Claims technology boosts business success and patient satisfaction

When Karen Urnise, DDS, purchased Two Rivers Dental Center in April 2012, she quickly found the opportunity to clean more than teeth as she reviewed business practices, financial strategies, and insurance claims processes. Thanks to the adoption of new technology-enabled financial strategies, the practice has realized significant business process improvements, strengthened its bottom line, and enhanced patient service. Even more importantly, the improvements delivered several unexpected business and patient benefits that have helped turn the practice around.

Delays impact practice and patients

As office manager, I realized we had inherited a lengthy accounts receivable (AR) cycle that made it difficult to monitor eligibility verification, benefit details, and claims status. Many 2011 claims hadn’t been submitted, while others needed additional documentation. This extensive amount of unprocessed claims meant patients were receiving large bills, which many refused to pay. We spent close to 16 hours a month tracking and resubmitting claims, but AR days still hovered around 90.

Changing to a more robust practice management system revealed that more claims were being rejected than accepted. It required significant time to manually verify eligibility and resubmit claims. Furthermore, the system didn’t allow us to monitor claim status, and took two or more months to provide copayment information. We eventually stopped running predeterminations because it took eight weeks to receive feedback, and by then we’d lost many patients to another practice.

Needless to say, all of this combined posed a challenge in maintaining a professional business office. We could recommend a certain treatment, yet we couldn’t estimate patient payment responsibility. We wanted our patients to feel comfortable with the financial aspects of their treatment decisions and be able to ask questions about procedures and costs.

A better solution benefits everyone

We knew the faster we received information and processed a claim, the lower our AR days and the better our cash flow and patient experience would be. Therefore, we knew we needed to adopt technology with the following priorities — automated eligibility verification, claims submission, and processing and payment with real-time technology.

We adopted real-time transactional technology that provides almost instantaneous eligibility verification and an accurate Explanation of Benefits (EOB), allowing precise collections during the first visit. Patients know upfront what has been billed, what insurance will cover, and what they will pay.

Previously, treatment was provided before calculating financial responsibility. We would begin a $6,000 treatment without discussing coverage or payment, then submit the claim and wait 60 days or more. The negative impact was two-fold — a patient might overextend his or her resources, and our practice couldn’t collect in a timely manner.

Now, the automated process benefits both our practice and patients. For instance, we can determine 30-day payment options for out-of-pocket costs over $500. Patient payments can be spread over several appointments. In addition, since a “clean” claim currently averages 14 days to process, payment is often received before the second appointment. This allows us to help patients manage their financial situations, and we can accurately predict our cash flow. Analyzing production over a period of time was something we never dreamed would be possible. Now, it’s a standard of practice.

Furthermore, we can analyze claims submitted, benefits paid, and remaining eligibility for each patient at year-end. We use this data for treatment planning, which helps patients maximize remaining benefits.

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Significant improvements for AR and production

Two Rivers now manages the revenue cycle before, during, and after patient visits. We communicate payment information at the appointment, which results in better patient collections and reduced staff time on claims and follow-up. With real-time claims, insurance payments are received in two to three weeks. Few accounts reach 60 AR days, in fact, AR days have dropped by 65%.

If a claim is outstanding, we immediately follow up rather than waiting for the 30- or 60-day cycle. Tracking data allows us to turn 90-day accounts over to collections, something we couldn’t do before because we didn’t have accurate data. The technology also allows us to stabilize and predict deposits.

In addition to eliminating sluggish cash flow, the system has the added advantage of helping us monitor production averages, which have continued to steadily increase. Almost instantaneous eligibility verification and higher clean-claims pass-through rates have been an unexpected benefit to both our practice and patients.

In one year, smarter financial strategies have revitalized our practice. Our profitability, productivity, and patient satisfaction all have risen, and we have time to see more patients. Improved clinical and administrative efficiency, and very few denied claims, have accelerated cash flow and lowered expenses. The virtually seamless process now provides the right balance between patient care and business success.

Alisha Millard is the office manager for Two Rivers Dental Center in Glenwood Springs, Colo. Karen Urnise, DDS, a hygienist, a dental assistant, and a receptionist complete the practice.