02 Oct Medusind’s Advanced RCM Techniques Put Money in Your Pocket
In dentistry, revenue cycle management (RCM) is the science of managing the financial transactions and interactions that occur among a dental provider, patients, and payers during the complete timeline of patient care. This includes the entirety of a patient relationship, ranging from when they first schedule an appointment to when you collect final payment.
Understanding the Importance of Dental Revenue Cycle Management (RCM)
Why is RCM critical for the financial health of your dental practice? It keeps your office doors open and pays the bills. Done properly, RCM delivers accurate and timely payment to your dental practice for services rendered with a steady cash flow, an essential necessity to pay for your operational costs— overhead, staff salaries, supplies, and equipment.
The common challenges in dental RCM include claim denials, patient billing, and coding issues. But how do you address these challenges?
Top 5 Dental RCM Strategies to Maximize Revenue
Here are five key strategies to optimize dental RCM:
Accurate insurance verification
Insurance verification is the crucial first step in the revenue cycle. By verifying a patient’s coverage before treatment, you can prevent denied claims, unexpected out-of-pocket costs for patients, and delayed payments. Because insurance verification is time-consuming, many dental offices struggle with it, but when it’s mishandled, it leads to administrative headaches.
Streamlined patient communication for billing
Effective patient communication regarding billing is vital for dental practices. If you clearly communicate with patients about their financial responsibilities, better collections are the result. It’s important to let patients know in advance what treatments and procedures will cost in advance to prevent surprise bills. Patient education results in an improved patient experience, faster payments, and enhanced trust. It also generates efficiency in operations and better insurance processing.
What are some tips on simplifying billing for patients? Consider offering flexible payment options and online payment.
Optimized claims management
Claims management is one of the most important components of RCM. Filing clean and accurate claims is essential to ensure timely reimbursement from insurance companies. Dental practices often face challenges with denied claims due to incorrect coding, missing documentation, or eligibility problems.
Coding accuracy
Coding accuracy is all-important for dental practices because it enables:
- Maximum reimbursement: Inaccurate codes can result in claim denials or delays.
- Regulatory compliance: Accurate coding helps maintain compliance and reduces the risk of audits and penalties mandated by the American Dental Association (ADA) and insurance companies.
- Patient care: Correct coding can determine the future of patient care. If it reflects the true nature of the services provided. It can ensure that patients receive the appropriate treatments based on their diagnoses.
- Optimized revenue cycle management: Efficient coding strengthens your bottom line by streamlining billing processes and reducing the administrative cost of correcting errors.
Financial reporting and analysis
How does financial reporting and analysis maximize RCM? It generates improved cash flow management. With detailed financial reports, your dental practice can track incoming revenue and outstanding accounts. It also enables you to identify trends in patient payments, service demand, and payer reimbursements. Analyzing billing data optimizes billing processes by identifying where the billing process may be slowing down or encountering problems. Financial reporting creates benchmarks so you can evaluate your practice’s performance. You can monitor and improve key performance indicators (KPIs) related to RCM, such days in accounts receivable, clean claim rates, and claim denial rates, Tracking and analyzing these KPIs can help you identify bottlenecks in revenue collection.
The Step-By-Step Process of Dental RCM: Exactly How It Works
Dental revenue cycle management progresses through three stages: front-end, mid-cycle, and back-end:
Front-End
Provider Contracts and Schedule
- Provider credentialing
- Provider network status check
- Generate a Patient Schedule Report for all daily scheduled visits
Eligibility and Patient Verification
- Eligibility checks
- Comprehensive benefit verification
- Attaching the patient to the plan
- Electronic funds transfer (EFT) setup
Mid-Cycle
Coding and Charge Capture
- Reviewing patient charts
- Ensuring dental records have been completed
- Attaching and billing correct codes
Claims Scrubbing and Submission
- Reviewing claims for accuracy
- Electronic claim and predetermination (Pre-D) submission
- Attaching correct documentation
Back-End
Claims Adjudication and Adjustments
- Posting payments to the correct patients
- Correct network adjustments
- Contract compliance
Accounts/Receivable (A/R) Tracking and Denial Resolution
- Claim rejection review
- Outsourcing A/R follow-up
- Denial resolution processes
Outsourcing vs. In-House Dental RCM: Which is Best for Your Practice?
The complex process of dental RCM can be overwhelming and a strain on your internal resource, burning up time that could be better spent on patient care. In that case, you might want to compare managing RCM in-house versus outsourcing dental RCM to third-party specialists.
When seeking an RCM partner, here are some key questions to ask:
- Do you get a dedicated team?
- Is there an option to choose solutions based on your practice’s needs and preferences?
- Can they customize systems and processes to fit with your current operations?
- Are they HIPAA-compliant?
- Do they support your Practice Management Software (PMS)?
- Does their average first-pass rate and turnaround time (TaT) meet or exceed industry standards?
Interested in exploring your options with an RCM partner? If so, feel free to contact Medusind. As a national leader in dental billing and collections, we can analyze your unique needs and engineer our sophisticated RCM strategies to boost your bottom line and fuel your practice’s future growth
