How to Optimize Revenue with Dental RCM Automation and Software?

Dental practices that rely on outdated systems to manage revenue cycle experience slow processes and errors due to manual tasks, which cause huge revenue loss.

Plus, it’s difficult for practice staff to manage that all if they’re dealing with a bundle of tasks like patient care, insurance claims, patient billing, and revenue tracking.

But, you don’t need to worry. You can overcome these hurdles by investing in advanced RCM automation and software solutions. From the initial patient registration to final payment collection, all the processes in your dental revenue cycle management become efficient and fast.

With that, you can easily track your payments, submit claims without any errors, and improve your finances.

Ready to optimize your revenue? Let’s get started!

How Can Implementing RCM Automation and Software Benefit Your Practice?

By implementing RCM automation and software, you experience:

• Improved patient experience
• Fewer claim denials
• Faster payments
• Reduced overhead
• Consistent cash flow
• Comprehensive reporting and analytics

All that helps improve your practice’s overall financial performance.

If you’re wondering how, let’s break down each aspect in detail.

Improved Patient Experience

Automating your dental revenue cycle provides an easy and smooth experience for your front office staff and patients.

Your front-end staff can verify patients’ coverage plans with benefits and limitations on time, so they can effectively communicate with patients, explaining to them what their insurance plan covers and what they owe.

The front office provides patients with clear written estimates of treatment costs, so patients can decide if they want to proceed with the treatment. With that, there are no surprise bills, which can impact your relationship with the patient. 

Plus, if patients can’t afford to pay all the charges on the spot, you can offer flexible payment plans to them. You can set up these plans in your software and allow contactless payments through patient portals, so patients can easily pay their dues remotely.

Another benefit of automation is that the system sends notifications or reminders via emails or text messages if patients have missed an appointment or there are any pending dues on patients’ end.

Fewer Claim Denials

Your system collects all the important data on patient demographics and insurance plans. It automatically applies payer rules on CDT codes, documents, and pre-authorization requirements for certain procedures, and fills claim forms accordingly.

Claims are checked in real-time before submission via RCM automation and software. The system automatically flags errors in claim forms and details that don’t comply with payer policies. Here, the system makes corrections, and an expert supervision is required to see if the software performs tasks perfectly.

And after that, clean claims are submitted, making it more likely for payers to approve these claims. It saves time required in further follow-up and denial management.

Faster Payments

Just imagine a scenario where you’re sending manual claims via paper. First, you fill the form, check it, correct details, and submit it to the insurer via mail. It takes 2-3 business days or more to send the claims.

And once insurers receive the claim, they review it, and then send the Explanation of Benefits (EOB), which again requires many days. The manual process from submission to reimbursement increases the revenue cycle. This delays insurance payments and managing your practice’s cash flow becomes difficult.

But, if you use RCM automation and software for dental billing, it submits claims electronically. The process is super fast. Claims are sent instantly, insurers review these quickly, and reimburse payments sooner.

Plus, if your claims are clean and compliant with payer rules, denials are less likely to occur, improving chances of faster payments.

Reduced Overhead

Manual tasks require a lot of time and you have to hire staff for each revenue cycle task, such as:

• Scheduling patient appointments
• Verifying insurance eligibility
• Checking payer guidelines
• Maintaining policy compliance
• Filling claim forms
• Scrubbing and submitting claims
• Following up on claims
• Managing patient balances
• Reducing accounts receivable

Add to it the costs of supplies, utility bills, and rental charges, and you see a surge in total overhead.

By investing in software, you can control these expenses. Whether you integrate multiple tools or use an all-in-one platform, software automation can perform all your revenue cycle tasks with near accuracy and completes most tasks in seconds. This step is cost-effective, as compared to paying high salaries to multiple staff members in each department.

Consistent Cash Flow

With automation, claim submissions are fast, payments are quicker, and collections from patient balances become smooth. Revenue streams are predictable and it’s become very easy to manage finances. As a result, you’re not short on cash, and your practice runs smoothly.

Comprehensive Reporting and Analytics

The software generates detailed financial reports, which give you an idea where you’re losing money. It gives you revenue trends, claim denial patterns, and other reasons which lead to revenue loss.

For example, you can identify the payers who deny more claims, delay payments, or reimburse lesser amounts, and know about the dental procedures, which are prone to repeated claim denials. With that, you can fix these errors and submit claims that are approved by the payer.

These analytics are available in real-time, presenting a clear picture of your practice’s financial performance.

How to Choose a Dental RCM Software?

Before you choose dental RCM software, there are some key features and other aspects to look out for. Review these and then make the right decision for your practice.

Brand Reputation

Before you buy dental RCM software for your practice, make sure that the software is trusted by dental practices that use it. Try checking if other practices use it.

You can do that by viewing their job openings which often require experts who are proficient in the software. You can also contact peers in your state dental associations, and discuss their experiences with their software.

All these discussions help you decide if the RCM software is worth the investment.

Reviews and Case Studies

Conduct your own research on a software. If you contact the vendor’s sales reps, they’re always going to tell you how it benefits you but no one tells the downside.

Online reviews tell that. Check details and reviews of a platform on websites like Capterra, G2, TrustPilot, Software Finder, TechCrunch, TechRadar, or Google. Users give star ratings to software and share their experiences in the feedback section.

While each software may not suit every dental practice, reviews give you an idea if the software is the right choice for your practice operations.

You can also check case studies, which might be published on the vendor’s website.

Online Demos

If a vendor is genuine and their software is reliable, they’ll never hesitate to share online demos. Dental RCM companies like TransDental offer dental practices to book a free online demo, in which they show and guide how they manage your practice’s revenue cycle with automation. They respond to your queries and provide complete support.

It builds confidence and trust with that vendor, knowing that they’re offering you a genuine product. If you’re satisfied with the demo, it’s easier for you to make the decision.

Pricing

Budget is an important factor when you’re buying an RCM software. If the software has excellent features but is too costly, you might think multiple times before investing in it.

The best practice is to plan your finances by estimating your practice’s monthly earnings, costs, and profits. If you’re easily able to save enough to invest in a software and pay its charges, go for it.

You might also choose to outsource your revenue cycle to a reliable RCM partner that easily integrates the process with your existing systems and databases. And there is no need to change the systems for that. You keep your systems while they manage it by accessing your portals. 

All you need to do is trust them, provide credentials to your system, and see the tasks running. The investment is minimal. There isn’t an upfront fee. You pay a small percentage of your total earnings.

Data Security

When you access Patient Health Information (PHI), it must be kept confidential, according to the Health Insurance Portability and Accountability Act (HIPAA).

Under 45 CFR § 164.504(e)(2), HIPAA requires practices to use a software by a vendor which confirms that they won’t disclose PHI, use it only according to the requirement, and store it in a secure system.

The system shouldn’t be vulnerable to hacking, viruses, and other issues, which may result in data leakage.

So, make sure that your vendor is HIPAA-compliant. If they are, you can confidently share access to the sensitive patient data with the vendor.

Key Features

Investing in RCM automation and software is a smart choice if your software has all the key features required for your practice tasks. Let’s review the core features you must check.

Payer Enrollment Tracking

The software should check your practice’s dental credentialing status to see if you’re enrolled with a payer network. This status should be active to submit your claims, otherwise payers can deny claims.

It also automates insurance fee schedule updates, keeping your reimbursement rates accurate and current to prevent underpayments. So, once payers reimburse your claims and post Explanation of Benefits (EOB) statements, the system automatically flags lower payments and generates appeal templates to request correct payments according to contracted fee.

Real-Time Eligibility Verification

Eligibility verification is the core requirement in a dental revenue cycle. If it’s missed or done wrong, your entire revenue cycle is affected. So, an RCM software should have built-in eligibility verification tools, which check a patient’s benefits and limitations like copays, coinsurance, and deductibles in real-time, not upfront, because coverage plans can change anytime.

Plus, these tools should also create, manage, and track preauthorization requests sent to the insurers to know if payers approve certain dental procedures like dentures, implants, and bridges.

PMS & EHR/EMR Integration

A dental RCM software should easily integrate with a practice management software to fetch all the financial and administrative records of a patient, such as demographics, insurance details, and claim history.

Plus, integrating with an EHR or EMR is also important to pull all the patient’s clinical details and documents required by the payer to submit claims. These may include periodontal charts, narratives, radiographs, intraoral images, consent forms, and relevant CDT codes for the procedure.This information helps the system process clean claims that payers approve.

Automatic Claims Scrubbing

Once the ADA claim form is filled with the accurate CDT codes and attached documents, it’s important to check the details before submitting claims.

The RCM software is designed with a built-in claim scrubbing software. This tool uses artificial intelligence to automatically check the claims, detect errors, and notify if the claim is ready for submission or requires correction.

Electronic Claim Submission and Tracking

The dental RCM software should feature built-in clearinghouses or allow native integration with these tools to transmit scrubbed claims into electronic formats like HIPAA 837D and send them directly to payers.

Plus, the software also monitors the claim progress in real time, checking their status regularly. 

Automated Post-Claim Management

Once the insurer sends the EOB for the claim, RCM automation and software works accordingly.

If the insurer reimburses the amount, the system reconciles the EOB to compare the received payment against the fee schedule. If the reimbursement matches the expected amount, the system processes payment posting automation, sending payments directly to the patient ledgers.

But, if payments are inaccurate, it prepares appeal templates to correct the amount. You can modify the template by mentioning the contracted fee against the submitted CDT code and request payer to submit the correct claim.

The same process works if a claim is incorrect and denied by the payer. The system automatically generates an appeal template for correction and submits the right details and documents. It then resubmits the corrected claim.

Continuous Revenue Tracking

The system generates dashboards, which track revenue performance in real time and present analytics. Key metrics are checked like:

• Claim acceptance and denial rate
• Appeals success rate
• Net collection rate
• Patient collection rate

You can also set revenue targets or key performance indicators in the system and it monitors progress. 

It also tracks unpaid and outstanding balances by payer and aging category and automates your accounts receivable management. The system initiates follow-up processes by analyzing aging and risk levels. Follow-up is more intense on aging insurance claims or patient bills, especially those older than 60 or 90 days, as these can be high-risk and require consistent pursuit for recovery.

Patient Payment and Portal Integration

A key feature in RCM automation and software is patient billing. Recovering payments from patients is difficult, as patients may not be reachable or ignore notifications. The result is that when the amount remains uncollectible for a long time, it is written off.

Make sure that your software has either a built-in patient portal or integrates with one. It generates digital invoices which are sent to patients via email or they may check it in the portal. It also generates automated payment plans and offers options for online payments.

Robotic Process Automation

Dental robotic process automation is the process of using pre-set instructions and integrating these with your revenue cycle. It follows these guidelines and performs all the repetitive revenue cycle tasks from scheduling patient appointments and verifying insurance to submitting claims, tracking claim progress, posting payments, and managing denials.

This ensures that processes are accurate, reducing all the errors. It reduces your staff’s stress. While RPA still needs human supervision for complex claims, very less effort is required than in manual processes.

Consider a software which uses dental RPA technology for precision, speed, and efficiency.

Does Outsourcing Dental RCM Optimize Your Practice Revenue?

Finding dental RCM software with all the key features might be a difficult task, and require time to make sure that it centralizes appointment scheduling, claims scrubbing, patient billing, claim submissions, denial management, and other aspects of a revenue cycle. 

If your system doesn’t centralize all these features, you might need to find other tools for integration. And that means you’ve to invest in more tools. Buying subscriptions can impact your profitability and disrupt your cash flow.

The best option here is to outsource your dental revenue cycle management to partners, which have industry expertise, HIPAA-compliant services, payer policy integration, and customized processes to meet your practice’s needs.

As compared to in-house RCM services, outsourcing is a cost-effective option, but some practices don’t embrace it as they don’t have complete control over the process.

But, if the partner easily integrates with your existing systems, offers transparency into revenue performance in real time, and produces daily, weekly, and monthly reports, it’s the right option for your practice. 

Plus, they also assign a dedicated account manager, who replies to your queries and provides support, making sure that the software performs consistently.

With that, there is no need to buy expensive tools, and your staff can focus on caring for your dental patients and restoring smiles, while your revenue runs smoothly, all under your supervision.

Summing it Up

Dental RCM automation and software optimizes your practice revenue by tracking key metrics, automating revenue cycle tasks, setting KPIs, and complying with HIPAA and payer policies. All that results in a healthy financial management with maximum profitability, so cash flow is consistent, patients are happy, and your practice staff isn’t overburned. 

Plus, if you choose to outsource your dental RCM to a reliable partner, you get desired results at very low costs which you can afford easily. The costs which you save from outsourcing can be spent on other aspects of your practice management.

Frequently Asked Questions (FAQs)