Understanding Practice Management Systems for Dental RCM
Running a dental practice isn’t easy. From paying staff salaries to managing patient care and submitting dental claims for treatments is too much. And when you’re occupied with so many things, you can’t divert your focus to a single task. As a result, you may not be able to deliver quality care to patients, which may affect productivity and revenue growth.
To prevent that, it’s important to allocate your time for each of the tasks. But that’s only possible if you structure them properly.
Modern practice management systems are the perfect solution here. These systems are mostly built to be all-in-one and can perform all the administrative, clinical, and financial tasks within a single platform. That makes it easy for you to manage all the practice tasks in one place.
Want to know how that works and what role professional dental RCM services play in it? Let’s discuss.
What are Practice Management Systems?
A practice management system is software that helps practices manage all of their daily operations, from keeping patient records to scheduling appointments and submitting insurance claims. The system performs all of these tasks electronically, so practices can reduce their manual workload.
PMS is important for managing the dental revenue cycle. It tracks and performs almost all the RCM steps from appointment scheduling to final revenue collections. It also detects billing errors, helping practices improve their processes.
What Revenue Cycle Tasks Does a PMS Perform?
Front-End Tasks
PMS manages all the steps in a front-end revenue cycle process: These include:
- Patient Registration: A PMS collects all the data of the patient at the time of registration. These include the patient’s insurance details and demographics that include name, date of birth, age, address, contact details, and other relevant information. The PMS uses the information to create a patient account, which it uses for further processes in the revenue cycle.
- Appointment Scheduling: PMS automatically schedules a patient appointment in real-time. It checks a dentist’s available slots for an appointment and allocates free slots to the patient. The system blocks double-booking.
- Eligibility Verification: The PMS matches the patient’s insurance information, such as the subscriber ID or the policy number, by integrating with the payer portal. It first sends the information to the payer and then receives the confirmation from it. Some advanced PMS systems work in real-time, as they check the patient’s coverage status (active or inactive) and confirm the available benefits, frequency limitations, and patient responsibilities.
- Point-of-Service Collections: If there are any patient responsibilities, such as coinsurance, copays, or deductibles, the system facilitates collections at the time of service before a patient is treated.
- Treatment Planning: Using the patient’s pre-op documents and diagnosis, the dental provider creates a treatment plan to present to the patient. Some systems also help determine the severity of the case, so cases with severe conditions are set as a priority, while low-risk cases are set for treatment afterwards.
Mid-Cycle Tasks
After verifying patient details and planning the treatment, PMS manages the mid-revenue cycle processes, which include:
- Clinical Documentation: The PMS proposes the documents for a dental procedure based on payer requirements. For example, if a crown claim requires a dental radiograph, PMS suggests that the provider or biller attach the X-ray. When all the documents are attached, they form a complete patient record in the system, and also assist in the billing process.
- CDT Coding: The PMS turns the dental procedure into the relevant payer-approved CDT code.
- Charge Capture: The charge capture is the process of recording all the treatment-related details, such as the CDT code, treatment performed, provider name, date of service, and billable fee according to the fee schedule.
- Claim Scrubbing: Modern practice management systems built-in clearinghouses to check a claim before submission and detect errors, such as incorrect CDT codes, missing documents, or incomplete fields in the claim form. By using the information, clearinghouses highlight these errors, so billers can check and fix them.
- Claim Submission: The clearinghouse converts the claim into the HIPAA-recognized ANSI X12 837 standard for electronic claim submission and then sends the claim to the payer for processing.
Back-End Tasks
After claim submission, the PMS fetches the payer’s claim decision and manages back-end revenue cycle processes. These are:
- Payment Posting: When the payer processes the payment, they send an explanation of benefits (EOB) or its HIPAA-compliant ANSI 835 electronic alternative, the electronic remittance advice (ERA). The PMS fetches the EOB or the ERA, which includes claim details, and then automatically posts payment into the correct patient ledger.
- Denial Management: As the PMS automatically tracks denied or underpaid claims after processing ERA, it immediately notifies you, so you can start the denial management process to recover payments.
- A/R Follow-Up: The PMS tracks all the unpaid claims or outstanding balances and lists them in accounts receivable. As outstanding balances get older, the system automatically creates A/R aging buckets and notifies you to follow up on the unpaid balances.
- Patient Billing: Patient billing is the process of charging patients for the remaining amount from an insurance claim after the payer has paid their share. With the patient portals in PMS, patients can manage their accounts, check outstanding balances, and pay the amount by using available payment methods.
How Does PMS Help Improve Revenue Cycle Performance?
Automation in Tasks
High-quality PMS is designed to automate manual tasks that rely mostly on paper and consume a lot of time. When you use software to manage all these tasks, it’s easy to process tasks fast and with near-accuracy. Some software also facilitates technologies like robotic process automation (RPA), which uses pre-set instructions to perform repetitive billing tasks. Complex tasks might still need human intervention.
Optimize Dental Revenue Cycle with Precise Automation for Smooth Collections
Better Claim Management
Built-in Diagnostic Features
Improved Patient Experience
Real-Time Reporting
What is the Impact of PMS on Dental RCM?
Practice management systems are growing in demand among dental practices. According to Precedence Research, the global market for dental practice management systems is currently valued at $1.82 billion. It’s expected to grow at a CAGR of 8.64%.
These tools use artificial intelligence (AI) in their daily processes to automate tasks, analyze performance, and suggest actions for better outcomes.
It indicates that the industry is rapidly shifting towards RCM automation and software solutions for paperless billing.
Plus, there is an increase in the number of patients who visit practices for treatment. As a result, it’s difficult to accurately manage patient records and process claims, leading the industry to adopt modern practice management systems.
The table below explains how PMS automation outperforms manual processes in dental revenue cycle management:
| Step | Manual Billing Work | PMS Automated Work |
|---|---|---|
| Procedure Entry | The front desk writes the procedure code (D2392), tooth number, and fee on paper. | Dentist completes treatment and marks the procedure as “completed” in the PMS. |
| Data Entry | Staff manually re-enter procedure details into the billing system. | PMS automatically pulls procedure, tooth, provider, and fee schedule information. |
| Claim Creation | Billing staff manually prepare a claim or retype data into the payer portal. | PMS automatically generates an insurance claim in the correct format. |
| Error Handling |
|
|
| Claim Submission | Claim is printed or manually submitted through the payer portal or mail. | PMS sends claims electronically through a clearinghouse or payer network. |
| Claim Status Tracking | Staff manually checks payer portals or contacts insurance companies for updates. | PMS automatically tracks claim status (sent, pending, paid, denied). |
| Communication Delay | Patients receive bills or status updates after significant delays. | PMS triggers instant patient notifications via SMS or email for co-pays and updates. |
| Payment Collection | Co-pays are often collected late or after the billing cycle. | Patients receive automated reminders, encouraging earlier co-pay collection. |
Reduce Manual Errors and Eliminate Stress with Automated Billing.
What are the Best Practices for Deploying Practice Management Systems?
Choose the Best PMS
Choose a practice management system that provides you with the option to customize the revenue cycle process according to your practice’s workflows. The PMS should adapt to these rules and implement them in the billing process.
For that, you must:
- Research the software vendor
- Check online reviews and case studies
- Contact the vendor and make sure that the system offers customization
- See if the system shares and manages patient information securely under the HIPAA framework
- Confirm all the contract terms before deploying software
When you finalize all these steps, you’re set to implement the PMS into your billing process.
Integrate Payer Policy Rules
User-Friendly Patient Portals
Get Complete PMS Outsourcing Support
PMS makes it easy to manage your complete revenue cycle. But, still, you need software expertise to operate the PMS and use it efficiently to accurately perform all the RCM tasks. If your staff isn’t proficient in using the PMS, it may not deliver the results you’re expecting.
Especially, if you’re running a smaller practice, you may not be able to afford software integration due to the high costs. Staff training is another issue.
The best solution is to outsource the RCM operations to an expert partner, like TransDontics, who offers reliable EMR/EHR support to manage the billing process on your behalf without the need for you to change or switch the system. You retain your software and provide credentials to the team, so they can gain access and optimize your revenue cycle performance.
The benefit is that your staff is relieved of the billing tasks, freeing them to perform other administrative and clinical tasks. You work with an RCM partner who manages all these tasks smoothly and doesn’t charge much. Revenue cycle performance is smooth, and you achieve higher ROI because you pay only a minimum percentage of your collections to these partners.
