How to Improve Billing Accuracy

U.S. dental support organizations (DSOs) are turning to modern revenue cycle management (RCM) technology to tackle costly insurance claim denials and streamline operations. Cloud-based RCM platforms can unify insurance, billing, and patient data across all practices, providing centralized dashboards and real-time analytics. By eliminating redundant systems and automating workflows end-to-end, DSOs gain clearer financial visibility and tighter control over claims. For example, one DSO reports that real-time eligibility verification built into scheduling reduces claim denials and administrative back and forth by catching coverage issues before treatment. These integrated systems ensure patient and payer data flow seamlessly from intake through payment, closing gaps that cause revenue leakage. Automation and AI also play a key role in scrubbing claims for errors before submission. AI-enabled coding tools can interpret clinical notes and automatically assign the correct procedure codes, staying current with the latest coding rules. When errors are caught early, first-pass claim approval rates soar. In fact, industry reports show that intelligent claims engines improve first-pass claim approval rates by validating data and codes against payer rules. This translates into fewer rejections and resubmissions, so billing teams spend less time on appeals. Similarly, automated claims scrubbing has been shown to cut manual claim-cleanup time by over 90%, yielding faster reimbursements and improved cash flow for practices. By reducing human error in coding and documentation, AI tools both reduce the number of denied claims and give staff more time to focus on complex cases. Verifying insurance coverage up front is another critical lever for denial prevention. Modern RCM suites often include real-time eligibility checks that automatically pull patient benefits and deductibles at scheduling. This means patients and staff know expected coverage before work is done. For DSOs, this upfront check is proving powerful: one study found that automating eligibility verification led to an 11x increase in checks and about a 20% drop in denials due to eligibility errors. In practice, real-time verification prevents surprise denials and billing surprises. Patients see transparent estimates, and practices avoid wasted claims submissions. Together with AI-fueled claims validation, real-time eligibility ensures that only clean, complete claims go out the door. Automated RCM platforms with built-in eligibility checks and AI-assisted coding not only slash denial rates, but also signal that the organization is committed to efficiency and growth. In practice, leading DSOs see measurably faster reimbursements, reduced revenue cycle costs, and fewer surprises on the balance sheet. 🔔 Follow me (Sina S. Amiri) for more insights on transforming dental RCM through AI and automation. #Dental #RevenueCycleManagement #ArtificialIntelligence #Tech

🔍 Unlocking the Power of RCM 👀 RCM isn’t just about processing claims—it’s about optimizing every step of the journey to ensure practices thrive. One area that often gets overlooked? Documentation, and documentation is everything. It’s the foundation that supports accurate billing, compliance, and financial stability for practices. Without thorough documentation, even the best processes can fail. Did you know that incomplete or unclear documentation is one of the leading causes of claim denials? 💸 yep have you seen these Denial Codes : 16: Claim/service lacks information or has submission/billing error(s). 17: Requested information was not provided or was insufficient/incomplete. 252: An attachment/other documentation is required to adjudicate this claim/service 50: These are non-covered services because this is not deemed a ‘medical necessity’ by the payer. 57: Payment denied/reduced because the payer deems the information submitted does not support this level of service N115: This decision was based on a Local Coverage Determination (LCD). This is just a few, if you are seeing these codes you have a documentation root cause issue, no amount of appeals will get you paid! Here’s why proper documentation matters: 1️⃣ Accuracy in Coding: Comprehensive notes ensure that coders select the right codes, reducing the risk of rejections. 2️⃣ Detailed documentation protects your practice during audits or appeals, providing the evidence needed to justify claims. 3️⃣ Faster Reimbursement: Clear and precise records eliminate back-and-forth communication with payers, speeding up payment cycles. 🔑 Pro Tip: Train your providers and staff to view documentation as a communication tool—not just a task. 🔑 The clearer the picture they paint, the smoother the revenue cycle operates. Investing in strong documentation practices today paves the way for fewer denials, better cash flow, and long-term success. What strategies do you use to improve documentation in your practice? #RCMExcellence #HealthcareDocumentation #RevenueCycleManagement #PracticeSuccess #MaximizeRCM

After a few candid conversations with health-system CFOs who collectively oversee billions in physician revenue, one theme rang loud and clear: revenue integrity only scales when clinicians can forget about billing. Here are the takeaways reshaping my roadmap: - Stop mopping—fix the pipe. Physician billing is high-volume, low-dollar. Every avoidable touch destroys margin. Accurate clinical context at the point of care is slashing denials before they happen. - Beware the DRG mirage. A $10 M coding lift can quietly blow up population-health costs if diagnosis creep inflates risk scores. Accuracy beats after-the-fact optimization every time. - 72-hour adjudication is coming. Medicare already pays 80 % of claims within seven days when the data are clean. Shared rails plus real-time records unlock a win–win for providers and payers. - Data as triage coach. Moving an ortho service from a 12:1 to 7:1 consult-to-surgery ratio freed OR time and lifted patient satisfaction, powered by feedback loops to PCPs. - Small practices = single-point-of-failure risk. One vacationing biller shouldn’t freeze cash flow. Submission logic must live in the platform, not in someone’s head. The future RCM stack won’t be a black box bolted onto the EMR. It will be a real-time, rules-aware copilot that flags payer changes before claims queue, adjudicates in hours, and lets clinicians focus on care, not CPT codes. Building toward that future now. If you’re experimenting in the same space, let’s chat. #HealthcareFinance #RevenueCycle #Automation #ValueBasedCare

#TipTuesday: Why You Should Avoid Unspecified Diagnosis Codes Unspecified diagnosis codes (those ending in ".9" or "0") can be tempting when documentation lacks detail, but they can trigger denials, payment delays, and compliance risks. Here’s why you should steer clear of them and what you can do instead: Why Unspecified Codes Are Problematic: ❌ Payer Scrutiny – Insurance companies may flag unspecified codes as insufficient for medical necessity. Some outright deny claims with them. ❌ Delayed Reimbursement – Payers may request additional documentation, slowing down payments. ❌ Higher Audit Risk – Frequent use of unspecified codes could suggest poor documentation practices and lead to compliance issues. ❌ Lost Revenue – Some payers downcode unspecified diagnoses, leading to lower reimbursement rates. When Are Unspecified Codes Acceptable? 🔹 New Patient or Initial Visit – If a provider is still assessing a condition, a temporary unspecified code may be justifiable. 🔹 Limited Documentation – If a provider lacks sufficient details (e.g., ER settings), unspecified codes might be necessary. 🔹 Payer Guidelines Allow It – Some insurers accept them in certain circumstances, but always verify. How to Reduce Unspecified Code Usage: ✔ Educate Providers – Train clinicians on the importance of detailed documentation. Encourage them to specify laterality, acuity, and underlying conditions. ✔ Query for Clarification – If the documentation is vague, don’t guess! query the provider for more details. ✔ Utilize Coding Resources – Use encoders, coding books, and payer policies to ensure you’re selecting the most specific code. ✔ Track & Audit Coding Trends – Identify patterns in unspecified code use and implement corrective actions. Specificity is key to accurate billing, clean claims, and compliant coding. Avoid the temptation of unspecified codes. Your revenue cycle will thank you! #TipTuesday #MedicalCoding #MedicalBilling #RevenueCycle #HealthcareCompliance #CoderLife

Back when I started as a coder, every afternoon we’d get a productivity report dropped on our desks. Our supervisor lived and breathed accountability—and backed it up with hands-on training. That kept us sharp, engaged, and hitting our targets. We had weekly meetings to discuss the schedule for patients and how to improve our teamwork and data capture. Today, real leadership should still look a lot like that: ✅️Make metrics visible: Post daily or weekly dashboards showing each coder’s claims-per-hour, accuracy rate, and denial turnaround. Transparency drives focus. ✅️Couple metrics with coaching: If someone’s code-review accuracy dips under 95%, pair them with a buddy or schedule a quick refresher on coding and billing procedures. Celebrate the wins and tackle gaps together. ✅️Own the alignment backlog: Track every misaligned process (e.g., delayed charges, claim resubmissions) in a shared log, assign an owner, and review top issues in your leadership huddle. That blend of clear goals plus real support is what makes teams thrive—no more just “doing more,” but “doing better.” ❓ How do you ensure your coders and billers not only know their numbers but actually improve them through training and accountability? Share one change that’s made a difference on your team!

📌FACT: 30% of a medical practice’s revenue is LOST due to poor billing processes. Let’s change that. IPPs, are you unknowingly giving away your hard-earned revenue? You see patients. You provide great care. But if your billing and collections aren’t optimized, you’re working harder and earning LESS than you should. Billing & Collections 101 Guide 1. Verify Insurance Before the Appointment 🔹 The #1 reason for claim denials? Patient ineligibility.  🔹 Don’t assume coverage—verify eligibility 48 hours before every visit. 2. Submit Claims DAILY (Not Weekly or Monthly) 🔹 The longer you wait to submit, the longer you wait to get paid. 🔹 Make daily claim submission a standard practice to speed up reimbursements. 3. Track and Follow Up on Unpaid Claims 🔹 50%+ of denied claims are never appealed. That’s lost money. 🔹 Set up a claims tracking system to follow up on unpaid claims within 7-14 days. 4. Collect Patient Balances at the Time of Service 🔹 The longer a bill remains unpaid, the less likely it is to be collected. 🔹 Implement point-of-service collections and offer easy payment plans (online, text, autopay). 5. Know Your Payer’s Rules and Contract Terms 🔹 Insurers change policies constantly—are you staying updated? 🔹 Negotiate better contracts & ensure you’re billing at the highest reimbursable rate. Your revenue cycle is the backbone of your practice’s financial health. Don’t let inefficient billing drain your income. At VaQya LLC, we help IPPs maximize collections, minimize denials, and take full control of their revenue. Want a free RCM health check? DM me “Billing” and let’s talk. #revenuecycle #physicians #physicianownership #privatepractice