Friday, January 4, 2019
As electronic technology continues to change the way dental practices do business, improving the process for recording and tracking patient health remains a primary challenge. Managing their billing processes and getting paid is another.
Bill collecting has never been easy. According to the United States government’s Consumer Financial Protection Bureau, more than 51 percent of collection services originate from unpaid medical bills. Almost 43 million people with credit records have outstanding medical bills, indicating the challenge that a practice faces when trying to collect from their patients. Medical and dental billing can be a complicated process, but these challenges can be overcome.
Collecting Full Co-Pays
Co-pays are down payment for services provided by caregivers. If providers don't get the full amount upfront they may struggle to get the rest of the patient's portion. Studies show the chance of collecting from a patient drops almost 20 percent as soon as the patient leaves the office. Losses can be avoided by requiring front desk staff to be clear about the practice’s policy for collection upfront and asking for a credit card to cover patient co-pays at check-in before the appointment. Amounts not covered by insurance may require an additional down payment on top of the deductible, too.
Collecting payments and co-pays at the time of service is best for the patients and the practice. A large bill after a procedure can be overwhelming and usually is more difficult to pay. In physician’s offices and dental practices alike, collecting co-pays before providing services is the way a thriving business thrives.
Writing off uncollected co-pays is not a viable solution because most practices can’t afford to do so. Here’s why: In a typical outpatient clinic with two PTs and one PTA, assuming an average co-pay is $25, means that if each clinician sees 12 patients, that's $900 in co-pays requiring collection per day. The practice in this example open 200 days a year means a total possible co-pay collection of $180,000 for the year.
Auto-Checking Insurance Coverage
Every patient’s coverage should be checked before they walk in the door. Practice administrators must make an effort to verify coverage before services are provided. While this can add to administrative tasks for the team, taking such steps can substantially prevent revenue loss and billing issues later on.
Approving Procedures that Aren't Covered or Require Pre-Authorization
Prior to performing a high-cost procedure, the provider should know what the patient's plan covers to determine if there is something the patient must cover out of pocket. Many patients are unable to cover the cost of their portion of the procedure. Likewise, some may think a procedure is fully covered by insurance but instead, the patient is responsible for the uncovered portion. Knowing this allows you the opportunity to prepare patients and offer a payment plan for procedures.
According to the Medical Group Management Association (MGMA), 94 percent of practices offer payment plans to their patients, but only 25 percent offer the plan at the time of service. About 45 percent of practices offer payment plans as a last effort before a bill goes to collection. Payment plans can ensure treatment gets done and the patient can manage affordable payment terms.
Staying Informed About Coding Changes
Dental coding expert Teresa Duncan, founder of Odyssey Management, said there are many constant coding changes. Materials and technology have changed, so have the materials being used in dentistry for procedures and implants. As new materials and procedures arise, so does the need for the coding to support them. If that were not enough, there are annual coding updates issued every year that can keep even the most experienced practice managers tripped up.
Each practice must review and note the changes for codes most often used and evaluate how they are affected. Codes change are required for the industry to respond to need and change within the industry. The coding updates help target new ways to create efficiencies for receiving reimbursements and address new procedures. There are changes in materials and even technologies, such as teledentistry, that must have corresponding codes to adapt to sector evolutions, as well as new ways to submit claims and process payments.
Because of the copious number of regular changes, billing managers must self-educate to ensure they are billing procedures appropriately.
Other Billing Challenges
Billing challenges loom large. We’ve only covered a few here. The following are some of the most cumbersome hurdles to jump.
- Time Constraints – A bustling practice with limited administrative support creates a potential problem, especially in practices where manual processes support billing. Automation will serve the practice well. Electronic attachments can quicken claims management. Automation means you won’t likely need additional support.
- Detailed Claims Processing Guidelines – Adhering to strict processing guidelines established by insurance companies and government agencies is required. Failure to comply means rejected claims, among other possible punishments. Managing processing guidelines can improve a practice’s billing cycle.
- Lack of Support Solutions – Kicked back claims most likely require supporting documentation. If this is the case, there’s no reason to print and mail materials to the payer. As previously discussed, this process is easily automated with a secure electronic claim attachment solution. Documents are instead sent electronically to the payer and can be tracked for easy reference meaning you can follow up accordingly, which equates to streamlined claim adjudication and quicker reimbursement.
Billing challenges may remain, but those can be overcome. For billing problems related to payer processes diligence on your part is required. Addressing shortcomings with your administrative processes might need some automation.