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Reimbursement lessons from the dental industry

The dental industry is not commonly considered a source of “best practices” for general healthcare reimbursement methods, but dental practices employ a number of strategic approaches that can be leveraged by other providers.

For instance, even though dental practices do not face the same level of government reimbursement regulation as hospitals and medical groups, caps on dental insurance coverage mean that the dental industry has always had to compete for patients’ disposable income. As a result, dental practices have long taken a retail-oriented approach to patient care.

With patients quite willing to switch providers if they are not satisfied with the entire experience, dentists focus on excellent customer service in clinical and non-clinical interactions. As healthcare patients experience more payment responsibility and higher out-of-pocket expenses due to increased deductibles, general healthcare will face the same need to refocus on patient satisfaction.

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Patient engagement

Just as a good retailer eliminates buyer’s remorse by providing good information and quality service that supports the purchase decision, dental practices have learned to handle patient care in a confident, educational manner that ensures the patient accepts treatment recommendations and returns for future services. The same reassuring approach is taken with financial interactions to strengthen the patient-provider relationship.

Because a major cause of patient dissatisfaction is a surprisingly large bill many weeks after a procedure is complete, successful dental practices often focus on verification of benefits and accurate predeterminations prior to the patient’s visit. This not only enables staff to prepare for the financial conversation but also mitigates risk of unexpected patient responsibility. These strategies not only improve the collection of patient fees and the payment of claims, but also enhance the patient experience. General healthcare would benefit greatly from implementing these strategic best practices into their overall approach to providing care.

Many dental practices have found that meaningful financial conversations to outline available benefits, total cost of the procedure and amount for which the patient is responsible can occur prior to the procedure. Patient involvement in decisions about how payments will be made ensure the patient understands and agrees to the responsibility, and that the payment strategy fits the individual’s financial situation – increasing the likelihood of timely payment.

Before these conversations can occur, however, staff need timely access to accurate information. While obtaining the information prior to the patient’s arrival is ideal, it is not always possible. In these cases, dental staff’s priority is to gather the information to support a detailed conversation about recommendations and financial obligations before the patient leaves the office. Dental patients are less likely to accept and schedule a recommended treatment once they’ve left the office than while in the office. For this reason, proactive dental practices rely on real-time eligibility and benefits verification.

Real-time connectivity

Even when payments are not made at the time of service, dentists have found that payments are made more quickly when real-time technology is used. For example, submission of correct claim information at the same time of a patient conversation speeds submission of claims and results in fewer denials and payment delays. Faster receipt of insurance payments means patient bills can be generated more quickly, rather than a month or more after the procedure.

For a patient, this efficiency is reassuring and a reminder of the recent financial conversation that already has taken place. When patients receive bills soon after the procedure and financial conversation, they are more likely to pay quickly as payment amounts are expected. With increasing High Deductible Health Plans (HDHPs) and patient responsibility for payment, healthcare organizations can also benefit from this proactive, technology-based approach to collecting from patients.

What dentistry has learned is that practices benefit on the bottom line by engaging patients in the financial conversation early. Yet shifting the financial conversation to the front-end of a patient encounter entails a cultural change for most general healthcare organizations. It also requires technology capable of breaking down institutional silos.

By using technology to streamline the reimbursement process and engage patients, the dental industry enables patient-provider interactions that increase collections without compromising patient care. It’s a model that could be adopted and customized to meet the challenges of hospitals and medical groups today, especially as interoperability continues to become a necessity and patients continue to be more responsible for medical bills.