Mastering Revenue Cycle Management: Essential Terminology To Know
What is Revenue Cycle Management?
Revenue cycle management (RCM) is a comprehensive process that involves your dental practice actively monitoring and evaluating the collection of payments and insurance claims throughout a patient’s entire care journey, starting from the moment their appointment is scheduled until the final payment is made.
Knowing the many terms that accompany revenue cycle management can help ensure you are properly managing and maximizing the cash flow of your practice.
Key RCM terminology every dental professional should know
- Claim: A request to the insurance company seeking compensation for dental services rendered. Typically, the claim includes an itemized statement of services and costs provided by the dental professional.
- Claim Denial: The decision of an insurance company to decline coverage for dental services.
- Real-time Eligibility Verification: Instant confirmation of a patient’s coverage and benefits from private or government payers.
- Preauthorizations: Confirmation from a third-party payer that the proposed treatment is eligible for coverage per the terms outlined in the benefit contract.
- Predetermination: The process of a dentist submitting a treatment plan to the payer for review, which includes patient eligibility, covered services, amounts payable, co-payments, deductibles, and plan maximums.
- Deductible: The set amount that needs to be paid for covered dental services before the insurance kicks in. It is renewed annually, typically based on the calendar year.
- Accounts Receivable (AR) Management: The process of pursuing and resolving unpaid claims. It includes monitoring, managing, reworking, and appealing denials until the claims are successfully paid and processed.
- Patient Collections: Billing the patient for any remaining balance once insurance payments are processed.
- End-to-End Dental RCM Software: A platform that empowers healthcare providers by equipping them with digital tools and resources to enable optimal revenue opportunities by electronically tracking and automating traditionally manual tasks like patient scheduling, insurance verification, billing, and collections processes.
Innovative solutions built to address the unique challenges faced by dental billers
Vyne Dental recognizes the range of responsibilities that dental billers encounter on a daily basis. From managing insurance verifications, claims submissions, and denials, to effectively communicating with patients, we understand the unique challenges you face. By incorporating our innovative technology, you can streamline your workflow and access solutions that are crafted for your specific needs.
Vyne TrellisⓇ, our end-to-end revenue acceleration platform, helps offices process, track, and manage claims electronically, and additionally:
- Provides batch and real-time eligibility of benefits
- Facilitates a secure environment for your communications
- Helps secure new patients 24/7 with innovative engagement tools
Connect today to learn why 74,000 dental offices trust Vyne DentalⓇ solutions to improve their workflows, reduce administrative costs, and streamline reimbursements.
Source:
“Glossary of Dental Administrative Terms.” American Dental Association, www.ada.org/en/publications/cdt/glossary-of-dental-administrative-terms#:~:text=preauthorization%3A%20Statement%20by%20a%20third,terms%20of%20the%20benefit%20contract.
