4 Challenges Dentists Face with Healthcare Reimbursements

In today’s complex healthcare payments landscape, Dental providers face many challenges with receiving their reimbursements. With multiple payers and portals, getting paid is not a simple process.

Many practices are small, legacy operations that still rely heavily on paper checks and EOPs. Let’s explore some of the obstacles on the road to success.

Limited Staff and Efficiency

Dental providers are concerned with lowering their overhead expenses. A dental office may only include a dentist, one or two hygienists and a front desk employee. Some practices are using home-built technology to help them manage their practices.

However, the majority often have less technology in place to increase efficiency. Limited staff coupled with operational inefficiency presents a clear challenge. With Zelis Virtual Card, dental providers can reduce office time and payments delays associated with errors. Payments can even be combined as a single transaction per payer per day, reducing manual card entries and mistakes. By simplifying administrative work, dentists give their staff back time to focus on higher value tasks.

Lower Payment Amounts from Fewer Carriers

Dentists receive a significant percentage of their payments directly from patients rather than health insurance carriers. And the reimbursement amounts are typically much lower and from fewer carriers than medical. In fact, according the CMS, out of pocket spending accounted for 41% of dental spending in 2017.

The average payment size for most dental reimbursements are smaller than medical reimbursements, due to less aggregation, but also due to lower bills for common procedures. Dentists need strong relationships with carriers so that operations run smoothly, and reimbursements are expedited. Zelis Payments helps dental providers reconcile their claims faster and more securely.

Lack of Data Value

835 adjustment data is not as useful in dental as in medical. The challenge is that codes and descriptions that explain dental claims and carrier payments are not always as valuable for dentists as they are for medical practices. The data can be confusing and difficult to understand for provider office staff. This often causes dental vendors to have gaps associated with full auto-posting.

Zelis Payments gives dental providers full visibility into claim and payment data. With the Zelis Provider Portal, dentists can remotely and securely access their payments history up to 10 years back. By getting their hands on more meaningful data, they can settle accounts quickly and easily.

Dental Service Organizations (DSOs) Are on the Rise

More dentists are joining DSOs to expand their ability to focus on patient care and less on administrative tasks. The American Dental Association Health Policy Institute indicates that 7.4 percent of all practicing US dentists are affiliated with DSOs in 2020. This is especially true among younger dentists, implying a millennial trend. Dentists might be leaving dental school with a large amount of debt. DSOs can help provide support to get operations up and running with limited initial capital.

However, getting paid as part of a DSO can be a difficult process, but it doesn’t have to be. With Zelis Smart Routing, payments can be routed to multiple locations within a DSO, eliminating complexity. Zelis Payments also helps DSOs increase adoption of electronic payments such as virtual card, simplifying reconciliation. For even greater efficiency, Zelis ACH helps dental providers get paid weeks faster than mailed checks. And the cash settles straight into the provider’s account, shortening their revenue cycle.

If you have any questions or would like to find out more, visit zelispayments.com or call (855) 496-1571.

Article Contributed by: Eileen Lee, EVP, Product, Zelis Payments

Eileen has more than 20 years of experience in the healthcare technology industry. She also has more than 15 years of experience as a programmer and technical architect. At Zelis Payments, she leverages her expertise to develop innovative business strategies and lead team engagement, while also engineering and managing the innovation and client pipeline.