How To Improve Day-to-Day Functions for Better Dental RCM (Part 1)

December 26, 2023 | 4 min read

Efficient day-to-day functions help your dental practice lower costs and improve productivity. But did you know it’s also essential for seamless dental revenue cycle management (RCM)?

This two-part series shows you how to standardize essential RCM processes, track claims, provide staff training, and improve patient collection.

Document Eligibility Checks and Pre-Authorizations

“Document processes to check eligibility and request pre-authorizations to minimize surprises for patients and delays in collections.” ~ Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper

Unexpected bills can impact patient experience, lower patient retention, and hurt your practice’s reputation. Well-documented eligibility checks and pre-authorization processes confirm insurance coverage for each patient before treatment begins to help them understand their financial obligations so they are less likely to dispute an invoice.

For eligibility verification: Outline the information your staff should collect during patient registration and the steps for cross-referencing insurance information with the provider network and coverage details. Also, define how and where to document the eligibility status in the patient's records for future reference.

For pre-authorization: List the steps involved in pre-authorizations for planned treatments and specify the information required, such as billing codes and supporting documentation. Establish timelines and roles for initiating, following up, and completing the process and include guidelines for handling urgent cases.

Create Billing Standard Operating Procedures (SOPs)

“Develop SOPs for billers, including expected turnaround times for getting billing treatments, submitting of claims, and handling of rejected claims.” ~ Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper

The billing department plays a critical role in dental RCM and ensures a healthy cash flow for your practice. To support accurate, timely, and compliant processes, develop SOPs to outline the complex billing procedures and define the roles and responsibilities of each billing team member.

Document the procedures for translating treatment details into billable codes, including coding standards and guidelines to follow. Detail the process for claim submission and provide guidelines for attaching supporting documentation. Also, indicate expected turnaround times for key billing activities like claim submission after treatment and resubmission of rejected claims.

Include instructions on how to track the status of submitted claims and the procedures for identifying and addressing rejected claims. Define communication protocols for sharing sensitive information regarding claim status or rejections. Also, provide guidelines to ensure compliance with relevant billing regulations and coding standards.

tab32’s advanced billing module simplifies claim submission and tracking. Our intelligent workflows help you get claims right the first time, every time while identifying and eliminating the root cause of mistakes so you can get paid faster with 40% less effort.

Assign Responsibilities For Posting EOBs and ERAs

“Assign staff members and document processes for posting Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) in an accurate and timely manner.” ~ Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper

Define the roles responsible for posting EOBs and ERAs and assign responsibilities to individuals and teams to avoid confusion. Document the process for receiving EOBs and ERAs and specify where to store the documents upon receipt. Also, establish data entry standards to transfer information from EOBs and ERAs into your billing system.

Document procedures for coding payments and adjustments based on the information in EOBs and ERAs. Ensure your staff follows a reconciliation process to verify the posted amount matches the expected payment. Additionally, set expectations for turnaround time from receiving EOBs/ERAs to posting in the billing system.

Assign responsible parties to conduct regular quality checks and audits of posted EOBs and ERAs. Provide instructions on how to address discrepancies. Also, include a plan for ongoing training to keep employees current on payment processing and documentation requirements.

Set Procedures For Denied or Non-Responded Claims

“Track and follow-up on denied and non-responded claims and filing appeals.” ~ Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper

Document a systematic approach for reviewing and categorizing denial reason codes. Use a robust system, like tab32’s billing module, for tracking claims status — a cloud-based dental practice management software (PMS) allows you to maintain a centralized record for multiple locations to streamline workflows, eliminate duplicate work, and reduce errors.

Define procedures and timeframes for regular and timely follow-up on denied and non-responded claims. Specify communication channels and protocols for contacting each payer and steps for addressing issues, seeking clarification, and obtaining additional information to support claim resubmission.

Outline the information required for filing appeals (e.g., additional documentation, medical records, and clarification on coding) and the steps to present the appeal to maximize effectiveness. Also, document a strategy to prioritize denied claims based on factors such as claim amount, the likelihood of successful appeal, and the impact on cash flow to focus your resources.

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