Dental practices lose most revenue upstream through eligibility issues, data entry errors, and poor verification processes before claims are ever filed, not during collections. Implementing clear financial policies, proper verification procedures, and SOAP-compliant documentation from first patient contact can recover significant lost revenue.
- Small data errors cause major problems: Seventy-eight percent of a $100,000+ receivable was tied to eligibility issues like nicknames, name changes, and transposed dates of birth.
- Effective solutions include clear financial policies, independent insurance verification separate from intake, and requiring patient paperwork before appointments are confirmed.
- Proper documentation using SOAP notes with carrier-specific requirements prevents claim denials and ensures payment.
- Practices should verify specific insurance plans rather than asking generic questions about carriers.
When the fourth quarter arrives, most practices look at their accounts receivable report and start chasing. Michelle Repash has a different starting point. After nearly 36 years in dentistry, including time in every seat except dentist and hygienist, she says money is usually lost long before a claim is filed.
In this episode of The DrBicuspid.com Podcast, host Kevin Henry talks with Repash, a longtime DrBicuspid.com contributor, about her new book, Revenue Protection Architecture: Why Revenue Breaks Upstream and How to Fix It. Her approach is less about traditional revenue cycle management and more about protecting revenue from first contact with the patient.
Repash shares the story of an office with more than $100,000 sitting in receivables, 78% of it tied to eligibility problems. The causes were small: a nickname entered in the wrong field, a name change made after a marriage, a transposed date of birth, a wrong subscriber number, or an incorrect payer ID. As she puts it, little issues like these keep revenue "on a piece of paper instead of in your pocket."
Her fix starts with strategy. Practices need clear policies, such as how refunds are handled, that don't depend on who is sitting at the front desk and an owner for every financial control point, including first contact.
Repash prefers that patients take charge of supplying their information to the office. A phone call triggers a message with forms and an authorization for electronic communication, the appointment stays tentative until the paperwork arrives, and someone other than the person who took the call verifies insurance. Repash points out that "Do you take Cigna?" is rarely a simple question, since a practice may be in network with one Cigna plan and not another.
The conversation also touches on documentation, a hurdle for the many new team members learning dental terminology on the job. Repash says a note that reads "crown on #15, patient happy" won't get a claim paid. She recommends following SOAP (subjective, objective, assessment, plan) notes, using templates, but making each note specific to the patient, and checking the provider handbook so the team knows what carriers expect before the service is performed.
For patients, she says part of the solution is awareness. Asking for the insurance card along with the forms gives the office a head start on verification.
Repash is offering a complimentary hour to anyone who uses the "Bring me your problem" page on her website. You can find her book on Amazon.
Listen to the full conversation below.
