Excellence in Dental Billing and Coding - NNOHA

1 Excellence in Dental Billing and CodingAndrea Dickhaut, MHA Private Practice RDH Assistant Clinical Professor Boston University Goldman School of Dental Medicine Adjunct Clinical Faculty QuinsigamondCommunity College and Mt. Wachusettcommunity college Dental Hygiene programs Senior Director of Dental Operations of a large FQHCA ndrea Dickhaut, RDH, BSDH, MHAP ractice Administrator, DentaQuest Oral Health Former SNS client Currently working with SNS clients as an expert advisor with process/finance improvement for over 5 years Current Practice Administrator at DentaQuest Oral Health Center Masters in Health Care Administration Certificate in Health Center ManagementAgenda Using data to measure Dental program sustainability Revenue cycle flow chart Coding CDT and ICD-10 Let s take a look at A/R Practice Analysis 2011 Practice Analysis 2017 What is Revenue CycleRCM is the time between when an appointment is scheduled and when you receive final payment for the work you ve done (or the claim is written off)

2 Revenue CycleIf the cycle is long there s a potential for more write-offsIf the cycle is short it will speed up your payment and increase your cash flowWhat does that mean for you? Financial sustainability for your Dental program Increase cash flow Improve net collections Decrease denied claims Decrease frustration Identify factors that impact your bottom lineSo, Why?With so much money on at stake, why do so many of us struggle with Revenue Cycle Management? s seeWhere do we begin?Set up a Revenue Cycle Management Flow ChartThe Goalof this process is to create a clean claim for submittal and paymentRevenue Cycle TimelinePatientReceptionistProviderDenta l AssistantDental BillingAccountingPayment ReceivedBilling posts and reconciles patient and 3rd party payments against the patient's reconciles all payments from the bank to the internal daily transaction TrackerCollectionsPatients with outstanding balances are offered to set up a payment plan to avoid credit reporting or being sent to a collection agency or small claims.

3 (In accordance with the payment policy)Accounting reviews monthly total outstanding ARRevenue Cycle TimelinePatientReceptionistProviderDenta l AssistantDental BillingAccountingBad Debt is Written OffBilling reviews aging report and cleans up patients accounts. (In accordance with the bad debt policy.)Accounting reviews monthly total bad debt adjustmentsRevenue CycleAccounting reviews all monthly adjustments, patient refunds, AR, bad debt, and financial reports from Dentrixand Orthotrac. Accounting records appropriate summary transactions each month to General can go wrong? How many steps are there and how many people does it take to get from start to finish? Steep learning curve Each step comes with a potential point of failure Every patient represents a new cycle, so these steps or combination of steps could possibly occur hundreds of times each week.

4 Staffing for a successful team can be difficultLeaving Money on the Table The revenue cycle process is flawed at some point of contact Provide services that are not covered Provide services to patients who say they have insurance (but don t) Failure to hold patients accountable for paying their share of charges at the time of the visit Claims not being processed in a timely mannerCommon Pitfalls Not having a dedicated Dental biller Not having a working interface between EDR and EMR to send charges over Manual charge entry vastly increases likelihood of human error resulting in lost revenue Should we bill out of EMR or EDR?CodingCodingThe responsibility for Coding correctly ultimately rests with the provider Critical for making sure we get paid for the work we do Critical for making sure we avoid Coding errors that could result in fines or worse Complete and accurate documentation of the patient encounter is crucial ALWAYSuse the proper codes for the actual Dental services provided Just because it s a Dental code, doesn t mean it s a covered codeCommon Coding Issues Using obsolete codes (eg, D1203 instead of D1206 or D1208)

5 Using the wrong code Codes charged out but procedures not referenced in clinical notes Procedures referenced in clinical notes but not charged out Referencing one procedure in the clinical notes but charging out a different codeNew CDT CodesICD-10 Who is using them Are they integrated into your EDR? Are they mapped?ICD-10 International Classification of Disease Diagnosis codes for CDT code rationale Pre-authorization if necessary CDT codes for procedure (Dentistry will continue its use of CDT codes for reporting procedures on Dental claims) Benefits of ICD-10 Allows for specificity, acute and chronic diagnoses, definitive disease or symptoms, expandable, same platform as WHOFor Dental programs it should lead to many positives.

6 Increase quality tracking Increase data for grants and special populations Increase medical- Dental integration at Health Centers Decrease denied claims Useful in clinical decision support tools, EBD Supports public health activitiesGeneral Guidelines-ICD-10 Coding Primary Diagnosis Code:Main reason the patient is seeking health care services Secondary Diagnosis Code: (not always necessary) Needs to be confirmed at time of serviceExample Encounter for Dental examination and cleaning without abnormal findings Encounter for Dental examination and cleaning with abnormal findings (use additional codes to identify abnormal findings) Know the rules and regulations of your major insurers Hold patients accountable for their financial responsibility Verify patient eligibility in advance of the visit (ideally when the appointment is scheduled) and again on the day of the visit Determine why claims are being denied.

7 Identify and resolve the root causes Code CorrectlyPractices that know their insurers rules and regulations and do the work upfront to submit clean claims can expect to achieve close to 100% collection ratesQuestions?