How We Elevate Dental Practices: Achieving a 0% Outstanding Claims Rate
One of Elevate’s dental billing team members should be called the “fixer,” though some might argue that “magician” is more appropriate. She is a recognized expert at cleaning up accounts receivable that have built up over time due to a practice having challenges hiring and retaining skilled employees or simply not having the bandwidth to give adequate attention to the dental billing process. When dental billing isn’t placed at a high priority in a practice, the outcome is inevitable: Aging will increase. And the longer the practice is distracted by other tasks, the worse it gets.
These situations create financial pressure and undue stress for a dental practice, and the only real solution is bringing on a dental billing partner to invest the same care in managing the practice’s revenue cycle as the dentist gives to his or her patients. The fixer gets excited when she’s handed an aging mess.
“It’s like a giant puzzle that’s fun to solve. I love my job so much, especially when it involves working on aging,” says the fixer. “Bringing the outstanding claims rate to 0% is an achievement that brings me great satisfaction.”
One of the fixer’s great puzzles was a general dentistry practice located in Los Gatos, California. This practice had employed two individuals to manage dental billing in-house, one who worked at the physical office and the other who was remote. When both the individuals left for other opportunities, it was discovered, among other things, that insurance data had not been entered correctly in the software and there were extensive duplicates.
“In order to clean up the situation, you basically have to unhook all the insurances that are tied to employer benefit plans and to individual patients,” explains the fixer. “It’s a three-step process just to eliminate one duplicate insurance.”
This insurance problem was one of several contributing to the high level of claims sitting in all categories. A third of the practice’s overall receivables were in the over-90 day column, and 53% of all reimbursements owed to the practice were beyond 30 days.
When the practice chose Elevate as its dental billing partner, Elevate deployed a team of billing professionals to assess the financial activities of the practice in their entirety. This is standard operating procedure for Elevate, which provides many practice management services beyond its core billing and insurance verification solutions. By conducting a comprehensive assessment of the practice, Elevate is able to counsel the practice on the various ways it might improve its profitability.
In additional to billing and insurance verification services, the Los Gatos practice contracted with Elevate to conduct a special project to address the inaccurate insurance data in the software. In this particular situation, Elevate decided the fixer was the perfect choice to manage the project, and she proved the company right. In only three months, the fixer was responsible for a heroic feat, cleaning up all the aging and restoring profitability to the practice. She accomplished this by overseeing a massive insurance consolidation project as well as establishing new processes to address outstanding claims. Today, this practice has a 0% outstanding claims rate, a dramatic improvement from the original 53%.
How was the fixer able to create this exceptional outcome? “The key is working together as a team. I had to get to know the practice’s staff, and we had to open up lines of communication and truly understand everyone’s roles,” says the fixer. “This office was extremely responsive to my requests, and the sooner I had the information I needed, the faster I could fix their aging.”
The fixer also had great success with a general and cosmetic dentistry practice in Birmingham, Alabama. In this situation, the front desk personnel were hard working but didn’t understand the complexities of dental insurance. Dental insurance requires extensive justification for a claim, and notes need to be written in a specific way in order for a claim to be considered. Thus, a keen understanding of the entire process and all of its intricacies is the only way to get paid. This practice’s lack of dental billing experience, despite great intentions, led to the over-90 aging category reaching $47,000. In just 90 days, the fixer was able to reduce the $47,000 to a single claim of $995.
“Dental practices tend to be small and there is a lot of personal interaction with office staff and patients,” remarks the fixer. “Being comfortable with outsourcing partners is critical to the success of the relationship, and the results we’ve achieved have been due to the team perspective we’ve all shared.”
What’s the “secret sauce” for bringing a dental practice’s outstanding claims rate to 0%? According to the fixer, a commitment to teamwork and clear and open communication will always lead to optimal outcomes. When all people and processes are working together in sync, success is inevitable.
Will your dental practice be the next puzzle for the fixer to solve?