The Main Trend
The main trend in EFT is toward technology for providers and payers that is easy to use, cloud-based to be accessible from home offices, and customizable to each payer network’s needs.
These needs will become even more varied as COVID-19 impacts each provider differently, depending on how they have adjusted their patient load to comply with state mandates regarding the COVID-19 virus.
The dental profession faces a number of emerging financial changes and challenges. Combined, they make achieving and sustaining a stable cash flow a difficult yet still essential part of any management plan.
How It Works
With skilled revenue management billing, you should get paid within 2-7 days by dental insurance if your team is sending “clean claims” by using technology. Otherwise, you wait for claims to be resolved, and your cash flow is affected.
Sending “clean claims” takes expertise, time, persistence, clinical knowledge, and hours of follow-up. If your billing over 30 days is not within the efficient range, then there is an internal problem. The top problems among dental clerical staff when it comes to dental billing include:
- A lack of time;
- Interruptions by phones and patients;
- A lack of expertise in insurance billing, coding, and claims processing
- A lack of motivation.
As a Result..
As a result, you acquire unresolved claims that hold up your cash flow due to several common errors:
- Incorrect patient, practice, provider, or employer information such as demographics (35% of errors);
- The front office forgets something and supporting documentation has not been submitted with the initial claim (25%);
- The insurance company delays payment by asking for more information (20%);
- The insurance is set up incorrectly in the patient’s account (10%);
- The front office does not know how to set up the account, especially in dual insurance, blended families, or plans that are administered by major dental insurances (5%);
- The insurance company did not receive the claim so there is a need to follow up with phone calls (5%).
In addition, as the insurance benefits decrease, the patient’s copay is increasing. As a result, the treatment-plan acceptance to proceed with treatment has decreased, and patient balances accounts receivable has increased. If patients’ balances are not collected at time of service, the aging patient balances get out of control and the team will need time to work the collections. Recovery of patient balances decreases significantly with time, and so does the dentist’s cash flow.