Opening or becoming the new owner of a dental practice is both a thrilling and daunting milestone. For many dentists, the clinical side of practice is second nature, but dentists may feel overwhelmed when it comes to the business side — particularly understanding and optimizing the practice’s dental revenue cycle management.
Because most dental schools offer fewer courses on financial management and business operations, you may not have learned how to navigate insurance claims, track payments and ensure a steady cash flow. But mastering RCM doesn’t have to be intimidating. With the right strategies and tools, you can build confidence to manage your practice’s finances and focus on what you do best: caring for your patients.
Successful RCM means understanding nuances, avoiding missteps
Dental RCM refers to the entire financial process a dental practice uses to track patient care from the initial appointment to final payment. This process is crucial for maintaining a healthy cash flow in a practice by ensuring that services provided are appropriately billed and paid for on time.
The nuances of RCM — such as understanding dental insurance coding, claims submission and reimbursement timelines — can seem like a maze to dentists who lack the formal education, but missteps in these areas can lead to costly errors, delayed payments and significant cash flow issues that jeopardize the practice’s sustainability.
The evolving landscape of dental insurance adds another layer of complexity. Determining the differences between in-network and out-of-network reimbursements, handling patient co-pays and understanding common claim denials can create an administrative burden.
A poor RCM system can create backlogs in billing, leading to frustration for the practice and its patients. Patients may experience delays in receiving accurate bills, face confusion over what they owe or even deal with surprise bills months after treatment. This not only damages patient trust but also makes it harder for the practice to retain loyal patients.
To thrive, a practice needs a steady and reliable cash flow to cover operational expenses, invest in new technology and ensure the entire team is well-supported.
When RCM is optimized, the administrative side of the practice runs smoothly, reducing stress for the dentist and their team. This allows the office to focus on providing top-tier patient care rather than chase down payments or deal with insurance disputes.
Invest, train and track: strategies for managing RCM
By adopting the right strategies, you can streamline your RCM and reduce the anxiety associated with managing the business side of a practice.
- Invest in the right RCM software: Comprehensive dental RCM software can automate routine tasks like appointment scheduling, insurance verification and claim submission. The right software provides real-time analytics, allowing you to monitor the financial health of your practice with ease. Consider medical-cross coding capabilities to help ensure accurate coding.
- Understand dental insurance plans: To confidently manage RCM, you need to understand the various insurance plans your practice accepts and how they impact your revenue. This knowledge will allow you to communicate effectively with insurers and patients about coverage, co-pays and out-of-pocket costs to minimize billing issues.
- Train your team on RCM best practices: Proper training on insurance coding, claims submission and follow-up is essential. Regular staff education on industry updates and RCM processes ensures everyone is working efficiently and in sync. A well-trained team can spot and prevent billing issues before they become costly mistakes.
- Track key performance indicators: KPIs, including 30-60-90 day accounts receivable, claim denial rates and patient collection ratios, provide valuable insights into where improvements are needed. By quickly and regularly reviewing KPIs, you can identify bottlenecks and take steps to optimize your RCM process.
- Outsource when necessary: Outsourcing can lead to higher reimbursement rates and faster payment cycles, helping to stabilize your practice’s finances and decrease the administrative burden on your staff.
- Prioritize patient communication: Before treatments, provide detailed cost estimates, explain insurance coverage and outline payment options. Automated insurance verifications can help you complete these tasks and schedule procedures and treatments before the next appointment, knowing those items are already covered.
- Stay updated on industry changes: Stay informed about changes in dental coding, insurance reimbursements and changes in laws that may affect your practice. Subscribe to newsletters for the dental profession, including CDA’s weekly member newsletter, Inside California Dentistry, attend relevant webinars and network with peers to keep up with the latest developments.
Have a strong financial policy that the entire dental team follows
Solid strategies will go a long way toward giving you confident control of dental RCM, but RCM is not fully optimized if the practice does not have a patient financial policy. The entire dental team should follow that policy and receive training on handling financial scenarios, including when the dental plan does not pay.
A strong patient financial policy also helps protect dental practices from the risks of a patient’s nonpayment and write-offs and protects the dentist-patient relationship by clarifying payment options, fees and other terms, for example. A signed financial agreement from the patient should clearly state that any expected payment from the dental plan is an estimate.
The CDA-member resource Patient Financial Policy covers payment options, financial considerations, collection systems and more.
CDA endorses iCoreRx cloud ePrescribing software by iCoreConnect. HIPAA-compliant iCoreRx is an easy interface to write, review, send, modify, and communicate prescriptions directly to the pharmacy. It integrates with your practice management system and the CURES database. Book a demo or call 888.810.7706. A CDA-member discount applies. Members with questions related to practice systems and patient financing can contact CDA for one-on-one guidance.
