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

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- April 25, 2023

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.

Here is a table highlighting some of the potential consequences of dental RCM errors on revenue and financial stability:

Consequences of Dental RCM Errors | Impact on Revenue | Impact on Financial Stability
Delayed or Denied Claims | Reduced Revenue | Cash Flow Issues
Underpayments | Reduced Revenue | Reduced Profitability
Overpayments | Reduced Profitability | Risk of Audit and Penalties
Non-Payment | Complete Revenue Loss | Bankruptcy or Closure of Practice

## 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.

## Prevention and Solutions Of Dental RCM Error

These are just a few examples of the types of errors that you can find in dental records management. But the most common errors result from transcription and data entry mistakes, accounting for over 50% of all claim submissions during the first year after implementation. Dental RCM errors must be monitored to ensure your organization complies with federal regulations.

You can prevent dental RCM errors by following these steps:

### Dental Management Software:

Dental claims management software helps dentists ensure their billing rates are correct when inputting them into their system. The software will help them avoid making transcription or data entry mistakes when entering information about patients’ medical histories, diagnoses, and procedures performed on them.

### Utilizing technology:

Dental practices can use revenue cycle management software to automate and streamline billing. This reduces the risk of errors and ensures all claims are submitted accurately and on time.

### Staff training and education:

Proper training and education can help prevent errors by ensuring staff members understand the billing process and correctly enter patient and insurance information. Ongoing education can also keep staff up-to-date on billing regulations or procedure changes.

### Regular audits and reviews:

Regular audits and reviews of billing processes can help identify any errors or inefficiencies in the system. This allows for quick correction of errors and can prevent future mistakes. It also ensures that the practice is maximizing revenue and minimizing financial risk.

### Timely Reporting:

It’s also essential that your dental practice has an accurate accounting system to accurately report its financial performance to its clients or potential investors at any time during the year (or quarter). Timely reporting is an essential prevention method for dental RCM errors. By reporting billing errors promptly, dental practices can avoid delayed or denied claims, which can lead to revenue loss and financial instability. Timely reporting also helps dental practices to identify and address the root cause of billing errors and implement corrective measures to prevent them from recurring. Additionally, timely reporting can prevent errors from becoming a compliance issue, as failure to report billing errors on time can result in HIPAA violations and fines.

## Conclusion

A dental practice’s financial stability and revenue can be greatly affected by RCM errors. By identifying common mistakes and implementing solutions for prevention and correction, dental practices can maintain financial health and provide quality care to their patients. Ultimately, it’s easy to see how RCM errors could lead to revenue loss and financial instability. But there are a few things that you can do to mitigate this risk:

- Have a process for tracking and managing your RCM program.
- Keep an eye on your data.
- Keep up-to-date with industry best practices.

If you have questions about how RCM errors might affect your practice financially, please contact us for help! We’re here to ensure that your dental practice runs as efficiently as possible so you can concentrate on providing excellent patient care.

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