A Beginner’s Guide to Revenue Cycle Management for Oral Surgery Practices

By Your Health Magazine Contributor

Your Health Magazine Contributor

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A Beginner’s Guide to Revenue Cycle Management for Oral Surgery Practices

Revenue cycle management covers the full process from collecting a patient’s information to resolving the final balance. For an oral and maxillofacial surgery practice, it connects scheduling, clinical documentation, billing and patient communication. An error at one step can create extra work several weeks later.

If you’re new to managing that process, start by giving each stage an owner. The goal isn’t simply to send claims faster. It’s to make sure the practice submits accurate claims, follows up on unresolved balances and helps patients understand what they may owe.

Get the front end right before surgery day

Verify coverage early in the scheduling process and obtain a benefit breakdown for the planned care. Recheck eligibility near the treatment date, particularly if the patient’s insurance or employment has changed.

The breakdown should identify relevant deductibles, coinsurance, benefit limits and exclusions. Treat the patient portion as an estimate, not a promise of coverage. Benefits can change, and the final amount depends on how the payer processes the claim. Save the information with the treatment plan so the coordinator and biller work from the same figures.

Prior authorization requirements depend on the payer, plan and procedure. Approval isn’t a guarantee of payment: eligibility, benefit limits and other claim requirements still matter. Record authorization numbers, approved services and validity dates. Assign someone to follow pending requests and tell the scheduling team when an authorization is still outstanding.

Route each case to the right payer

Oral surgery can involve both dental and medical coverage. Whether a service is covered, and which payer should receive a claim, depends on the procedure, diagnosis and patient’s plan. Having both types of insurance doesn’t mean every service is payable under both.

Write down routing rules so the team doesn’t have to guess. Start with the diagnosis and procedure notes, then check the applicable payer requirements. Dental claims use CDT procedure codes; medical claims generally use CPT or HCPCS procedure codes with appropriate diagnosis codes. Coding should reflect the documented care, not whichever route appears most likely to pay.

When both plans may apply, establish the applicable coordination requirements before choosing the submission sequence. Record relevant payer guidance and any call reference numbers. This gives the next person handling the claim a useful starting point rather than another investigation.

Make documentation and claim review routine

Clinical documentation should support the procedures billed. Confirm that the operative report is complete and that any required images, narratives or other attachments are included. Check patient identifiers, provider details, dates of service and codes before submission.

After submission, review acknowledgment reports rather than assuming that sending a claim means the payer accepted it. A rejection occurs before adjudication, often because of missing or invalid information. A denial follows adjudication and requires a response based on the payer’s stated reason.

Give rejected claims a correction queue with a named owner. For denials, decide whether a corrected claim, an appeal or another action is appropriate. Record filing and appeal deadlines so a workable account doesn’t become uncollectible while waiting for attention.

Explain patient balances clearly

Give patients a written estimate before treatment when possible, showing anticipated insurance payments and their estimated responsibility. Explain that the final balance may change after claim processing. Follow applicable payer contracts and practice policies when requesting payment before or at the visit.

For larger balances, discuss any available payment arrangements and document the agreed dates and amounts. Avoid leaving the billing team to reconstruct a verbal conversation later.

Once insurance payments are posted, send clear statements that reflect the remaining responsibility. Give patients a contact for billing questions and use a consistent follow-up schedule. Clear explanations are more useful than repeated statements that don’t tell someone why a balance remains.

Post payments and prioritize follow-up

Post payments and adjustments promptly, using the payer’s remittance information to reconcile each claim. Investigate unexpected adjustments and underpayments rather than treating every payment as a closed account.

Review accounts receivable, or A/R, by age, payer and next action. Older balances matter, but an approaching filing deadline may be more urgent. Each unresolved account should have a follow-up date and an assigned person.

Track recurring denial reasons, too. If missing attachments keep causing problems, fix the submission process instead of repeatedly repairing individual claims.

Decide what you can run in-house

When posting and follow-up begin to slip, compare internal capacity with outside support. Practice Metrix offers dental and medical billing services tailored to oral surgery, alongside Practice Pilot reporting and analytics. When assessing any provider, ask who handles rejections, appeals, patient questions and reporting, and what work remains with your team.

Keep oversight even when someone else works the claims. Useful measures include days in A/R, net collection rate, claim acceptance and denial rates. Days in A/R estimates collection time relative to average daily charges; net collection rate compares collections with the amount collectible after contractual adjustments. Agree on calculation methods and reporting periods before comparing results.

Set a regular review time and choose one process improvement at a time. Begin with a manageable issue, such as unreviewed rejection reports or missing authorization records. Assign an owner, set a review date and check whether the change reduced repeat work. A consistent routine makes revenue cycle management easier to run and problems easier to spot.