How Dental RCM Errors Can Lead to Revenue Loss and Financial Instability

Dental RCM errors can significantly impact your organization’s revenues and financial stability. These errors refer to dentists’ mistakes while converting paper claims into electronic payments. These errors are either payment delays or payment errors. A lot of dentists report making a variety of dental RCM errors every day. In this guide, we’ll explain what dental RCM errors are and how they affect your business. We’ll also discuss how these mistakes can lead to lost revenue or bad debt write-offs that could leave you struggling financially.

What Is Dental RCM?

Dental revenue cycle management is crucial for maximizing income in dental practice by efficiently managing revenue across all business systems. There are two sources of revenue in dental practice: patients and insurance companies. Effective management of both these revenue sources is critical for RCM. The processes for managing patient and insurance revenue differ significantly but are interdependent. These managed revenue sources greatly impact the practice’s cash flow.

Dental RCM Errors And Their Impact On Revenue 

Dental RCM errors can significantly impact your business’s bottom line. These mistakes can lead to revenue loss and financial instability, making it hard for you to stay in business. If you’re a healthcare provider, you may think your business won’t be affected by such an error—and you’d be right! However, if this type of mistake occurs regularly, it could cause significant issues for your practice: When a dentist makes an error in their RCM process (which is often caused by human error), they may miss out on making money due to insufficient documentation or poor review skills. An example would be if a patient receives two billing codes for one tooth extraction procedure—one with more complicated surgery than the other—and both bills were submitted without any explanation. Dental RCM errors can occur at various revenue cycle stages, including patient registration, insurance verification, claim submission, and payment processing. 

Type Of Dental RCM Errors 

Here are the following types of errors that occur during dental billing management:

Payment Delay and Error 

Payment delays and errors happen when a claim is submitted but not paid. It can occur when the information entered on a claim form is incomplete or incorrect. Payment errors are caused by human or computer errors in processing payments for dental procedures. The causes of these types of errors vary depending on their severity and frequency, but they all result in revenue loss for your practice:

• If you submit an incomplete claim form with missing information or incorrect data entry, it may take up to 30 days to receive payment from insurance providers (credentials). This creates issues with payroll planning because employees’ paychecks will not be correct until after their next payday without reimbursement coming through first!

Errors in data entry can lead to inaccurate decisions about treatment options. This can have negative impacts on patient care and outcomes. They might make an error during their work, such as sending an incorrect bill to patients or not billing for services performed. 

Missing Information 

Another standard dental RCM error is missing or incorrect information. In this case, you must look at the patient’s records and ensure all required data are entered correctly. This error can also lead to duplicate payments made on behalf of the same patient multiple times in one year. For example, suppose two claims are filed against a single patient account during the same year. In that case, they receive different amounts due from their insurance company based on what was paid out previously by your practice’s billing office that year. You will pay twice for those services when they should only have been charged once!

Patient Eligibility Verification

Patient eligibility verification is crucial to the dental Revenue Cycle Management process. Failing to check a patient’s insurance eligibility before providing services can result in claim rejections and loss of revenue. Inactive insurance policies are one of the most common reasons for claim rejection and can be easily avoided by verifying patient eligibility before providing treatment. It is important for dental practices to have a system in place to check insurance eligibility in advance to avoid costly errors and ensure successful claim submissions. 

Data Entry Errors 

Regarding data entry and transcription errors, you can find the following errors in dentists’ work: misspelled words, wrong dates, duplicate claim numbers, transcribed partial claims numbers, and incorrect billing rates. Lack of training can lead to data entry errors in electronic systems. Doctors and clinicians rely on these systems to make treatment decisions.

Coding Errors 

Coding errors are significant dental errors that lead to low collections and fraudulent activity. Accurate coding is essential for submitting successful claims and avoiding costly denials. With CDT procedure codes changing every year, it can be challenging to keep up with the details and nuances of dental coding. One significant change in dental RCM is the transition from ICD-9 to ICD-10 diagnosis codes. Errors in selecting diagnosis codes can result in claim denials and loss of revenue. Experienced billers should be aware of which coding set to use when submitting claims for services provided on earlier dates. Dental practices must prioritize the accuracy of diagnosis coding and ensure their billing staff is trained and experienced in selecting the correct codes for each claim. 

Dental professionals must understand the potential risks of RCM errors and take steps to prevent them from maintaining a financially stable practice.

This post originally featured at DRG's blog!