Hidden Costs of Inefficient Dental RCM—And How to Fix Them

In the quest to provide high-quality patient care, it becomes easy to overlook the business side of healthcare. However, inefficient dental RCM—and the hidden costs associated with it—can cause a whole slew of problems for today’s dental practices and dental support organizations (DSO). When gone unchecked or unaddressed, these problems easily erode the bottom line and can even negatively impact the patient financial experience. In this article, discover hidden costs in dental RCM and learn effective strategies to streamline processes.

Common dental RCM inefficiencies🔗

While each dental practice or DSO may struggle with its own unique dental RCM inefficiencies, there are several that tend to be universal across settings. These include the following:

1. Claim submission delays. Some dental practices and DSOs struggle with submitting claims promptly after treatment because of staffing shortages and/or because they rely on paper-based processes.

2. No upfront, automated process to collect and validate patient insurance information. Some dental practices and DSOs do not have processes in place to collect important details and verify insurance coverage, check coverage limits, and obtain prior authorization before the appointment.

3. Poor denial management. Not being able to track denials and rework denied claims as quickly as possible can contribute to inefficient dental RCM and be very detrimental to overall financial sustainability.

4. Ineffective or infrequent patient collections. In the absence of a clear policy on how the dental practice or DSO will handle the patient financial responsibility—and clear guidance for staff on how to implement it—it becomes difficult to address inefficient dental RCM.

5. Error-prone medical coding. Incorrect or invalid CDT codes can lead to claim rejections. So can misusing modifiers or not properly documenting procedures.

6. No insight into dental RCM performance. Blind spots in revenue trends can easily lead to missed opportunities to improve dental RCM.

Hidden costs of dental RCM🔗

Dental RCM inefficiencies have associated costs that no dental practice or DSO wants to incur. Here are some examples:

1. Increased administrative costs. With delayed claim submission comes the potential for timely filing denials. In addition, without up-front processes to collect and validate insurance information, dental practices and DSO could experience denials due to lack of prior authorization or lack of coverage. Invalid CDT codes can also drive denials. All of this translates to additional administrative costs associated with rework and/or appeal and resubmission. In turn, increase denials can cause cashflow challenges that can impact a dental practice’s or DSO’s ability to manage rising expenses effectively.

2. Missed revenue opportunities. Incorrect medical coding—particularly when medical coders undercode a visit or don’t append the right modifier—cause dental practices and DSOs to leave money on the table. Practices and DSOs also leave money on the table when they don’t strengthen their patient collections process either by collecting money up-front, sending automated payment reminders, offering flexible payment options, or some combination of the three. Finally, dental practices and DSOs may experience missed revenue opportunities when they have no insight into why claims are denied. The same is true for lack of insight into key performance indicators like days in accounts receivable, collection rates, or denial rates. Without this insight, dental practices and DSOs can’t implement proactive measures to improve dental RCM processes and prevent denials on the front end, nor can they identify claims to rework and resubmit.

3. Patient leakage. When medical bills continually include errors and omissions, frustrated patients may seek care elsewhere. Over time, decreased patient volumes can negatively impact profitability.

How to fix the inefficiencies🔗

Addressing these inefficiencies is critical for long-term financial health. Here are three areas on which dental practices and DSOs must focus:

• People. Ensure front desk staff and billing staff are fully trained on insurance policies, dental coding versus medical coding, and dental RCM billing practices. This includes training on new, revised, and deleted CDT codes, ICD-10-CM codes, and payer-specific requirements.
• Process. Create clear and consistent policies and procedures for patient registration, insurance verification, prior authorization, code assignment, fee schedule updates, patient collections, accounts receivable follow up, and denial management.
• Technology. Leverage technology to replace manual, paper-based processes for benefit verification, medical coding, timely claim submission, patient reminders, and more. Also ensure integration between the electronic health record and billing system for maximum dental RCM efficiencies.
  

Want to learn more about how Medusind can help streamline billing and address many different types of dental RCM inefficiencies? Visit https://www.medusind.com/contact.