There are numerous challenges in a dental practice today, from providing quality patient care to managing administrative tasks. Among the most critical elements to running a successful dental practice is sound financial standing. This is where dental revenue cycle management (RCM) comes into play.
The fact that the revenue cycle is properly managed allows dental practices to remain financially healthy and, therefore, focus on what they do best: provide excellent dental care to patients.
What is Dental Revenue Cycle Management?
Dental revenue cycle management oversees the overall financial activities of a dental practice beginning at the point where a patient is registered to where the last payment is made to clear a balance. Such management includes all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. Essentially, RCM streamlines and optimizes the billing and payment processes to maximize collections within regulatory guidelines for services delivered.
A good revenue cycle management system involves processes such as scheduling the patient, verification of insurance, planning for the treatment, billing and coding, submission of claims, and posting of payments. Each component is considered necessary to ensure the compensation of dental practices in return for the services they offer. Improper management of any of these processes could have a negative effect on cash flow, delay payments, and even turn the financial situation upside down for dental practices.
The Importance of Dental Revenue Cycle Management
Like any other business model, dental practices are also dependent on the cash flow. Very low cash flow owing to mismanaged revenue cycles can result in huge losses financially. The same can be detrimental to the overall practice performance. Here are some key reasons for why dental RCM is essential:
Increased Cash Flow: In most cases, well-managed cycles of revenue ensure that accounts are paid on time, reducing the time taken between service delivery and payment. This maintains a steady cash flow for the practice to meet all its financial obligations.
Fewer Claim Denials: Most of the claim denials for dental practices occur because of errors in billing and coding or even incomplete documentation. An effective RCM process automatically brings a reduction in these errors, further leading to less claim denial and rejection. This also increases the probability of total reimbursement regarding the services.
High Patient Satisfaction: Patients prefer openness and transparency when it comes to billing and payments. A smooth RCM process shall ensure that a patient’s bill is correct and patients have a clear understanding of their financial responsibility, thus increasing patient satisfaction and improving the patient-practice relationship.
Compliance with regulations: The healthcare industry is heavily regulated, and the operations of every dental practice need to adhere to many billing and coding standards. Proper RCM keeps the practice in compliance with these regulations, so it does not run into legal issues and potential financial penalties.
Increased Revenue: The full revenue potential in dental practices can be attained only if they optimize the revenue cycle—the realization of all the billable services done, proper coding, and following up on unpaid claims. A robust RCM process facilitates dental practices to achieve financial goals and support long-term growth.
Key Components of Dental Revenue Cycle Management
Manage the revenue cycle effectively: The main ones to which dental practices should address consist of several key components. For that, each of the components is very effective in making sure the practice remains financially successful.
Patient Registration and Scheduling: The first process in the revenue cycle is the registration and scheduling of a patient. Identifying the patient exactly can offer verification of insurance coverage and eligibility. At this point, practices are supposed to gather vital information of patients, including contact details, insurance information, and medical history. Good scheduling sees to it that appointments are well planned, thereby minimizing no-shows or cancellation of appointments, which affects revenues.
Insurance verification is one of the key important stages within the whole process of RCM. Insurance verification will secure that the services to be provided will correspond to the insurance coverage of the patient, resulting in a lower chance of claim denial. The practitioner should verify insurance before the appointment time so that an issue does not manifest at the last moment, which could, in turn, impede successful service delivery—for instance, coverage limitation or pre-authorization requirements.
Treatment planning and cost estimation: It is important to communicate clearly with the patient about the treatment options available to them, along with the cost that will be incurred. Issuing a proper treatment plan and associated costs to the patient will help him realize his share of the finances and be prepared for out-of-pocket expenses. Transparency earns trust on the part of the patient and compels them to undertake what is prescribed for them.
Correct Coding and Billing: Rightful reimbursement forms the very cornerstone of the revenue cycle. Proper reimbursement is highly dependent upon dental practices using the accurate codes pertaining to services that have been provided. Included in these proper practices would be the use of CDT codes for dental procedures and how to work within the payer’s criteria. Coding and billing errors have a direct effect on the denial of claims and delay in cash; it does drain the revenue.
Claims Submission: The practice will submit the claims to the patient’s insurance company for reimbursement after providing services. To avoid delays in submitting the claims, the same should be done timely. They are also to monitor the status of the claims and follow up on any pending claims so as to prompt them into payment.
Payment Posting and Reconciliation: The payment made by the insurance company has to be posted against the patient’s account, with proper reconciliation of any irregularity in practice. Such a process will ensure proper recording of payments, as well as proper billing of the patient, including a notice about remaining balance. It also helps right-size underpayments or overpayments that occur.
Patient Billing and Collections: The practices must create a statement to be sent to the patient for any balance remaining and commence collection. Good, effective communication with the patient concerning their financial responsibilities will serve much to breed promptness in payment. The practice should also make it easy to pay in other ways, such as online payments, to make it convenient for the patient to pay their bills.
Denial Management and Appeals: Despite best efforts, some claims may be denied by an insurance company. Good denial management is able to identify the source of the denial, rectify the errors, and resubmit the claim. The practice must also be ready to make appeals on any denied claims if proper reimbursement is to be ensured.
The Role of StafGo Health in Dental Revenue Cycle Management
It can be an arduous process for dental practices to manage their own revenue cycle. Outsourcing to a professional revenue cycle management company, like StafGo Health, can help a practice become efficient and offer dramatic improvement in a practice’s financial result.
StafGo Health is focused on delivering full-scope RCM services based on the unique requirements for a dental practice. With a group of experienced professionals, StafGo Health offers services such as the following:
- Insurance Verification and Pre-Authorization: Ensure services are covered under a patient’s insurance plan and that required pre-authorizations are executed to prevent claim denials.
- Coding and Billing Services: This service codes and bills accurately to increase your reimbursement and minimize your risk of denial of claims.
- Claims Submission and Follow-Up: Submitting claims in a timely manner and following up on them proactively to make sure they get paid promptly, thus reducing revenue loss.
- Denial Management and Appeals: This function involves detecting and resolving denied claims so that a provider is properly reimbursed for services.
- Patient Billing and Collections: Management of billing and collections from patients for services rendered.
In fact, in outsourcing RCM to StafGo Health, they will remain focused on excellence in patient care while, at the same time, securing a healthy financial state. With expertise in dental revenue cycle management, practices enjoy an increase in revenue, reduction in administrative burdens, and overall improvement in efficiency with StafGo Health.
Conclusion
Dental revenue cycle management is really a very integral aspect of running a very successful dental practice. With a great focus on areas like patient registration, insurance verification, coding and billing, and denial management, practices can improve their financial performance and ensure long-term success. Joining efforts with a reliable RCM provider like StafGo Health will provide additional impetus toward helping dental practices achieve preset financial goals while delivering the highest levels of quality care to their patients. More information on how StafGo Health can assist your practice in successfully managing the revenue cycle for financial success is available at stafgo.com.