Are Dental Billing & Dental Revenue Cycle Management the Same?

Did you know that nearly 25% of dental claims are initially denied, delaying cash flow and creating operational challenges? While dental billing errors are a common source of denials, they’re certainly not the only one. That’s why it’s important to understand the role of dental billing in the larger context of dental revenue cycle management. Seeing the big picture—including the many other points at which errors can occur—helps dental practices improve financial stability, patient satisfaction, and operational efficiency.

What is RCM in dentistry?🔗

Dental revenue cycle management refers to the entire financial life cycle of the patient visit. While dental billing is an important part of this life cycle, dental revenue cycle management also includes several other critical steps beginning with the collection of patient demographic and insurance information and ending with a fully paid claim.

Having a comprehensive view of the entire financial process helps dental practices pinpoint dental billing errors and other types of errors so they can fix them proactively. Dental practices that only focus on dental billing may have a myopic view of their finances and struggle with revenue loss due to denials, unpaid patient balances, or inefficient workflows.

Dental revenue cycle management includes the following three key stages:

1. Pre-visit, including dental credentialing, patient registration, and insurance verification
2. Point-of-service, including patient presentation and acceptance of treatment, dental coding, and claim submission
3. Post-visit, including insurance payment posting, accounts receivable management and follow-up, denial management, and patient collections

Each of the three stages in dental revenue cycle management is equally important, and each stage plays a unique role in promoting revenue integrity. The pre-visit stage of dental revenue cycle management is all about gathering accurate information, and it lays the foundation for clean claims. The point-of-service stage of dental revenue cycle management ensures patients receive the high-quality care they need and that CDT codes reported on dental claims reflect the care that’s provided. During the post-visit stage of dental revenue cycle management, dental practices receive payment, handle any denials, and address any outstanding accounts receivable.

How is dental revenue cycle management different from dental billing?🔗

Dental billing is a core component of dental revenue cycle management. Important dental billing tasks occur during each of the three dental revenue cycle management stages listed above. More specifically, pre-visit dental billing tasks include dental credentialing and dental insurance verification. Point-of-service billing tasks include CDT code assignment for dental procedures and claim submission to payers. Post-visit dental billing tasks include insurance payment posting, denial management, and accounts receivable follow up.

Key dental revenue cycle management challenges🔗

Today’s dental practices continue to face several dental revenue cycle management challenges, including:

• Claim denials and payment delays. Payers may deny or delay payment for various reasons, requiring dental practices to appeal and/or comply with additional requirements to ensure payment.
• Cross-coding for medical claims. Dental practices need to know when CDT and CPT codes may be relevant for certain dental procedures.
• Dental coding complexities. CDT, ICD-10-CM, and CPT codes change frequently.
• Insurance requirements and regulations. Payers and regulators frequently impose new rules with which dental practices must comply.
• Outstanding patient balances. Dental practices need comprehensive, tech-enabled strategies to collect patient balances while mitigating administrative costs.
• Staffing shortages. Dental practices struggle with ongoing healthcare staffing shortages and the ability to recruit and retain skilled dental revenue cycle management employees.

Best practices for efficient dental revenue cycle management🔗

There are several ways to increase dental revenue cycle management efficiency. Consider the following:

1. Leverage technology. Augment staff capabilities with tools that improve dental revenue cycle management. Technology can help dental practices maintain up-to-date fee schedules, open claim investigations, merge duplicate claims, identify claim status with ease, and so much more.
2. Train staff on CDT coding. CDT code revisions, additions, and deletions occur annually. Train staff on these and other regulatory changes to promote clean claims and reduce claim denials.
3. Perform regular audits. Audit claims to ensure compliance and prevent errors proactively.
4. Form a team dedicated to dental billing processes. Hire qualified staff internally—or partner with a high-quality vendor—to ensure dental billing and dental revenue cycle management receive the attention they deserve.
5. Implement proactive denial management strategies. Learn from claim denials and take the time to drill down into the root causes of denials.

How outsourcing can boost dental revenue cycle management🔗

The best way to reduce operational burden and improve profitability? Adopt strategies that streamline dental billing and dental revenue cycle management and/or partner with a vendor that does the same. The right dental revenue cycle management vendor partnership helps dental practices focus on what they do best: Provide high-quality patient care. Learn how Medusind can help.