A Beginner's Guide: Revenue Cycle Management for Dental Professionals

From a dental RCM perspective, a healthy system works in concert with industry best practices and technical solutions that help identify leaks and improve operational workflow. But as every

practice is unique it is difficult to prescribe a “one size fits all” approach. Therefore, there are key performance indicators that can and should be followed to measure the dental billing and coding performance of a practice.

Let’s talk about Dental RCM

The revenue cycle incorporates data capture, claims and denials management, and the

collection of payments from both patient and insurance receivables. Basically, it lets you keep your receivables and aging organized with many automated tools to improve revenue and reduce costs. 

Within Dental Revenue Cycle Management, several potential KPIs provide valuable insight into the collection’s performance and the financial health of the practice. These include, but are not limited to, Collections percentage, production growth, Aging accounts receivable, Days sales outstanding, Adjustments percentage, and Credit Balances. At the end of the day, the ultimate goal of any practice is to generate revenue appropriate for financial stability and continued growth.

The Three Goals of Dental RCM

Understanding the cycle as a holistic and comprehensive view of a dental RCM service is the first step in developing the strategy to respond. Therefore, a healthy revenue cycle management strategy enables practices and providers to

Increase profitability		Identify gaps and employ proactive measures to reduce the time spent collecting past-due balances and get paid faster.
Gain financial control over your practice		Monitor and manage all areas of the practice, thereby establishing standards and benchmarks required for collective action if required.
Decrease administrative burden		Streamline and automate tasks, saving time on administrative duties and leading to effective patient care.

Did you Know?

CareStack’s practice management platform is built to help growth-focused practices run their revenue cycle management operations smoothly and efficiently. With integrated features for credit card processing, electronic claims attachments and auto posting of claims, CareStack helps your office to streamline your RCM operations better than all other software.

Identifying and resolving leaks in the Revenue Cycle 

When a dental practice is leaking revenue, issues need to be identified and resolved promptly. Both clinical and administrative processes can lead to revenue loss. Therefore, understanding the entire revenue cycle in a complete and thorough way is the first step in creating a strategy to address these issues.

Here is a short guide to Dental RCM and how to resolve leaks within your revenue cycle:

Contracts and credentialing

With changes in the healthcare landscape, network participation is becoming more necessary. It is also the area that produces among the highest claim rejections, often as a result of lapses in licensure, missing documentation, or failure to meet filing deadlines.

Data capturing

When performing such a repetitive task, it's common to transpose a number or transcribe a name incorrectly. A simple mistake can lead to significant issues over time, resulting in processing delays and lost revenue. Everyone at the practice should understand the importance of data in an environment that prioritizes quality over quantity.

Eligibility and benefit verification

With more than 80 per cent of patients covered by some form of dental insurance, it is critically important that a practice employs comprehensive verification processes. Capturing insurance demographics, plan coverage details, and eligibility specific to each patient is the gateway to optimizing a practice's reimbursement potential. Proper carrier and plan setup, including fee schedule attachment and limitation or exclusion details, ensure accurate fee estimation and secure the trust of your patients.

Coding and charge-out

Often overlooked or disregarded altogether, coding and charge-outs play a significant role in the revenue cycle. As each dental procedure code is specific to the diagnosis, proper understanding of Current Dental Terminology (CDT) is vital. Accurate charge-outs result in clean claims, which ultimately results in faster reimbursements and fewer denials.

Claim submission

Maximizing reimbursement potential extends beyond complete and accurate claim forms and avoiding common data entry mistakes. It requires a fundamental understanding of how insurance companies receive, process, and pay claims. Many procedures require the attachment of supporting evidence, including radiographs or clinical photographs, periodontal charts, narratives, or other relative reports or findings necessary to review and determine clinical requirements.

Payment Posting

Payment posting in today's landscape is more sophisticated than ever. It requires knowledge of complex technology, downloading and reconciling reports from multiple platforms, and capturing EOBS from various sources. Many of the issues in the revenue cycle can be prevented or resolved with accurate payment posting and the lessons learned from payment and denial trends. The ability to identify reasons for line item denials or differences in expected reimbursements is the first step in preventing them in the future.

Denials Management

While denial management has become an expected part of day-to-day operations, working denials is a tedious and time-consuming task that is subject to timely filing constraints. Failure to measure denial rates, identify trends, and analyze the root cause for common denials leads to a cycle that unnecessarily repeats itself. "An ounce of prevention is worth a pound of cure."

A/R-follow up 

The likelihood of accounts receivable collections decreases as the balances age. When you consider the staff time, mailing, and supply costs associated with collections efforts, the total revenue lost is more damaging to the practice than the actual charges. It is essential to have a process in place that automates the recovery process and alerts users to take action to minimize the amount of time it takes to secure payment.

Reporting and Analytics

With many moving parts and claims undergoing processing every day,

real-time insight is essential to identifying gaps early. The longer an issue moves through the cycle, the harder it is to recoup the time and financial resources lost in the attempt to recover. Consistent monitoring of the trends and financial performance allows a practice to learn and resolve the root cause of issues in the revenue cycle and develop strategies to influence positive change.

Did You Know?

CareStack’s unique opportunity miner module helps you quickly identify patients who owe you money, and helps you reach out to them via text or email to collect outstanding debt. 

Successful claim submission and faster reimbursement

While insurance rates, reimbursements, or limitations should never influence clinical diagnosis or quality of care, it is crucial to understand what is needed for insurance to process a claim and get paid the first time.

Filing electronic claims with attachments results in faster processing. All dental insurance claims need to be verified to contain accurate information, including carrier name, address, group number, and payor ID.

Attachments

X-rays

Radiographs should be clear and of diagnostic quality, ensuring that the entire crown and root are visible and pathology is evident. Pre and post-operative X-rays should be sent for the following procedures:

• Cast restorations and veneers

• Crown repairs

• Endodontic procedures

• Implant and prosthodontic services

• Periodontal procedures (FMX)

Periodontal chart

Periodontal charts need to have the following details:

• Patient name

• Date of exam

• Pocket depth measurements for all

the teeth under treatment

• Indications for missing teeth

Narratives and clinical documentation should include the following: 

• Objective diagnosis: clinical findings, diagnosis, recommended treatment, and prognosis.

• Be unique to each patient, avoiding the stock or generic templates.

• Include relevant information such as tooth number(s), surfaces, quadrants, initial placement, or treatment history.

• Document patient complaints, primary diagnosis, and the benefit of those services over another.

Increase collections with patient-centric solutions 

Focus more on patients by employing a solution to increase collections

With CareStack’s online Revenue Cycle Management Software, you can run your practice at peak efficiency and profitability with centralised dental financial services and insurance processing at its core.  

Fee schedule management

As the healthcare industry continues to move from a fee-for-service model, practices and providers are forced to manage contractual rates and regulatory obligations across multiple insurance plans. CareStack offers the flexibility to handle various providers and specialty fee schedules across different insurance plans, making patient billing for dentists easier than ever.

Eligibility and benefit Verification.

Maximizing insurance reimbursement potential begins with substantial eligibility and benefit verification. With advanced limitations and exclusions-based logic, CareStack's integrated eligibility form accurately coordinates benefits and estimates financial responsibility for both patients and insurance.

Claims Management

Speed, accuracy, and automation are recurring themes in revenue cycle management. CareStack provides a dynamic claims module that enables electronic claim submission, automated processes to identify claims requiring attachments, and monitoring of electronic rejections and claim responses.

Denial Management

The key to an effective denials management strategy is a focus on prevention. CareStack facilitates processes to identify, analyze, and implement a prevention-based strategy.

Payment Posting

Accurate payment posting is a fundamental feature of the revenue cycle and extends beyond merely posting a payment. With CareStack, a user can post payments and adjustments at a line level, mark claims and procedures for appeal, capture interest payments, and so much more.

Financial Reporting

Having the right reporting and analytics strategy is critical to the economic success of a practice. CareStack solution operates from a single database essential for gathering and aggregating data from multiple locations and analyzing the performance from all areas.

The CareStack RCM optimizes your dental office financial workflow by addressing both clinical and administrative inefficiencies in your revenue cycle. 

Ready to enhance your revenue cycle? Talk to our expert today!