Managing your collections and accounts receivables in an Endodontic practice requires precision, particularly when throwing insurance claims into the process. Collections is the total payments received for services rendered, while Accounts receivable (AR) is the balance of money still due to your practice for services rendered. If your practice files insurance on behalf of your patients and processes insurance payments, you will have both Patient AR and Insurance AR. It’s important to be able to easily track them separately so you can analyze the efficiency of your collections efforts and pinpoint particular workflow inefficiencies, when necessary.
The goal is to collect 100% of your net revenue, which is the billable revenue after in-network write-offs. If you are not in-network with any insurance companies, your net revenue would be the billable revenue after any patient courtesies have been accounted for.
Achieving a 100% rate in collections can feel impossible anytime you factor in insurance reimbursements. In this article we’re breaking down how to get as close as possible to a 100% collection rate, including how to choose the best billing protocols in your practice, and how to equip your team with the tools and resources necessary to ensure efficient collections success with minimal workload.
Understanding your Patient Billing Options
Ensuring accounts receivable success starts first and foremost by understanding your patient billing options and establishing treatment estimate and payment collection protocols in your Endodontic practice. To understand which methods are best for your practice, here are some basic questions to ask yourself.
- Will we be filing insurance on the patient’s behalf?
- Will we be contracting as an in-network provider with any insurance companies?
- Will we be filing insurance for our patients and waiting for the insurance to reimburse our practice directly? (aka: Assignment of Benefits)
- Will we be providing an in-depth treatment estimate (requiring time investigating eligibility and benefits) or will we provide a conservative average cost to patients?
- Will we only require the patient to pay an estimated copay at time of service? Or will we be collecting from the patient for the full procedure amount at time of service and reimburse the patient after the insurance has paid?
As an Endodontic provider you have the option to choose how deeply you wish to involve your practice in insurance filing. Anywhere from not at all (collecting in full from your patients with zero Patient and Insurance AR), all the way to filing in-network and waiting for the insurance to reimburse for outstanding balances, creating a much higher AR burden. Many of these factors are influenced by your region and demographics, the demand for insurance coverage in your area and whether patients can mostly afford to pay up front for services rendered.
Set your Billing Protocols
Once you have answered the 5 questions above, you can move forward with setting consistent billing protocols in your practice. This is particularly important to ensure team members are confident when presenting treatment costs to patients, and to ensure the team is as efficient as possible when it’s time to collect from patients and provide consistent care.
Billing protocols include:
1. Establishing what type of treatment cost estimate you will provide patients on a regular basis.
You might choose to invest your team’s time in verifying insurance eligibility to estimate costs as accurately as possible for patients. This process involves gathering patient information beforehand, accessing insurance benefit eligibility checks, and creating a custom treatment estimation. Gathering this data ahead of the appointment allows time for researching insurance benefits but it’s not always a viable option for emergency last-minute appointments. While eligibility verification can be done via phone or an insurance website, these methods are time-consuming for your team, especially alongside their daily tasks. To streamline this, consider using a clearinghouse that consolidates eligibility and verification for multiple insurances, such as DentalEMR’s partnership with EDSEDI, offering an integrated workflow for checking patient eligibility and benefits.
Alternatively, you may choose to offer a set fee structure based on popular insurance plans or your standard service fees. Similar to a services menu, this method allows for cost transparency to patients at a fraction of the time. It’s essential to note that detailed treatment estimates aren’t obligatory for Endodontic practices like yours. Patients should be made aware of the potential full fee, but then encouraged to contact their insurance for coverage details, if needed.
2. Based on your treatment estimate, will your team be collecting only the estimated copay from the patient or the full fee at time of service?
You might decide to collect the full fee from your patients at time of service to minimize your AR. In such cases, insurance reimbursements go directly to either the patient or your practice, where you credit back any difference to the patient. Alternatively, opting to only collect the estimated copay increases your Insurance AR, as you hold balances awaiting insurance reimbursement. Insurance payouts typically take 1-3 weeks, but delays or denials can extend this period, affecting your Insurance AR timeline.
Regardless of your collection approach, thorough documentation is crucial. Presenting physical treatment estimates or at the very least written payment agreements during treatment presentation ensures mutual understanding. Signed agreements by both your practice representative and the patient serve as vital defense in case of payment disputes and ensure confidence in your team, especially when discussing patient financing.
Include payment options in your agreement to assist patients in financing their care. While patients often pay by cash, check, or card, offering financing options like Care Credit or Lending Club requires that you understand the associated merchant fees. These financing organizations often charge higher rates, sometimes three times that of an average credit card, for processing patient loans.
Improving Claiming Accuracy through Advanced Tools
If you’ve committed to filing claims and accepting insurance payments on behalf of patients, the real challenges emerge. Managing insurance filing can be tedious and time-consuming. Not only will this process require team members that are experienced in insurance best practices, but it’s essential to guarantee they possess the necessary tools and resources for efficient insurance claiming.
- Leverage a Clearinghouse Service: Submitting electronic claims through a clearinghouse service is the best way to expedite claims to insurance payers.
- NEA Attachments: Platforms like EDSEDI allow electronic attachments, ensuring timely submission of x-rays, narratives, and vital documentation for optimal processing.
- Initial Claim Check: EDSEDI’s Claim Check function filters claims for errors, omissions, and duplicates, reducing human error in initial submissions for accurate claims.
- Minimize Paper and Postage Costs: While some insurance payers do not participate in electronic claim submission, EDSEDI will print and mail the claims for your team as an included service.
- Real-time Claim Statuses: EDSEDI provides ongoing feedback from insurance payers, updating on claim receipt, denials, processing, and payments. This eliminates time-consuming calls to insurers.
- Unified ERA Reporting: When available, receiving Electronic Funds Transfers (EFTs) instead of insurance checks is a faster payment method. EDSEDI’s ERA reporting consolidates incoming EFT reports, simplifying tracking and decreasing your team’s workload so they’re not hunting down payments in your bank statements or insurance portals.
Set Collection Protocols
Ultimately, if you choose to manage Patient and/or Insurance AR, it’s crucial to establish collection protocols for outstanding balances.
For Outstanding Insurance Balances:
- What is the maximum number of attempts for refiling claims due to repeated denials before involving the patient?
- What is the amount of time you will hold an unpaid Insurance balance before involving the patient?
For Outstanding Patient Balances:
- How long will you keep a patient balance without payment before sending to a collections agency?
- Do you have a collections letter ready to send to patients?
- If a patient asks, what payment plans do you offer to pay off an outstanding balance?
- Do you have a payment agreement in place to sign the patient up to make payments, including how you will manage their card on file and process scheduled payments?
If you choose to forward an outstanding patient balance to a collections agency, it’s imperative that your team writes off the outstanding balance in your books as a “collections bad-debt” to signify that the balance is deemed uncollectable. If the collections agency is able to collect on the balance, you will receive a payment net their service fees at which time you can apply toward the patient’s account. Routinely writing off such balances appropriately documents the balance transfer to collections, and prevents AR escalation over time.
In summary, managing collections in an Endodontic practice demands clear billing approaches, efficient insurance filing, and well-defined collection protocols. It’s about understanding patient billing options, using the right tools for accurate claiming, and setting guidelines for handling outstanding balances. These strategies ensure team consistency in maintaining financial health and streamlining the billing process for lasting success in your practice.