Reversing Revenue Loss in a Dental Clinic
A dental clinic operating within the healthcare industry was experiencing significant revenue losses due to denials. Denials were occurring frequently, impacting the clinic’s financial stability and operational efficiency. Concerned about the ongoing revenue leakage, the clinic sought assistance from RCM Matter, a renowned Revenue Cycle Management (RCM) company, to address these challenges.
Background
Dr. Emily Watson, a recent dental school graduate, embarked on her journey to establish her own practice. However, she soon encountered challenges in navigating the complexities of dental coding and billing. Despite her clinical proficiency, she found it challenging to keep up with ever-changing coding regulations and ensure accurate claims submission.
Challenges Faced by the Dental Clinic
- Complicated Insurance Policies: The clinic finds it hard to understand insurance rules, leading to many rejections and not getting enough money back.
- Slow Claim Process: They use old-fashioned ways to submit claims, causing mistakes, delays, and more rejections.
- No Analysis for Rejections: The clinic can’t figure out why claims are rejected often, making it tough to fix the problem.
- Staff Not Well-Trained: Employees don’t know enough about billing, so they make mistakes when submitting claims.
- Outdated Technology: The billing software they use can’t talk to insurance companies, making it tough to check if patients are covered and track claims in real-time.
- Bad Communication with Insurers: They don’t talk well with insurance companies, which slows down getting answers and solving problems with claims.
- Not Following Rules Properly: They sometimes don’t document things right, causing insurance companies to reject claims and possibly investigate them.
- Missing Opportunities for More Money: They don’t always bill for all the services they provide, losing out on potential income.
- Issues with Patient Bills: Patients get confused about what they owe, leading to late payments and money owed piling up.
- Not Enough Help for Claim Rejections: They don’t have enough people or skills to quickly deal with rejected claims, causing a big backlog.
Approach
The Program:
- Duration: 8 months
- Team: 10 RCM Matter billing specialists
Strategy
Thorough Check: RCM Matter looked closely at how the clinic does its billing. They found places where mistakes often happen.
This included looking at:
- Making sure the codes and paperwork are correct
- Fixing mistakes in the claims before sending them
- Following the rules from insurance companies
- Fixing mistakes when claims get denied
After checking, RCM Matter did a few things:
- Taught staff how to do coding the right way and used software to keep it consistent
- Used technology to find and fix mistakes in claims before sending them, which helped decrease denials
- Made sure there’s clear communication with insurance companies to get claims processed correctly and fix any problems quickly
Results
The program made big improvements:
- More Money: The clinic made 78% more money compared to before the program.
- Less Denials: The rate of denials went down by 52%, which means they didn’t lose as much money.
- Easier Process: It became easier to do the billing, so they could do it faster and with less work.