21st Century Dentistry Needs Modern Billing Workflows

Craig Kasten


Benefits administration and payment collection workflows are the leading costs for healthcare providers, but they also represent some of the biggest revenue opportunities.

A 2019 study by the Center for American Progress found that provider billing and insurance costs surpassed $496 billion in the United States annually. In a related finding, a 2018 Duke University study found billing and insurance-related costs can represent up to 25% of healthcare systems’ revenue.

In the dental industry, a logical starting point for potential savings is to eliminate traditional, office workflow inefficiencies. So what exactly is holding us up from embracing digital transformation to accomplish these savings?

While there are clearly understood benefits of using electronic payment web portals to run claims and pre-determinations through the entire edit and adjudications process instantly, most dental offices today would be challenged to produce a real-time patient bill with their traditional, internal office workflows.

Blame for providers’ inability to adopt real-time payment adjudication cannot be placed solely at their doors, though, since most insurance payers simply don’t have the technology to process single patient claims.

Since the absolute most critical, time-sensitive step is payment, electronic payment adoption is increasing, and we have seen a steady rise in the use of electronic payment web portals and applications.

The Upside of Real-Time Payment Adjudication

Real-time payment adjudication with web-based payment portals is enabling dental procedures to be planned for and paid for with greater speed and accuracy than ever before. But far more importantly, there is also increased patient satisfaction.

Patients gain a greater ability to plan and pay for dental procedures because they understand the cost of care up front, which ultimately leads to better retention and an overall more satisfying experience of dental care.

In addition, providers can charge patients for those services that are the patient’s  responsibility on the spot, and they don’t need to chase a patient later for the payment that is due, eliminating losses from unpaid claims.

However, I have learned a surprising thing in my conversations with dental providers. Dentists actually place a higher rank, in terms of value to their business, on the ability to get a real-time, pre-treatment cost estimate over having the capability to get paid right away.

A common scenario that happens regularly is that after diagnosis, a dental patient doesn’t know how much of the cost their insurance is going to pay. So, they delay a decision on treatment until they can find out. Then, the patient leaves the dental office and never comes back for treatment.

One of the biggest challenges that dental providers face is that it is relatively easy for patients to postpone necessary care. Patients regularly make decisions about foregoing dental care based on what it is going to cost them out-of-pocket, unlike in other areas of medicine. In life-saving interventions for ailments like heart disease or cancer, patients don’t wait to begin immediate treatment. Dental patients don’t feel that urgency and generally accept waiting.

This is where the ability to provide a real-time cost estimate while the patient is still in the office is so valuable for dental providers. It cuts down on the number of visits, and the amount of patient outreach required, before a patient decides on treatment—and that has a massive impact on a provider’s business.

If a dental provider has the capability to provide real-time cost estimation, patients will know the cost their payer will provide up front, as well their out-of-pocket cost for the treatment prescribed, and can make a more informed and quicker decision while the medical diagnosis is top of mind.

Greater Connectivity Is Long Overdue

We envision a future of greater connectivity and interoperability of data in the dental industry, where payers receive instant and regular feedback from members about the overall experience of dental care and gain valuable information for their business about providers. Members can benefit from tools like mobile apps that deliver convenient access to plan information and provide a communication channel between member and payer.

To further connectivity between providers, payers, state agencies, suppliers, and third-party administrators, we are investing in a platform built to bring these dental stakeholders together to solve problems and change how business gets done in the dental industry.

Technology that allows for a comprehensive view of all of the data about a member and a patient’s history is critical. When dental providers consult patients, they can readily leverage a complete, accurate, and up-to-date record of an individual’s medical history, including past treatments, x-rays, and even prescriptions.

Getting all of that data out of a particular dental provider’s office and into a single medical record that is easily shared between providers, payers, and patients would be another significant step toward digital transformation within the dental industry.

Mr. Kasten leads SKYGEN USA in creating next-generation, technology-enabled solutions that power the business of healthcare. Through his visionary leadership, SKYGEN USA leads the market with transformational technology and service offerings that reinvent healthcare benefits. He is an accomplished leader whose career in the managed healthcare industry spans more than 30 years.

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