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How Dental Insurance Verification Helps to Enhance Revenues?

by Dental RCM DentalRCm

Summary: Presently, dental healthcare technology is all about networking with various sophisticated software solutions and the frameworks to increase revenue, save time, and optimize processes. There are different electronic alternatives available to confirm patient dental insurance verification, and every one of them will impact the revenue stream in one method or the other. The highly famous one is that which offers real-time verification of eligibility via a website that all stakeholders in the healthcare and dental sector can log on to, to access information, and update.

Body: The primary goals are to make dental insurance verification speedy, price-effective, mistake-free and in real-time. The adopted verification method can vastly enhance the speed of payment for both the payer and the provider. It is a highly recognized fact that a manual examination requires extra time as compared to electronic verification. The real-time verification of eligibility assists in updates, confirm and cross-check data of patients online. In a healthcare facility, this will improve the RCM (revenue cycle management).

What is Real-time Dental Insurance Verification?

The real-time verification of eligibility assists us to access data on the dates of coverage of the patient’s policy; if personalized properly, it can also offer comprehensive information on the insurance comprising billing amount, out-of-pocket expenses estimate, deductible and co-pay status, and the extras that the patient might have to send out based on the therapy choice.

Performing the real-time verification necessarily signifies the facility of healthcare does not accept blindly the information given by the patient. Also, the real-time verification of eligibility can be performed even before the facility is visited by the patient. The help desk team qualifies the eligibility information of the payer via the personalized software tool, to automatically create the right demographics of the patient; this contradicts the requirement to re-enter data of the patient.

Thus real-time dental insurance verification process restructures the process of admission of the patient.

Real-time Dental Insurance Verification

How Does Real-time Eligibility Function?

Various stakeholders in the healthcare system, comprising pharmacists, payers, and providers are attempting to synchronize the information of the patient gathered at the desk with an insurers network and backend systems for speedy verification of eligibility. This type of test will reduce the prices, improve health outcomes and enhance the experience of the patients.

In fact, the patient eligibility verification utility might be personalized to fulfill various requirements. These days’ machine learning and AI solutions assist to give alerts if corrective action is not started, detect risks of claim denial in advance, and collate payer-remit data.

This assists to make the team very proactive as there is responsibility. Deployment of real-time dental insurance verification, therefore, decreases denials.

The real-time verification of eligibility permits direct insurance coverage verification, comprising information on many or all of the following:

Medicaid & Medicare health maintenance organization (HMO)

Kind of medicare coverage

Dates of Coverage

Demographics of patient

Advantage options – comprising patient accountabilities for co-pay, deductibles & co-insurance,

Remaining & Total co-pays and deductible amounts

Pre-authorizations & referrals

The mailing address of claims

Maximum lifetime

Claims submission address

Out-of-network or in-network status

Durable dental equipment coverage

Real-time eligibility tool collects all details as information inputs; it will record essential and important information such as:

Patient’s name spelling

Address

Date of birth

Social security number

Name of the insurance carrier

Number ID

Number Group

Kind of plan and coverage information

Policy status of the patient and efficient date

Exclusions Plan

Benefits payable

These are then electronically approved and sent to dental coverage payers on the software system; the software utility then verifies payer response and gets eligibility outcomes in real-time as discussed in the listing previous.

Real-time Verification vs. Traditional Eligibility Verification

Verification of eligibility is the second and most important stage in the revenue cycle management. In traditional eligibility verification, there is no efficient verification process as it is tough to call payers and decide on the patient/payer payment accountabilities. As the outcome, the number of mistakes made during the submission of claims is many.

Traditional eligibility verification might skip or delay your normal A/R days and decrease the monthly income. Dental insurance verification by examining via multiple phone calls or individual payer entries is a very monotonous and timely delay and efficient patient access to treatment.

A real-time verification procedure which is available via a single website is considerably much effective. It streamlines interaction with payers and offers instant eligibility replies, which signifies your team can confirm the insurance coverage in a few seconds, not days or hours. With the right real-time dental insurance verification tool, healthcare providers can make use of a highly effective workflow to interact with almost all kinds of insurance payers.

Eligibility outputs are instant, easy to read, and include important deductible and co-pay information. These services will permit you to decide if a patient is qualified and what their insurance coverage information is even before they go to the dental care provider office. There is no time for waiting involved, as the provider no longer requires to struggle with computerized IVR (Interactive Voice Response). It is a system to examine a patient’s eligibility advantages; it saves time for both payers and the providers thus increasing collections.

The Advantages of Real-Time Eligibility Verification

Healthcare practices rely overly on the front office team to handle eligibility verification and payment collection; however, they are not delivered excellent tools for implementing these tasks.

As per the American Association of Professional Coders, the top three causes of claims denial are the following:

Partial or wrong patient data

Expired coverage of insurance

Excluded services

Prior authorization needed

Many of these challenges might be fulfilled with the deployment of real-time dental insurance verification software.

Let us discuss some of the advantages of real-time eligibility verification:

Enhanced Claim Pay-outs

A flourish claim submission process starts the moment a patient calls for an appointment or walks into the dental care facility. With real-time verification of eligibility, this is quite viable, as also are reasonable and timely pay-outs. Dental practices require taking complete advantage of simple, cheap software applications that let the reception or reception speed up the patient registration without losing any details; this assists to enhance claim pay-outs.

Improved Cash Flow:

High patient deductibles and fluctuating pain make the job of confirming insurance coverage and advantages complicated and time-consuming.

The best approach to fight this challenge is to utilize the tools which are created in the EDI (electronic data interface), which can confirm insurance eligibility of the patient and advantages on a real-time basis. This greatly assists to increase revenues. If your Electronic Health Record (EHR)) system is error-free and trusted, automatic coverage confirmation on a monthly, weekly or daily basis is viable.

The satisfaction of Patient:

Electronic real-time verification of eligibility streamlines the full front office process – judgments on benefits, coverage, and eligibility can be taken after an instant examination with many payers. Instant examinations decrease threats such as plan expiry of the patient, lack of coverage of a specific process which affects directly the satisfaction of the patient.

Resource Box: We are a team of Certified Dental Billers and Coders. We have been serving the nation's most respected Dentists for the last 10 years Contact DentalRCM for dental insurance verification. Dial (888) 315-2050 toll-free telephone number of DentalRCM for more information.

Author Bio: Hi, I am John. I am an avid reader and a passionate traveler who has traveled to almost every nook and corner of India and is ideologically motivated to travel the world with equal precision. Well, I am someone with an endless fascination for reading, writing and traveling, when I'm not traveling, I sit by my laptop and write about my opinions and experiences.