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SKYGEN USA

“Payer web portals are ending the dental billing chaos”

Publication: dentristry iq

Publish Date: November 2019
By Marcel Tetzlaff

SKYGENUSA Powering Healthcare for the Digital Age

AUTHOR: marcel tetzlaff, vice president provider experience and dental benefits management

In a world where everyone is pressed for time, it is difficult to ask a patient to wait more than a few minutes while you bill them for dental services you have just provided. Nevertheless, it is critical to expediting revenue and ensuring cash flow. But by embracing the digital economy and filing claims electronically on payer web portals, you don’t have to ask—but you can still get paid in real time.

The cash flow challenge

Dental service providers—especially smaller practices or those just starting out—face more challenges today than ever before. Cash flow is especially a big concern for providers operating on ever-thinning margins. A provider’s ability to quickly and efficiently process claims and quantify denial rates is crucial to ensuring a smooth revenue cycle and managing dental provision reimbursement.

All health-care providers rightly focus their efforts primarily on delivering quality care and ensuring better patient outcomes, which directly leads to growth. A provider’s ability to accurately predict reimbursement income, as well as reduce claim delay and denial rates, will lead to quicker payments and more time to focus on administering quality, value-based care.

Some of the most common reasons claims are denied or delayed include:

  • Incorrect or missing patient information
  • Invalid or inaccurate current dental terminology codes
  • Incorrect or incomplete submissions, i.e. missing tooth number, lost x-rays, noncovered service was performed, etc.
  • Duplicate claims filed
  • Failure to confirm eligibility prior to treatment
  • Failure to request preauthorization, or requesting preauthorization when not required

To make dental providers’ claim submission and administration of payment processes as simple and accurate as possible, the use of a portal that offers electronic claims and payment processing can be an asset. Using automated electronic claims submission is a simple way to reduce incorrect, unclear or missing information, which reduces both claim delays and denials. Innovative, technology-enabled solutions minimize administrative costs, so health-care providers can drive efficiencies and reallocate more dollars for better health care for all Americans.

Electronic payment for dental providers

Improving your dental practice is a team effort that involves acquiring new patients, serving patient needs in a manner that ensures an ideal outcome, getting paid for service, and keeping patients returning. All of these steps can be measured and improved, but the absolute most crucial step is payment. Surprisingly, it’s the step that today’s dental providers are consistently failing to optimize to their benefit.

It's difficult to assess the exact detrimental impact of claim denial rates on dental providers. Across the US health-care industry, claim denial rates range from 5% to 10%, according to the American Academy of Family Physicians.1 Meanwhile, the US Government Accountability Office maintains that annually up to one-fourth of claims are denied.2 However, when one considers the above-mentioned reasons most claims are delayed or denied, it is clearly evident that automated electronic claims submission can help ensure your practice has lower denial rates and healthy cash flow. 

According to a 2018 article by McKinsey Company, each year more than $3.5 trillion flows through the US health-care system to providers. Of that, more than $200 billion is paid directly from consumers to providers.3

Until 2018, the US dental industry achieved significant year-over-year increases in adoption of several types of electronic transactions.4 However, according to a report by the nonprofit Council for Affordable Quality Healthcare, the US dental industry’s adoption of four of the five main electronic transactions involved in billing administration remains at 50% or less.4 As a result, providers are leaving an estimated $2.1 billion on the table.4

How can dental providers move their payment administration into the digital age? The answer is by enabling the practice to transact electronically on all key payment-related functions:

  • eligibility and benefit verification
  • claims submission
  • claims status inquiry
  • claim payment
  • remittance advice4

As consumers take on a greater share of health-care payments, it is increasingly important that dental providers implement smarter methods to predict and adjudicate payments and thereby improve cash flow, reduce consumer bad debt, streamline administration, and eliminate costly errors.

Moving to electronic transactions

A provider web portal, such as the Skygen Provider Web Portal, can assist in moving to full electronic transactions. The portal should focus on building electronic relationships with providers that offer significant benefits through electronic transactions, saving time and money, enabling providers to streamline payment administration,  and getting paid faster.

Paperless provider web portals are improving payment outcomes in the following ways:

  • Eliminating the inefficiency and cost of having to file claims through an insurance payer clearinghouse, and thereby enable faster (online) billing
  • Automating data entry, which reduces errors and claim denials by preventing incomplete claim submissions
  • Providing guidelines to verify member eligibility, service coverage and history, giving providers real-time answers about a patient’s current status in the benefit program—making it quick and easy to answer member questions about their benefit programs and coverage
  • Getting instant explanation of benefits (EOB), freeing-up time for providers’ staff to provide patient care
  • Enabling accurate preauthorizations by uploading supporting documentation and even x-ray image files easily and without additional cost to providers
  • Allowing real-time billing for services that can improve provider cash flow and enable electronic payments
  • Facilitating submission of claims using the provider portal at no charge to the provider and enable receipt of direct deposits from payers

One of the most important ways a web portal can streamline the payment administration process for dental providers is by eliminating the middle-man—the step of submitting claims to a clearinghouse. Most clearinghouse companies not only charge providers for each claim submitted, but also charge additional fees to send paper claims to payers. If a clearinghouse has to send a claim to other clearinghouses, then the entire claims process can perpetuate, taking longer and rerouting claims multiple times before reaching the intended payer. Once clearinghouses process payments, providers cannot collect until information about the claim returns to them in the form of a remittance statement, which details what has been paid by the payer and what is owed by the patient.

Web portals can empower providers to avoid this unnecessary, time-consuming billing chaos, providing immediate information payment administrators need to know about exactly where their claims must go to expedite payment. In short, provider web portals provide payment information immediately at the front end, enabling providers to capture more billable revenue in a shorter period of time.

For example, if a provider payment administrator enters information on services rendered to a patient directly into the payer web portal—while the patient is still in the practitioner’s office—the portal will provide real-time information on what is covered and what isn’t covered, and what has a co-pay and what doesn’t. Payment administrators can immediately charge patients for those services that are patient responsibility before the patient leaves their office. Providers do not need to wait for an EOB to come back before they can bill, and they don’t need to chase a patient later for the payment that is due.

Benefits of automated electronic submission

After collecting payment from patients in your office, a practitioner can proceed to enter their payer claim directly into the claim submission software at no cost. The automated system on the software’s portal minimizes keystrokes, because the software provides prefilled data fields and automatically verifies the data as the administrator works to fill the forms, such as member identities, dates and procedure codes—ensuring accuracy by preventing claims and authorizations that contain errors from being allowed to be submitted through the portal. This eliminates delays, pends, or administrative denials that hold up payment.

Real-time status updates are viewed easily on payer portals, and as claims are processed and paid and authorizations are determined, their status is instantaneously updated in the portal. Providers know at any point in time if the claim is under process, has been paid, and when funds have been deposited to a provider’s bank account (usually within 24 to 48 hours of approval for direct deposits). A provider’s accounting administration is provided instant access to current and historical details about claims, authorizations, remittance advices and fee schedules, greatly aiding the reconciliation process. 

Conclusion

On-demand solutions, such as those summarized in Figure 1, are increasing efficiency by enabling an automated, electronic and paperless provider relationship with payers.

As the dental reimbursement landscape continues to change, dental practices will continue to adapt. As they evolve, they can be smart and stay ahead by having the right technology on their side.


References

  1. https://www.aafp.org/practice-management/administration/finances/denial-rate.html.
  2. https://www.gao.gov/assets/320/316699.pdf
  3. “The Silent Shapers of Health care Services”, Patel, Foo, Sutaria, McKinsey & Company, 2018.
  4. CAQH Index, www.caqh.org, 2018.

 

Marcel Tetzlaff

About Marcel Tetzlaff

Vice President of Dental Benefits Management, Marcel Tetzlaff leads SKYGEN USA’s continuing commitment to helping its clients provide superior dental program stewardship. He and his team are responsible for developing and executing the company’s Enhanced Benefit Management program that is designed to ensure delivery of the most appropriate and efficient care possible. By leveraging SKYGEN USA’s technology, clinical, analytical and administrative expertise, the appropriate intervention can be initiated to achieve optimum performance, including recognizing and rewarding high-performing providers.

Mr. Tetzlaff comes to SKYGEN USA with more than 20 years of experience in managing government and commercial healthcare and dental plans. He was previously Director, Program Implementation at Integrated Health Network of Wisconsin, a multi-system, clinically integrated accountable care network. During his tenure, he oversaw all aspects of their Medicare Advantage program with payers and health systems, implemented best practices and operational standards across all health systems, and developed workflows, reports, education, training, and documentation for the Medicare Shared Savings Program (MSSP), Risk Adjustment Factor (RAF), Healthcare Effectiveness Data Information Set (HEDIS) and other quality and efficiency measures. Prior to that position, he was Regional Vice President, Provider Networks at DentaQuest, where he oversaw provider networks in 12 states and new network development efforts nationally. Among his accomplishments was managing the risk business that improved loss ratios with millions of dollars in claims expense reduction. He also implemented pay-for-performance reimbursement models for providers.

Mr. Tetzlaff earned his MBA at the University of Wisconsin-Milwaukee with a major in healthcare management. He also holds a Bachelor of Business Administration Degree from the University of Wisconsin-Whitewater.