Revenue Cycle Management

Hi friends!

In last week’s newsletter about identifying tasks worth solving, which were revenue-generating tasks, I wanted to lead into a major task that I believe is worth solving in my business.

For the past year, I’ve tried two dental insurance outsourcing companies to submit my insurance claims and to enter my insurance checks. My thinking was that if I could outsource this to specialists, they would be able to flawlessly submit the claims for quick approval and payments and to enter the claims accurately, so my accounts are clean.

Also, since they are specialists, they would have the appropriate verbiage to collect any outstanding balances from my patients. This would alleviate a lot of the issues I’ve had last year with our inability to accurately submit claims, get paid in a timely manner, and also effectively collect balances from our patients.

Challenges with Outsourcing and the Importance of Building Patient Relationships in RCM

When we worked with these companies, the claims were not being entered into the accounts cleanly, and as a result, there was a lot of confusion surrounding the patient’s accounts when they called in to inquire about them.

Also, I would notice that they would write off incorrect procedures on the patient’s account, which led to incorrect balances (or credits) on the patient’s accounts.

On top of that, when these companies would reach out to our patients to try and collect a balance, they would be somewhat rude, impersonal, and abrasive, so our front admin team would be inundated with patients calling in to ask about their balances and complain about the treatment they were receiving from the third-party company.

So not only was I not collecting on my accounts receivable, but there would also be erroneous credits to the patients. My administrative team’s time was being taken up trying to put out the fires, and we were losing patients due to how they were being treated.

This was truly a lose-lose-lose situation at hand. Am I one of the few who have experienced this? Or have my fellow colleagues also experienced this? Truly terrifying. 

Since my goal is to grow into multiple offices, I need a solution that is scalable. I’ve come to the conclusion that if you outsource your billing to a third party, it is difficult for them to collect balances from your patients because they have not built a relationship with them.

Building trust and a relationship with our patients is key, as without it, we don’t have the right to even start a conversation about their balance with us. For the patients to trust us, it must be the same team members talking to them about their balances, as it is the same team members serving them.

There’s no way around it; we need to bring this back into the house.

Implementing a Scalable Solution for Efficient Claims Processing and Patient Balances

My solution to this is to have one team member who has experience working in my office and talking with my patients overseeing the whole operation, and to have remote assistants submit the claims, attach additional information, and post the claims for us.

This should take care of around 75% of the claims that go through without any issues, and the other 25% of the claims will be forwarded to the team member in charge.

From there, the team member will audit the claim, and we’ll have protocols on how to handle it from there. If there’s a balance that must be collected from the patient, the claim will be forwarded to the office manager in charge to give a personalized phone call to the patient in order to have a personalized, empathetic touch to this difficult phone call.

The true unlocking of the potential of this system is that it’s scalable.

When we increase the quantity of claims we need to submit, we hire more remote assistants to help us submit and enter claims. The additional bandwidth required from the supervisor in charge is only incremental, as they would purely be directing questionable claims to the appropriate person to handle them and seldomly solving them themselves.

At least, that’s the theory! We will go ahead and try this system out very soon, and we will keep everyone updated on how the system is working out so far!

Have any of my colleagues run into the same issues as me? I would love to hear from you about your struggles. Please forward this email to other friends if you’ve found it useful!