AADOM LIVEcast: Revenue Cycle Management Pipeline for the Dental Team

Approved for 1 CE towards AADOM Designations when viewed in AADOM’s Learning Management System. 

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Video Description:

Join Penny Reed on a journey through the revenue cycle management pipeline, where every team member has a crucial role to play – from the initial patient interaction to the completion of treatment and payment. The revenue cycle is the lifeline of any practice, as it directly affects profitability. By being proactive in your processes and patient communication on the front end, the back end of dental insurance billing and collections can flow much smoother. This results in a healthy bottom line, happy dentists and team members, and a stress-free culture.

Course Learning Objectives:

  • Learn the aspects of effective revenue cycle management (RCM)
  • Discover the opportunities that every team member has to impact practice collections
  • Identify the greatest pitfalls in RCM that prevent practices from being paid what they are rightfully owed

Stop the Leaks in Your Revenue Cycle Management Pipeline

By Penny Reed

If you’re currently reading this article, chances are you understand just how chaotic a typical day in a dental office can be. With a never-ending list of responsibilities to juggle, such as managing schedules, coping with understaffing, and working with inexperienced team members, simply making it through the day can feel like a major accomplishment. When bandwidth is limited, it can be easy to allow non-urgent tasks to slip through the cracks.

One “silent” process that may receive little attention is the practice’s revenue cycle. This process usually flies under the radar until there is a cash flow crunch or an unhappy patient with an unexpected balance. What is revenue cycle management or RCM? It is the entire process that begins with patient registration and ends with dental billing and collections.

During my time as a full-time practice management consultant, I’ve noticed that many people think of revenue cycle management as simply an administrative task. And while it begins and ends with administrative functions, revenue cycle management is truly a team sport. Every department and role in the practice plays a vital part. When everyone on the team understands the process from start to finish and collaborates effectively, magic can happen with their accounts receivable.

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Involve the entire team in walking through the revenue cycle process

To start, let’s consider a new patient phone call or an appointment scheduled online. While the patient’s benefit plan should not be the first thing to come up in the discussion, the practice should obtain their benefits information at the time they schedule the patient’s first appointment. With this information in hand, the office should have a process in place for verifying coverage.

For new patients, benefits should be confirmed sooner than later so that any questions or concerns can be addressed early on. For existing patients, the plan benefits should be reverified 2-3 business days prior to the patient’s appointment. The ultimate goal is to be sure that the patient’s benefits have been verified and entered into the practice management software prior to the patient’s visit. This makes treatment plan estimates as accurate as possible and builds trust.

If you are not able to verify the existing patient’s insurance prior to their appointment, be sure to obtain their updated dental plan information before they are seated in the clinical area. In most practices, you should ask the patients to sign in on a roster or a kiosk when they arrive. The challenge with a sign-in sheet is that the patient cannot see the information you have on file. The well-intentioned question, “Has anything changed with your dental insurance?” would be great if existing patients could see what we have on file. One method that can work well is to specifically ask the patient if they have what is on file. An example would be, “Mrs. Jones, do you still have Cigna Insurance with ABC company?” Or another alternative is to print the patient information form or route slip and have the patient review the insurance as well as the address, email, and phone number on file.

One of the next areas where there can be a significant leak in the RCM process is the financial discussion with the patient. This typically involves informing the patient about their financial obligations and the terms of payment. Two common challenges exist at this stage. Often, dental teams can be too busy to have a thorough financial discussion. Additionally, teams sometimes assume that a signed treatment plan is a commitment to pay at the time treatment is rendered.

Work together as a team to determine the threshold – or floor limit – of a treatment plan’s value that will cause you to want a signed financial agreement. For example, let’s say you determine that all treatment plans of $1,000 or greater should have a signed financial agreement. In that case, the clinical team will want to route those patients to the financial coordinator for a discussion. The patients who meet with the financial coordinator will choose from the practices’ payment options and sign a simple agreement regarding that commitment. To be clear, this is not a recommendation that the practice extends payment plans. It simply means that the patient is committing to pay. If they select third-party financing, that should be documented, and ideally the patient should apply before they leave the office.

The clinical team plays a vital role in providing the “evidence” that the treatment is needed – before, during, and after the procedures are performed. This documentation consists of notes in the patient record, charting, diagnostic films, and photos. The images should be obtained pre-treatment, mid-procedure, and post-procedure. Artificial Intelligence, also known as AI, is here to stay and will serve the role to provide the needed support for treatment. The flip side of AI in the clinical setting is that the payers are also using this type of software to evaluate the necessity of treatment. For these reasons, dentists, dental assistants, and hygienists have a significant impact on revenue cycle management because of their role in an office’s ability to send out clean claims.

When the patient arrives for their treatment appointments, they should make their estimated payment portion prior to being taken into the operatory. If this is a surgical appointment, especially one involving sedation, those payments should be made at a pre-operative visit.

Once the treatment is completed, this is entered into the practice management system and the claim is batched for payment. There is a critical RCM step that must take place here! All claims should be reviewed by a highly skilled team member before they are filed. This allows for things like verifying the patient information is correct, that all of the needed information is on the claim, and that the appropriate electronic documents and images are attached. In addition, the rejected claims report or dashboard should be monitored daily, and those claims should be corrected and resubmitted.

The next phase of RCM involves a proactive approach. Once a claim reaches 14 days of aging, the in-house or outsourced dental biller should begin to follow up to see where the claims are in the payment process. This step is crucial because it allows the office to ensure that claims will be paid on time, giving them ample time to follow up on any issues that may arise. The ultimate goal is to have most claims paid as close to the 30-day mark as possible. This enables timely filing of any secondary coverage. If any arise, unexpected balances should be sent to the patient as quickly as possible.

The last area where there can be significant leaks in the RCM process is patient billing. The ideal time to send a patient statement is as soon as all dental claims that have been filed are paid or denied. If you are waiting until the date of the month when all statements are batched, you are late! Another huge time saver is to send statements through an electronic processor. When using an electronic processor, the practice batches the statements and the 3rd party company prints and mails them. Additionally, if your office’s practice management software allows for encrypted storage of credit card information, you can request a card to be kept on file for the patient. This will simplify the patient billing process going forward.

The RCM pipeline ends when the treatment has been paid for and or balances have been adjusted so that the patient account reaches a zero balance. A healthy dental practice’s accounts receivable should be no more than 1x the practice’s average monthly production. This excludes credit balances. The best way to prevent these leaks in your RCM system is to approach these aspects of practice management as a team, outsource these duties when you can, and advocate that both you and your patients are paid what you are rightfully owed.

Learn about the presenter:

Penny Reed is the Chief Growth Officer at eAssist Dental Solutions, and the author of the book, Growing Your Dental Business. Penny was recruited by her own dentist to run his growing practice, after spending two years as an IT manager with the Walmart Corporation.
Penny has over 30 years of experience as a speaker and dental business coach and has been designated a Leader in Dental Consulting by Dentistry Today from 2007 to present. She is a certified “Behavioral Consultant” through the Institute for Motivational Living, and a former Dale Carnegie Trainer.
Penny supports the marketing department at eAssist, the nation’s leader in outsourced dental billing. She speaks at dental meetings about team coachability, effective revenue cycle management, and practice growth.
Penny is a member of the Academy of Dental Management Consultants, The Speaking and Consulting Network, and a Speaking/Consulting member of the American Association of Dental Office Management.

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