Dr. Victor Saunders, Sabrina Dorman, and Katie Grandle explain how technology helps to accurately communicate benefits and treatment estimates and simplifies office procedures



Founded in 1980, Shenandoah Valley Implant Institute faces many of the economic concerns typical to specialty dental practices. In addition to managing complex reimbursement policies and complying with ever-changing government regulations, we deal with patient no-shows, treatment rejections, and bad debt. Because the dental implants and other cosmetic procedures the practice provides are elective, a certain number of patients decline treatment if the cost is perceived as too high.

In addition, because early-stage periodontal disease doesn’t usually cause any discomfort, clients don’t always realize that treatment is a medical necessity. Others are reluctant to undertake procedures because periodontal surgery is notorious for being painful. So, slow eligibility verifications, payer pre-determinations, and out-of-pocket expense estimates are the perfect excuses for postponing—or cancelling—care.

Shenandoah Valley Implant Institute providers, Steven Saunders, DDS, Victor Saunders, DDS, and Jeffrey Dickson, DDS—all board-certified in periodontology—are no strangers to these issues. Among the three of them, they have more than 50 years’ combined experience providing dental implants, periodontal disease treatment, and cosmetic dentistry. Our practice also offers the Laser Assisted New Attachment Procedure™ (LANAP™, Millenium Dental Technologies Inc.), a pain-free, noninvasive treatment that doesn’t require cutting or suturing of gums and can save many teeth that were previously considered hopeless.

Yet, even with these advanced technologies, discussing periodontal treatment with patients is difficult without the ability to share up-front patient financial responsibility. The main office in Harrisonburg, Va.—also staffed by a hygienist, two office co-managers, and three dental assistants—serves up to 40 patients a day. A satellite office in Winchester, Va., with a hygienist and one dental assistant, sees approximately 20 patients daily. Combined, the practice serves about 10,000 patients each year, most of them adults.

The “nightmare” of paper claims processing

Administrators Katie Grandle and Sabrina Dorman coordinate treatment plans, billing, insurance, scheduling, and administration for both sites from the Harrisonburg office. Before 2010, they relied on paper, the phone, and the US Postal Service to verify insurance eligibility, submit claims, process payments, send bills, and communicate benefit details to our patients.

With the paper-based system, it wasn’t unusual for office staff to spend up to 3 to 4 hours a day calling 800-numbers or waiting on hold for eligibility verifications. Pretreatment estimates often took 4 to 8 weeks to receive by mail from payers. And if the insurance company needed more information, that added time to the process.

In the time lapse between treatment plan and pre-determination, it wasn’t unusual for patients to forget what procedures were being considered and have to be rescheduled for a second consultation. Others would change their minds about whether or not the treatment was necessary, or back out because of the out-of-pocket expense. In an economy where people are struggling to pay for the necessities of daily life, dental priorities can be quickly reduced to an “emergency” or “pain-only” basis.

Paper-based claim submission was also an administrative nightmare. X-rays had to be duplicated, and hard copies of charts and other information had to be manually attached to each claim, inserted in the envelope, stamped, and mailed to the payer. If a critical piece of information—such as a patient’s date of birth or Social Security number—were incorrect or missing, the claim would bounce back, requiring more time. There were also frequent and time-consuming follow-up phone calls to payers and patients.

Besides being awkward and error-prone, the paper-based system had serious negative effects on the bottom line. A 6- to 8-week turnaround between time of service and receipt of payment was average, but depending on the payer and circumstances, it could stretch from 3 to 4 months. Overall, the practice was experiencing unnecessary treatment rejections and bad debt in 2009. Meantime, claim processing was becoming increasingly time-consuming and difficult to manage.

Enter RTA technology

Clearly, it was time for a change. A former office manager who has since left the practice discovered real-time adjudication (RTA) at a professional conference in 2009. This Internet-based technology allows office staff to verify eligibility, process claims and receive accurate pretreatment estimates in real time, online before the patient leaves the first appointment. Realizing that this could streamline administrative processes, save money, and take the guesswork out of insurance benefits, eligibility, and claims transactions, the administrator further investigated RTA.

With input from the dentists, she evaluated ClaimShuttle™, an RTA solution offered by Roanoke, Va.-based MDE, with Electronic Data Interchange (EDI) capability. Everyone liked the product’s support for electronic real-time and batch-claim submission, single desktop interface, and ability to electronically attach digital x-rays, charts, and other documents. The fact that it interfaced smoothly with Delta Dental—the payer for the vast majority of Shenandoah Valley Implant Institute’s patients—was also a plus. The decision was made to implement the system in 2010.

Shortly thereafter, the office manager left the practice. Fortunately for the remaining office staff, however, the software saved hours of time formerly spent on the phone or shuffling paper. Compared to filing paper claims, electronic submission takes about half the time. In fact, the system allowed the two administrators to easily manage a workload that had previously required three staffers. Payments in 2 days versus 2 months
Now, when patients present to Shenandoah Valley Implant Institute, insurance eligibility is verified online at the first appointment, or sometimes even the day before the first appointment. Electronic claims are filed before patients leave their appointments. Digital x-rays and other supporting documents are also easily attached electronically, saving the practice hundreds of dollars each year on x-ray duplicates alone.

In addition, the system helps us file clean claims by prompting for necessary attachments—such as narrative, chart, or SMX—as well as missing or incomplete information (such as patient’s date of birth or Social Security number). Flawed claims—and the resulting rejections, follow-up phone calls and payment delays—are a thing of the past. Faster, cleaner claims also drive a more robust revenue cycle with some payments electronically deposited only a few days after submission. And consequently, the time between treatment and patient billing has shrunk to 5 to 14 days. In the rare case where there is a delay on the payer’s part, administrators can track the claim online to check its status, or refer to daily reports.

Our patients have welcomed on-the-spot eligibility verification and accurate, real-time, pre-treatment estimates while they’re still in the consultation room. Knowing in advance exactly what the procedure will cost—as opposed to relying on “guesstimates”—makes them more comfortable and leads to shorter turnaround times between consult and treatment. In fact, since implementing RTA technology, treatment rejections have been reduced by about half.

More face time with patients

The biggest benefits, of course, can’t be measured in numbers. We now have more time to spend greeting patients and answering their questions because we’re no longer tied up on the phone with insurance companies. Patients are impressed and pleasantly surprised that we can tell them precisely what a treatment will cost and what their financial responsibility will be. Knowing these costs—plus understanding the need for and benefits of treatment—makes it more likely that they will follow through with care that will enhance their dental health.

Whether patients forego procedures because they don’t understand the need, are uncertain about the cost, fear the pain, or a combination of factors, the end result is the same: compromised dental health. As a dental practice, we want to see our patients happy and healthy. Being able to accurately communicate benefits and treatment estimates is the first step toward building a rapport with patients and gaining their trust. Once we do that, it’s easier to educate them about disease and treatment and steps they can take to improve their dental health.

Bio

Victor Saunders, DDS, is co-owner of Shenandoah Valley Implant Institute and a graduate of the Medical College of Virginia. He also holds a Certificate in Periodontics from the Medical College of Georgia. Sabrina Dorman and Katie Grandle co-manage the practice.