How Pearly Optimizes Specialty Dental Patient Billing

Patient Billing for specialty dentistry is a tough nut to crack. Regardless of specialty, the nuances of the patient portion for specialized dental services make billing a bigger hassle compared to general dentistry.

And across the speciality industry, the needs can be specific to the service.

What works for endodontic patient billing is often different from what OMS practices need, which is a variation of what periodontics can require.

It is understood that there are a plethora of challenges throughout the entire revenue cycle for specialty dentistry–diverse insurance coverage variations and complex claim denials and appeals to name a few. And while insurance verification and claim processing take the lionshare of the headache for specialty dentistry, patient portion collection is a compounding issue in the industry.

In this Dentistry Huddle post, we discuss the specific challenges that specialty dental practices face when collecting the patient portion, and how leading practices have addressed them with specific dental practice software. Let’s dive in.

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Challenge #1 - Limited relationships with patient base

For patients, exposure to specialty dental practices is often intermittent. With the exception of post-operative check ups following a procedure, patients rarely will see dental specialists as  frequently as they would see their general dentist.

Because of this dynamic, it is not common for a relationship to develop between patients and specialist practices. Those usual bi-annual cleanings are opportunities for building patient loyalty and for establishing a routine.

On the topic of patient portion billing, unpaid bills can be addressed in person and at regular intervals. Through establishing practice expectations, general dentists can bill patients and collect accounts receivable much more effectively. 

It is this consistency of exposure that specialists usually lack.

Without direct exposure to patients, it is more difficult and costly to remind patients about unpaid bills. Staff time needs to be allocated to follow-up calls, auditing patient accounts, and batching statements for mailing or sending digitally.

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Challenge #2 The timing for billing the patient portion can be complicated

Timing can make or break your billing process, and getting that timing right for patients is another challenge that specialty dental practices face more often than in general dentistry.

Successful billing timing is often a balancing act of trying to bill patients in an error-free manner while ensuring that payment velocity maintains your practice’s cash flow.

It is this “error-free” element that we want to focus on here.

Billing errors make for payment delays and patient frustration, which can both negatively impact practice success.

Bill too early, and there’s a good chance that adjustments need to be made, which makes for a poor patient experience and delayed reimbursements.

Bill too late or inconsistently, and you have an A/R management problem.

Practices can address this challenge by issuing a predetermination claim form for proposed services not yet provided. While this coverage estimate is useful to best determine a patient’s out-of-pocket cost, it’s far from 100% accurate for specialty dental procedures given the complexity of both medical and dental insurance estimates that are often filed simultaneously.

So how can practices strike this balance without overextending their staff? Let’s talk about software solutions next.

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Why RCM automation benefits specialty dental

Software outperforms dental staff when it comes to consistency–almost invariably.

If configured correctly, it eliminates human error, acts consistently, and covers a scope of menial tasks unsuited for the busy schedules of RCM staff.

While RCM automation software is incredibly important for general dentistry, it can be argued that it is even more crucial for specialty dental, given the complexity and unpredictability of the patient billing process.

RCM automation software like Pearly addresses the esoteric patient billing issues of every dental specialty.

For oral and maxillofacial surgery (OMS) billing, oral surgery procedure codes can often start with a general dentist, followed by a referral to an oral surgeon. Communicating information across practices adds a layer of complexity to the billing process. Pearly seamlessly transfers all of this information from practice to practice  regardless of their internal system or RCM process.

For orthodontic treatments, payments are often made at regular intervals, sometimes quarterly or monthly. Pearly’s Pay Over Time feature allows patients to enroll in payment plans without staff intervention.

For periodontics because gum disease is often co-billed with both dental and medical insurance, separate statements are often confusing to patients who are not trained to navigate them. Pearly’s smart statements give a transparent and easy-to-understand view of patient visit history with granular, itemized statement information that syncs with a practice’s PMS.

For endodontics, though the patient portion is more straightforward, the sizes of the balances are larger, and can often require adjustments via the appeals process. Having software that can clearly delineate these adjustments for patients in a secure portal improves the patient experience and reduces the number of calls needed to solve issues.

Pearly is used by hundreds of dental specialist private practices, groups, and specialty DSOs. Its suite of tools empowers both practitioners and patients with the means for flexible billing communication and transactions—automatically and accurately.

If your practice is looking for a way to collect more patient portions faster, you can book a consultation call with one of our RCM experts.

At the end of the day, services are rendered and payment is made. Pearly cuts through the complexity to give your practice staff their time back for more meaningful responsibilities.

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