Managing the business side of your dental practice efficiently while providing patients with excellent treatment can be very challenging. Financial success depends greatly on efficient billing and communicating properly with insurance companies to maximize reimbursement. Outsourcing companies that provide dental billing services can make these processes much easier. Here are six strategies to boost your dental practice’s revenue.
- Perform patient eligibility verification: Successful billing depends on performing dental insurance verification before the date of service. Dental offices need to check the patient’s eligibility, coverage and active benefits with the insurance company. In addition to verifying demographic information, important questions to ask existing patients are whether their dental coverage has changed since their last appointment and whether there were any recent changes in their employment situation. If the patient has a new plan, the office has to obtain the summary of benefits and understand what services are covered under their new plan. According to a recent ADA news report, eligibility verification is especially important as dental offices reopen after the lockdown as they may “find themselves seeing unemployed patients who have lost the coverage they used to have when they were employed”.
- Review contracted fee schedules: Reviewing contracted fee schedules annually and setting the right fees is crucial for long-term financial success. Take a good look at your fee schedule and see what prices can be increased. Avoid a fixed percentage increase across the board. According to www.marketplace.ada, adjusting your fee schedule can provide extra revenue right away.
The recently released guidance from the ADA notes that infection control and use of personal protective equipment will substantially increase cost of care for dental procedures. This makes it even more important for dental offices to review and readjust their fee schedules. In order to individually negotiate fee increases with third-party payers, the ADA news report says that dentists may need provide payers with the following information:
- The desired fee for each procedure code
- Costs associated with operating the business
- The date when their fees were last revised
- Establish clear payment policies for patients: Practices should collect the patient’s co-pays or fees not covered by their insurance at the point of service. The best practice is to have a written financial policy so that patients understand their obligations. If these obligations are not met, develop a proactive strategy to collect the payment, such as sending out reminders and statements on a bi-weekly, weekly, or even daily basis. You can also offer an incentive for early payment. Having clear policies and procedures in place can reduce stress, ensure timely collection of payments and keep cash flowing consistently into your office.
- Ensure an efficient claim submission process: Having a proper system in place for submitting insurance claims is critical to ensuring reimbursement. Techniques for improving insurance collections include submitting claims on a daily basis and setting up a system for reviewing all claims for accuracy before they are sent out. Tracking claim status will tell you about the status of the claims. Contact the insurance company immediately at the first sign of delay or non-payment and investigate the reason so that you can fix it quickly. Outsourcing dental billing to an experienced service provider is one of the best ways to handle the challenges associated with claim submission.
- Assign the correct codes: Assigning the correct codes for each procedure performed is essential for successful dental billing. Practices need to have a proper understanding of the CDT and ICD code sets and when to use them. Each of these code sets has a specific purpose and payers have their own rules regarding the use of these codes for claim submission. Code changes occur every year and practices should review and note the changes for frequently used codes most often used and evaluate how they are affected.
If the code reported does not accurately represent the procedure performed, it can result in allegations of fraud. While a carrier may change a dentist’s submitted procedure code to a less complex or lower-cost code, dentists should always take care to report the accurate code to describe the procedure performed. One example of this is with regard to alternating codes D1110 and D4910. In an RDH article dated March 1, 2019, Mark Rubin, JD, legal counsel for the American Dental Association, said, “Knowingly alternating D1110 and D4910 to maximize insurance benefits constitutes fraud. We must code for the procedure being performed. By doing otherwise, the attorney general could make a convincing case for prosecution.” Clinical need should determine treatment, not just what is considered a covered services.
- Track claims: Dental practices should have proper systems in place to track claims. In fact, this is one of the most important services provided by a dental billing company. They regularly monitor claims on the dental practice management software and review insurance related reports generated by the system. This ensures timely follow-up from claim submission to payment posting. If a claim is rejected, a dental billing service provider will appeal it, make the necessary adjustments, and resubmit it in a timely manner.
The ADA guide notes: “…fee schedules are typically part of the participating provider agreement – a legal contract between the dentist and the third-party payer … It is important to review these documents carefully before trying to project revenues and negotiating fees with the payer.”
Today, many dentists are realizing that outsourcing dental billing is a cost-effective solution that can increase practice revenue. Companies that provide dental billing services have a comprehensive understanding of the ins and outs of insurance and can ensure efficient claims submission to maximize practice reimbursement. Partnering with a dental billing company would be more economical than hiring an in-house team as there would be no sick time, insurance, vacation, time off, or employment taxes to pay. Outsourcing would also free up staff to focus on patient care.