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Knowledge is
revenue cycle power
By Teresa Duncan, MS, FADIA, FAADOM
Take a look at the claims in your office affected by payment delays. Is reimbursement being held up because of incomplete information? All too often, the slow process to request and supply missing claims information devastates the revenue cycle in dental offices. Every day you spend receiving or answering an information request letter is a day your office is not getting paid.
It’s not always a matter of forgetting to include patient date of birth or Social Security number. Insurance companies frequently require specific attachments or supporting documentation before they will even begin to process certain claims. An X-ray, for instance, might be necessary before a payer will reimburse for a particular gum disease treatment. But how do you know?
Traditionally, of course, you mail the claim and a week later you receive a letter asking for the missing information. After another week spent gathering and mailing back the required data, the three- to four-week claims evaluation process commences. It might take six weeks or more before you see insurance payment—at which point you begin trying to collect the patient balance.
It is possible, however, to know your claims information needs before a patient even leaves the office. Real-time adjudication (RTA) technology now exists that allows communication with insurance companies and patients right at the point of care. Instead of waiting days, practices know immediately when missing information is preventing claim processing. By accurately defining insurance and patient responsibilities upfront, offices can collect patient payments at the time of service, clear their books to $0 and then wait two or three weeks—or sometimes just a few days, depending on payer and systems used—for insurance to pay.
But in addition to using point-of-service claims information to speed the revenue cycle, dental offices must also set proactive financial policies. Answer the questions patients commonly ask, such as: How long will you extend credit, and for how much? What discounts will you offer to clergy or the elderly? By taking the time to write down a comprehensive set of financial procedures, you provide your office staff with clear and consistent operating guidelines.
Missing and incomplete information—whether on the claim itself or in your practice’s financial policies—ultimately affects the entire revenue cycle. With the help of technology and solid reimbursement guidelines, however, the payment process can be hastened.
About the Author:
Teresa Duncan is a consultant, speaker and writer with over 20 years experience in healthcare. Visit her online at www.OdysseyMgmt.com and www.TheDentalImplantBlog.com.
What's New at MDE
MDE and the American Association of Dental Office Managers (AADOM) have announced that they have renewed their strategic relationship for another year—one that further supports both organizations’ commitment to empowering the office manager. Improving day-to-day financial efficiencies in the dental office is a key element of success for all office managers; and, through this affiliation, MDE serves as AADOM’s official clearinghouse solution, providing members nationwide with access to a full range of real-time electronic data interchange services. To read more about this relationship, visit here.
Information Center
- Delta Dental of Illinois goes live with real-time transactions with MDE. If you are already sending claims through MDE, these will now return a real-time response. If you’d like to learn more, please call 866-633 -1090.
- Teresa Duncan, known to many as “Dentistry’s Revenue Coach,” helps dentists analyze and improve their revenue cycle, as well as detect fraud and embezzlement activities. She is a certified HR consultant with Brent Ericksen and Associates and a member of the Association of Certified Fraud Examiners, Academy of Dental Management Consultants, American Association of Dental Consultants and the Speaking Consulting Network. Tune into one of Duncan’s upcoming presentations:
- Virginia Academy of General Dentistry: February 25, at the Omni Hotel in Charlottesville, VA. – “The Agony of The Code and How to Unravel the Mystery of Periodontal & Implant Insurance” from 8:30 a.m. to 5:00 p.m. (earn 7 CE hours)
- VDA Annual Meeting: June 17, at the historic Williamsburg Lodge in Williamsburg, VA. – “Successful Systems for A/R and Insurance Management,” time TBD.
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Tuesday, 03 / 15 / 2011