatment is confirmed, it’s time to verify insurance eligibility details. This means that you need to confirm if a patient’s insurance plan covers the treatment. You also need to check the total benefits available in the plan, so you can identify if the entire dental procedure is covered in insurance, or the patient has to pay some amount.
If the patient has to pay some amount, charge them immediately before the treatment begins. This ensures that you’re paid in advance for the procedure, and you can perform the treatment without worrying about payments.
Timely dental insurance eligibility verification ensures that all details are checked beforehand, and your claims are processed accurately, minimizing claim denials and ensuring quick settlements.
Pre-Authorization
Some dental procedures, like surgical tooth extractions, full mouth rehabilitation, and orthodontic adjustments, require prior approval from insurance companies. You must check these procedures and consult with insurers for pre-authorization to know if the company pays you for that treatment.
Ignoring that can lead to heavy losses for your dental practice.
So, pre-authorization is a must for certain dental procedures, and ensure that you do so before treating your patients.
Coding
Using the right CDT codes is important for each dental procedure, because insurers identify a dental procedure via these codes. Codes are subject to change each year, so you must follow the American Dental Association’s complete list of codes and the latest updates. Wrong codes for a procedure lead to claim denials, something a practice can’t afford.
Documentation
Add the relevant documents in your claims submission request to inform the insurance company of all the treatment details. These include prescription notes, X-rays, or other tests to justify a dental treatment, along with your invoice for the treatment. So, insurers can process and reimburse claims accordingly.
Claims Submission
Insurance companies provide their claims submission forms, which contain all the details related to your claims, including CDT codes. In today’s time, where technology has evolved and AI has taken over, electronic claim submissions are replacing manual processes. Claims forms are now downloaded, filled out, and submitted to the insurance companies electronically.
These reduce paperwork and manual effort, thus saving time, minimizing your workload, and ensuring accuracy for smooth claims submission.
And make sure that claims are submitted within 24-48 hours of a treatment, so the process is speedy and you receive your payments on time.
Payment Posting
Once your claim submission is approved, the insurer reimburses your claims. After the claim settlement, ensure that the payment is posted in the right payment ledger in your EHR software, so you know that you’ve recovered payments by treating a certain patient. By comparing the collected amount with the actual fares, you can easily identify underpayments and claim discrepancies.
Denial Management
Dental practices often encounter the issue of claim denials or partial payments by insurance companies that can be due to various reasons. These can be incorrect CDT codes, typos in patient name or other details, incomplete documentation, or wrong amount billed for a dental procedure. In any case, it’s important to manage these denials and ensure claims are recovered.
For that, firstly, identify the errors in your claim request. After that, initiate the appeal process by writing a letter or generating an online request to the insurance company. Enter all the details and documents, such as a copy of the original claim, an Explanation of Benefits (EOB) file that shows the denial reason, and any other relevant notes.
Ensure that you follow the insurer’s policies and use an appeal form if required and provided by the insurance company.
A/R Recovery
One aspect dental practices often overlook is accounts receivable (A/R) and overdue payments. Sometimes, it’s been several days, and you’ve forgotten about the pending amount you haven’t recovered yet.
You’ve to follow the proper process by submitting a request for an unpaid claim within a 30-90 day timeframe. Similarly, contact patients who haven’t paid you for dental procedures within 120 days of the treatment. Send them reminders to alert them about their payments, and try to recover the amount fast.
Best Practices and Tips for Effective RCM
Following a few practices helps improve your dental practice’s revenue cycle management and makes it a lucrative investment.
Automate Your Dental RCM
By installing AI-powered systems and dental RPA, you can automate all the steps in revenue cycle management. With automation, you can complete lengthy billing tasks in just a matter of seconds, and these tools do so almost accurately. It saves much time and reduces workload for your staff, leading to efficient practice management and quality care for dental patients.
Train Practice Staff
Your RCM can deliver excellent results only if your staff is proficient in handling all the billing tasks and operating all of your systems, such as top dental EHRs like Dentrix, EagleSoft, and iDentalSoft. Expertise in system management leads to fewer errors and reduced claim denials.
Set KPIs
Key performance indicators (KPIs) with set goals are crucial to identify your billing patterns and see if you’re able to meet these goals. For example, you can set your claim turnaround time to 24-48 hours, or clear your A/R to a huge extent within 26 days. With set targets, your staff performs better and works harder to achieve these goals. And in case you’re unable to meet goals, you can detect weaknesses in the processes and improve your strategy.
Outsource Your RCM
You can save costs and minimize workload by outsourcing your dental RCM to a reliable partner like TransDental. With in-house dental RCM, your staff is occupied in managing all the tasks, and it also results in staff burnout. Staff turnover can also affect your dental RCM, as you need to hire and train new personnel. However, by subscribing to revenue cycle management services from third-party companies, you can avail several benefits.
To discuss these potential benefits, let’s jump to the next section.
Benefits of Dental RCM
By implementing some best practices, you can improve your practice’s overall dental RCM. So, let’s see what it delivers and how your dental practice can drive revenue growth.
Complete Progress Tracking
Dental RCM is a lengthy process that encompasses various steps, including eligibility verification, claims submission, payment posting, denial management, and follow-up on overdue payments and aging A/R.
With RPA, you can track all the steps of RCM and get real-time visibility throughout the entire process.
By supervising the entire process from the very beginning, you are well-informed about all the steps, which helps you proceed accordingly with minimal chances of errors. As a result, you can expect to receive claim settlements very soon.
Fewer Claim Denials
RPA systems verify patient insurance eligibility and process claims only if the insurance plan covers the patient’s treatment. Moreover, these systems process your claims faster and enter accurate details, including correct CDT codes and the right documentation for each procedure. It accelerates your clean claims rate, meaning fewer denials and faster recoveries.
Improved Cash Flow
Steps like automation and outsourcing minimize your expenses to a great degree, while maximizing your collections. As a result, you can increase your profitability with huge margins. Higher earnings lead to a smooth dental practice management.
Enhanced Staff Productivity
These steps free up your staff as RPA tools or outsourcing companies handle your billing tasks and RCM. It allows your staff to focus on other clinical tasks, such as patient care, which is the primary task for any dental practice. Whether it’s a root canal or a dental implant, your staff assists you in treating patients and restoring their smiles.
Conclusion
Handling dental RCM is an important task for your practice management to ensure a smooth dental claims billing with fewer claim denials and maximum collections. But that is possible with a better approach: outsourcing your RCM to an AI-powered company that automates tasks with speed and precision using robust RPA systems. Ultimately, it skyrockets your practice revenue growth!
Frequently Asked Questions (FAQs)
What is RCM in dental billing?
Dental RCM is the full financial roadmap your practice follows from the patient walking in to the final insurance payment hitting your bank account.
What are RCM KPIs?
KPIs (Key Performance Indicators) are the goals you always set to measure your billing success, like aiming for claims to be paid within 26 days or submitting claims within 24 hours.
What are the main benefits of outsourcing Dental RCM?
Outsourcing Dental RCM reduces staff workload and burnout, saves time, minimizes billing errors, and ultimately leads to faster, higher collections for your practice.
What is the biggest reason dental claims get denied?
The biggest reasons are usually simple mistakes, like using the wrong CDT code, having incomplete documentation (missing X-rays), or typos in patient or billing details.
Why is verifying insurance eligibility so important?
Verifying eligibility before treatment confirms the patient’s coverage. This prevents claim denials later and lets you collect the patient’s portion (co-pay) immediately.
