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RCM and Dental Billing

May 2, 2024

Dental billing is complicated for sales cycle management firms and most healthcare practitioners, including dentistry. The slightest error can result in significant revenue loss. Revenue cycle management firms can handle the dental billing process to improve earnings and reduce the burden on healthcare providers. Revenue cycle management minimizes the workload and allows practitioners to focus more on patient care. Eligibility and verification issues can be solved by using an updated RCM tool. Healthcare providers should consider it as it is crucial in the dental billing process. There are several vital steps in RCM of dental billing.

Step 1: Pre-Authorization

Pre-authorization is when the health provider or plan determines whether a prescription drug, equipment, facility, or treatment is essential. In dental emergency cases, there is an exception from pre-authorization. However, pre-authorization doesn't necessarily mean that the insurer will cover the expense. Patients and providers must double-check if there is any uncertainty about the insurer's coverage.

Step 2: Insurance Verification

Eligibility issues are the most common reasons for claim denials. Eligibility verification is required for patients to pay for the services or treatment they receive. During every visit, insurance eligibility verification must be completed so that you can inform your patients about payment before their treatment. Most insurance plans make it a requirement to get advance approval for medications, facilities, clinical treatments, and dental examinations ordered by doctors.

Step 3: Collecting Deductible and Copays

Once insurance verification is completed, the next step is collecting deductibles and copays. Having insurance eligibility verified makes it easier for dental practices to manage the same. From there, practices can proceed with the patient's treatment. Despite the importance of every step, patient care needs to take priority. Everything else, including payments, will be in place if your patients are satisfied with the care and service provided.

Step 4: Claim Submission

Submitting claims to the insurance company is the next step in the RCM billing process. Dental practices submit claims once treatment is finished. Then, the insurance company evaluates the submitted claims and either get rejected or accepted based on several different factors. The dental billing team must submit the claims on time accurately to reduce claim denials.

Step 5: Managing Denials

Because there are so many rejected claims, this can decline revenue. Denial management that is well implemented will improve the earning and keep patients happy with the services they receive. Modern-day denial management techniques make it easier to uncover the cause for denied claims and have them paid quicker. A professional team that completed denial management will determine the cause of the claim denial and investigate why it was denied. In this process, the denials can be appealed, and the rejection can be reversed. This process reduces the number of denials and improves revenue cycle management.

Step 6: Collection of Payments

Then the insurance companies pay the dental practices based on the amount mentioned in the submitted claim. The dental billing team then informs the patient of the remaining balance they are responsible for paying once the claim is settled.

These steps take revenue cycle management to the next level for dental practices by accessing claims with no errors, reducing denials, and sustaining revenue growth.

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