The medical billing outsourcing market is growing rapidly, with an estimated total value of $19.32 billion by 2025, according to Predence Research. Its further growth is forecasted at $54.17 billion by 2034, indicating that this industry is steadily shifting towards outsourcing billing and RCM tasks.
As a dental practice owner, you can tap into the emerging market by outsourcing dental billing and RCM. Your RCM partner handles everything from eligibility verification to claims submission and payment posting.
If you want to avail this amazing opportunity, we’ll guide you through how outsourcing dental RCM can help your practice thrive.
What is Dental RCM Outsourcing?
Before we proceed to the details of RCM outsourcing, we must understand what it is and how it works.
So, basically, outsourcing is the process of partnering with a dental RCM company that manages all the aspects of your revenue cycle. A revenue cycle is usually divided into three phases:
| Phase | Key Activities |
|---|---|
| Pre-Claim |
|
| Billing Process |
|
| Post-Claim |
|
A dental RCM company carefully navigates the entire process and works with you to ensure that all activities are accurate and you’re able to recover your claims.
Challenges with In-House and Traditional Billing
There are various reasons why healthcare practices are heavily considering subscribing to revenue cycle management services provided by an RCM outsourcing company.
Let’s navigate these reasons first, before stepping into the benefits of RCM outsourcing for your dental practice.
Poor Performance and Ineffective Results
Traditional billing processes that require more paperwork and manual intervention have become a thing of the past.
Outdated billing practices include:
- Calling insurance companies to confirm patient eligibility for insurance
- Presenting treatment plans without verifying insurance coverage or estimating patient out-of-pocket costs
- Using miscellaneous CDT codes for common dental procedures
- Mailing paper claims and attachments like dental X-rays
- Entering the Explanation of Benefits (EOB) document manually into the patient ledgers
Such practices are slow and ineffective in the age of AI, and can’t deliver your desired outcomes.
Lag in Competition
Nowadays, the healthcare billing industry is embracing technology quickly. Latest AI-powered systems, like dental RPA, automate lengthy tasks and complete them within just seconds. And these systems do so with near accuracy.
Practices that understand the benefits of automation in dental billing are quickly upgrading their workflows. And if you don’t capitalize on the increasing AI adoption in the industry, you can’t stay ahead of your competitors. The result is that your billing processes remain slower, error rates increase, and so do claim denials, while you also lose potential patients you can treat.
Staff Issues: Expense and Turnover
Hiring in-house staff to manage your dental RCM comes with a fair share of expenses. You’ve to pay hefty salaries to dental billers and other staff to manage your day-to-day administrative and clinical tasks. With that, your profits are reduced to a huge extent! And running a practice isn’t possible without good finances.
Moreover, staff can resign at any time, disrupting your billing workflows. To overcome the issue, you either hire new staff or train your existing professionals for billing. In any case, it requires time, effort, and costs, which impact your practice’s financial management.
Lack of Real-Time Visibility
Identifying your progress and billing patterns is a must for timely corrective actions. But in-house billing doesn’t give you real-time reports and analytics on your claims progress. Your staff is mostly occupied with handling billing and other tasks, and therefore, you can’t track your claims progress on the spot.
Coding and Documentation Issues
Manual and in-house processes are at a higher risk of errors in the billing process. No matter how trained and experienced your billing staff is, they can still make mistakes, especially if there is a workload.
An easy example explains this. Suppose your staff is handling a couple of billing tasks. Some are easy, while a few are very complex. Due to this burden, your staff may end up adding incorrect codes for dental procedures and forget to complete the documentation. This is a common issue most dental practices face while relying on manual billing practices.
Aging A/R and Ignoring Unpaid Claims
A dental practice has a busy routine that involves booking patient appointments and arranging for their treatment (if required), among other tasks. In such stress, it becomes very challenging to identify overdue payments, like unpaid claims and aging accounts receivable (A/R). And therefore, you may forget these claims and A/R. It means you’re leaving a lot of money on the table, and that can lead to a significant revenue loss for your dental practice.
Now, having discussed some of the challenges your practice may experience with manual processes, we’ll see how outsourcing your dental RCM can benefit your practice.
Is RCM Outsourcing the Right Decision for Your Practice?
Efficient Billing Processes
An RCM outsourcing company supervises the entire dental RCM process, right from patient appointment scheduling to eligibility verification, claim submissions, payment posting, and A/R follow-up.
Staff at these companies are experts in their field and can easily manage every step of your dental RCM, while providing you with assistance. They carefully handle your RCM and ensure all processes go smoothly for error-free claim submissions and timely reimbursements.
Technology Implementation
Most dental RCM outsourcing companies leverage the potential of AI and technology, implementing them into the day-to-day RCM processes. Using smart tech systems, these RCM companies automate billing tasks, and each step is performed with speed and precision.
Whether it’s verifying patient eligibility or submitting claims, these high-tech tools streamline your dental RCM under the supervision of experts.
Electronic Claims Submission
Instead of relying on paperwork, RCM companies take a step further by using your EHR software to submit claims. Forms are downloaded online from the insurer’s website or can be requested via email. They fill the forms and attach the right CDT code, as per the American Dental Association’s ongoing guidelines, and then submit the claims electronically.
The process is super fast, ensuring your claims are reimbursed much faster. But, before that, these companies perform claim scrubbing via up-to-date tools to detect and rectify errors..
Effective Denial Management
RCM outsourcing companies process your claims responsibly to prevent claim denials in the first place. But, in case a claim is still denied, these companies make efforts to start the process immediately. Since they’re supervising each step in dental RCM very closely, they identify denial reasons on the spot. Reasons can be inaccurate coding, incomplete documentation, or the patient’s insurance eligibility issues.
By spotting the reasons, RCM companies submit appeals via paperwork or electronically, as per the insurer’s preference. After that, they make corrections in the resubmission form and highlight it as a corrected form. And then follow up with insurance companies to ensure claims are settled and you recover your amount.
Cost-Effectiveness
RCM outsourcing is a cost-effective option if you compare it with the monthly salary of RCM specialists at your dental practice. An RCM outsourcing company usually charges a minimum percentage of what you earn per claim. If you take TransDental, as an example, it covers your dental billing and RCM in a complete package without any upfront or hidden charges.
A benefit of outsourcing to these companies is that they have experienced staff who use their skill set. You can use that to your advantage by leveraging that expertise at the total cost you pay to the RCM company.
Real-Time Reporting
There are many perks of working with an RCM outsourcing company. Perhaps, a crucial component is that the company generates reports in real-time, informing you of your claim progress and billing patterns. It helps you strategize your workflows and plan improvements to achieve better results.
Enhanced Compliance
A major concern for practices is to secure patients’ sensitive details. Violation can lead to serious compliance issues and reputational damage for your practice. But there is no chance of it with RCM outsourcing.
An established RCM outsourcing company complies with the Health Insurance Portability and Accountability Act (HIPAA), a law enforced by the US government in 1996. HIPAA sets regulations to protect Patient Health Information (PHI), ensuring that it’s not misused. So, you are relieved because your patient’s sensitive information is in safe hands.
However, you must inquire if the company is HIPAA-compliant before signing a contract.
Frequent Audits and Balanced Accounts
The dental billing audit is an essential component of your RCM, as it helps you identify billing gaps, review payments against each patient ledger, and plan strategies required for improvements. Audits can be monthly, quarterly, or annual. These can also be categorized patient-wise and payer-wise.
Audits help find if you’ve charged the right amount to your payors. In case of underpayment or overpayment, audits help maintain your proper balances.
Underpayment means that you’re paid less than the right amount, and with that, you can submit an appeal to the insurance company within the 120-day time frame of the procedure to pay the remaining balance.
And overpayment means that you’ve charged or received more than the right amount. Evaluation can lead to external audits by authorities and result in legal complications, which may lead to license cancellation and reputational damage.
However, reviewing your billing history through audits via an RCM outsourcing company protects your practice from these issues. Following this process assists you in regulatory compliance while ensuring that you recover your rightful dues.
Improved Patient Billing
Patient billing is the process you billing your patients for the remaining balance not covered by an insurance company for a dental procedure. To make it easier, let’s suppose a patient insured by Aetna visits your practice for an anterior root canal therapy. Aetna pays 80% of the total charges, requiring the patient to pay the remaining 20% of the amount. So, you have to bill the patient for that 20%, and ask to do so.
With dental RCM outsourcing, you’re relieved of the stress of patient billing. A billing company efficiently handles all the aspects of patient billing that include copays, deductibles, and coinsurance, among other pending payments. It streamlines processes for your practice and your patients, freeing you up completely from financial hurdles.
24/7 Support and Operations
Manual billers can’t work 24/7 to handle your dental billing. They get tired, need to take rest, go on vacations, and so forth.
However, if you outsource billing to an RCM company, it manages your dental practice’s financial aspects 24/7. With the combined workforce of RPA and manual intervention for AI supervision, a dental RCM company doesn’t let the process stop, even for a second. This ensures that your quest to claim recovery continues and payments are posted in accounts while you’re resting during off-hours after a tiring routine.
What to Look for While Choosing an RCM Outsourcing Company?
You can avail the aforementioned benefits only if an RCM outsourcing company is capable of performing billing tasks proficiently. So, you must conduct extensive research on the company before making a decision. Let’s discuss the key factors you need to evaluate before initiating a partnership.
Expertise in Dental Specialties
Along with general dental services, dentistry has a wide range of specialties, including orthodontics, periodontics, prosthodontics, endodontics, and others. Each specialty has varying CDT codes.
For example, some ongoing CDT codes for orthodontics are D8050 covering interceptive primary dentition, D8080 covering comprehensive adolescent dentition, and D8090 covering comprehensive adult dentition. Each dental procedure has its own requirements for treatment and documentation.
If you’re outsourcing your dental RCM for a certain specialty, make sure that the practice staff is well-versed in that. But the preferred option is to choose an outsourcing company that can easily manage dental RCM for every specialty. With that, you don’t need to incur extra charges and can easily work with a single, reliable RCM partner.
Clean Claim Rate
An RCM outsourcing company should be able to successfully recover claims for dental practices. And since you’re paying that company, you’ve every right to verify if the company has a clean claim rate, like TransDental, which has a first pass resolution rate of 98%, which is highly above the ideal FPRR of 90%. This means that an overwhelming majority of its claims are settled in the first submission attempt without the need for resubmissions or denial management.
To confirm the authenticity of these claims, contact the company and check some case studies and client testimonials. This is strong evidence of client satisfaction with the company, proving the company’s excellent track record of settling claims for dental practices.
With that being said, consider the clean claim rate as a primary factor for outsourcing. It boosts your confidence that your RCM partner can achieve satisfactory results from your claims submission.
Impressive A/R Cleanup
A/R recovery is one of the most difficult aspects in your dental RCM, as patients may ignore your notifications by not responding to them. Ultimately, you have to accept the financial loss and mark it as a write-off.
But an experienced RCM outsourcing company can leverage its expertise and assist in cleaning your accounts receivable as much as possible. Look out for an RCM partner that can clean A/R to a great extent, as it boosts your revenue improvement.
User Reviews and Industry Reputation
User reviews are a great way to check if a company can deliver satisfactory results for dental practices. Most satisfied clients praise dental RCM companies, helping them with smooth claim submissions and fast recoveries within just a couple of days.
Ensure that the company you’re looking to partner with has a positive reputation among dental practices.
Visit the company’s website for user engagement and comments. Some companies may also get reviews on external sources like social media handles, Google searches, or business pages across various platforms. Community forums may also feature independent reviews by dental practices.
Range of Services
Since dental RCM is a lengthy process from patient registration to claims submission, and post-claim follow-up on overdue payments, you need an RCM outsourcing partner that offers all RCM services.
Consider choosing a service provider by evaluating their range of services, and determine your budget and priorities for it. If the pricing and services align with your budget and requirements, prefer working with a company that facilitates all steps of dental RCM.
While most dental RCM companies charge separately for each service, some service providers cover your complete RCM at competitive pricing, so you can spend less, earn more, and drive your practice to growth.
Tech Capabilities
Technology is evolving, and so is the healthcare industry. Practices now implement solutions powered by artificial intelligence for automation to improve the quality of care for patients and manage finances efficiently.
And you must adapt to technology to stay ahead of your competitors and thrive in the cut-throat industry. For that, consider working with an RCM outsourcing partner who leverages AI for speed and precision to perform tasks with ease. Using smart and robust AI solutions reduces manual errors, unnecessary paperwork, and eventual claim denials, empowering you to transform your processes.
Moreover, the company must easily integrate with your practice’s EHR systems. The company should be capable and proficient in your existing systems to manage patient and insurance billing.
Excellent Customer Service
Your RCM company should be able to respond to your concerns or queries with a professional approach and offer practical solutions. Availability in communication makes things easier, as you can contact them anytime to inquire about updates on the billing process. Renowned companies assign dedicated billing managers, who supervise your entire dental RCM, staying on top of things and keeping you informed.
On top of that, some companies also offer dashboards for real-time visibility into your billing process and other key metrics. This eliminates the need to consult with an account manager for most of the queries. But you can still stay in touch with the manager for complex queries and custom solutions.
Transparent Pricing
While you’re signing a contract with a dental RCM company, make sure to negotiate pricing beforehand. An authentic company communicates pricing details on the spot, enabling transparency without any hidden or upfront charges. You should ensure open communication with their sales team to prevent any future hassle.
Conclusion
Patient satisfaction and a smoothly running dental RCM are the backbone of every dental practice. A practice cannot thrive without both these aspects. And if you want to succeed with it, capitalize on the growing trend of outsourcing RCM. Choose a reliable partner that offers competitive pricing, real-time visibility, excellent customer support, and decent revenue for your dental practice. Make an instant decision and see your practice scale!
Frequently Asked Questions (FAQs)
What is RCM outsourcing?
It is the process of outsourcing your dental practice’s revenue cycle management to a dental RCM or dental billing company. A billing company manages everything from verifying patient insurance to submitting claims on your behalf at very affordable prices.
What are the 7 steps of RCM?
Key steps in a dental RCM include patient registration, eligibility verification, treatment planning and cost estimation, dental coding, claim submission, payment posting, and denial management and A/R follow-up.
What are the costs and ROI expectations when outsourcing dental RCM compared to maintaining an in-house billing team?
Outsourcing dental RCM typically reduces overhead costs tied to staffing, training, and software while improving claim accuracy and reimbursement speed. Most practices see a higher ROI through faster collections, fewer denials, and reasonable pricing.
Will outsourcing RCM affect the patient experience?
A good RCM partner enhances the patient experience by ensuring accurate billing, clear statements, and faster issue resolution, allowing your team to focus more on patient care rather than administrative tasks.
How do I know if outsourcing RCM is right for my dental practice?
If your team struggles with claim backlogs, high denial rates, or inconsistent cash flow, outsourcing is the right choice. It’s especially beneficial for growing practices that want to scale operations without adding administrative burden.
