Excellence in Dental Billing and Coding

Andrea Dickhaut, MHA

• Private Practice RDH

• Assistant Clinical Professor Boston University Goldman School of Dental Medicine

• Adjunct Clinical Faculty Quinsigamond Community College and Mt. Wachusett community college Dental Hygiene programs

• Senior Director of Dental Operations of a large FQHC

Andrea Dickhaut, RDH, BSDH, MHAPractice Administrator, DentaQuest Oral Health CenterAndrea.Dickhaut@dentaquestohc.com

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• 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

Management

Agenda

• 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 Cycle

RCM 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)

Revenue Cycle

If the cycle is long there’s a potential for more write-offs

If the cycle is short it will speed up your payment and increase

your cash flow

What 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 line

So, Why?With so much money on at stake, why do so

many of us struggle with Revenue Cycle Management?

Well…..let’s see

Where do we begin?

Set up a Revenue Cycle Management Flow Chart

The Goal of this process is to create a clean claim for submittal and payment

Revenue Cycle Timeline

Patient Receptionist Provider Dental Assistant Dental Billing Accounting

Payment Received

Billing posts and reconciles patient

and 3rd party payments against

the patient's account.

Accounting reconciles all

payments from the bank to the internal

daily transaction Tracker

Collections

Patients 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. (In

accordance with the payment policy)

Accounting reviews monthly total

outstanding AR

Revenue Cycle

Timeline Patient Receptionist Provider Dental Assistant Dental Billing Accounting

Bad Debt is Written Off

Billing reviews aging report

and cleans up patients

accounts. (In accordance

with the bad debt policy.)

Accounting reviews

monthly total bad debt

adjustments

Revenue Cycle

Accounting reviews all monthly adjustments,

patient refunds, AR, bad debt, and financial

reports from Dentrix and Orthotrac. Accounting

records appropriate summary transactions each month to General

Ledger.

What 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.

• Staffing for a successful team can be difficult

Leaving 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 manner

Common 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?

Coding

CodingThe 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• ALWAYS use the proper codes for the actual dental

services provided• Just because it’s a dental code, doesn’t mean it’s a

“covered” code

Common Coding Issues• Using obsolete codes (eg, D1203 instead of

D1206 or D1208)• 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 code

New CDT Codes

ICD-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-10Allows for specificity, acute and chronic diagnoses, definitive disease or symptoms,

expandable, same platform as WHO

For dental programs it should lead to many positives:

– 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 activities

General 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 service

Example• Z01.20 Encounter for dental examination

and cleaning without abnormal findings

• Z01.21 Encounter for dental examination and cleaning with abnormal findings (use additional codes to identify abnormal findings)

Remember…• 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; identify and resolve the root causes

• Code Correctly

Practices that know their insurers’ rules and regulations and do the work upfront to submit clean claims can expect to achieve close to 100% collection rates

Questions?