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A Mid-sized dental practice in a suburban area was facing significant challenges with their revenue cycle management (RCM) process.

Challenge
Dental Clinic was experiencing several challenges with their RCM, which were impacting their financial health and operational efficiency.

  • High Claim Denial Rates: The clinic faced a 15% claim denial rate, which was significantly above the industry average.
  • Delayed Reimbursements: There were frequent delays in payments from insurance companies, leading to cash flow problems.
  • Inefficient Billing Processes: Manual billing processes led to frequent errors and delays, causing frustration among the administrative staff.
  • Low Patient Collection Rates: The clinic struggled with collecting outstanding balances from patients, impacting overall revenue.
Solution
CEC implemented a comprehensive suite of solutions tailored to address these issues:Claims Management Optimization

  • Denial Management: Implemented advanced denial management techniques to identify patterns and root causes of claim denials.
  • Claims Scrubbing: Introduced automated claims scrubbing to catch errors before submission, reducing the number of denied claims.
Improved Reimbursement Processes

  • Insurance Verification: Implemented real-time insurance verification to ensure eligibility and reduce claim rejections.
  • Follow-up Automation: Deployed automated follow-up systems to track unpaid claims and expedite reimbursement processes.
Streamlined Billing Procedures
CEC implemented a comprehensive suite of solutions tailored to address these issues:Claims Management Optimization

  • Denial Management: Implemented advanced denial management techniques to identify patterns and root causes of claim denials.
  • Claims Scrubbing: Introduced automated claims scrubbing to catch errors before submission, reducing the number of denied claims.
Improved Reimbursement Processes

  • Insurance Verification: Implemented real-time insurance verification to ensure eligibility and reduce claim rejections.
  • Follow-up Automation: Deployed automated follow-up systems to track unpaid claims and expedite reimbursement processes.
Results
  • Reduced Claim Denial Rate: The claim denial rate decreased from 15% to 5%, leading to claims being paid on the first submission.
  • Faster Reimbursements: Average reimbursement times improved by 30%, alleviating cash flow issues and more financial stability.
  • Efficient Billing Operations: Billing errors decreased by 40%, the time spent on billing tasks was reduced by 25%.
  • Increased Patient Collections: Patient collection rates improved by 20%, more effective payment plans and automated reminders.