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Revenue cycle management (RCM) issues often start with small breakdowns. A missed verification, an incorrect code, or a delayed follow-up can slow payments and leave money on the table. When these problems stack up, they make it harder to invest in your team, upgrade technology, or expand care. In a market where hygienist salaries are rising and staffing is tight, steady cash flow is critical. This guide breaks down five common RCM challenges and how to address them. From insurance checks to patient collections, you’ll learn how better systems and on-demand staffing can keep revenue moving and reduce day-to-day stress.
Jul 11, 2025
1. Insurance Verification and Eligibility Gaps
When insurance verification is skipped or rushed, the result is predictable: denied claims, frustrated patients, and wasted time chasing down payments. These issues often come down to outdated notes, missed pre-authorizations, or last-minute insurance checks that happen too late to fix anything.
The good news is that you can prevent these common insurance problems with a few straightforward steps:
Create a simple, standardized verification process your entire team can follow consistently
Develop a one-page insurance verification checklist that covers all essential steps
Use real-time data from payer portals to verify procedures and payment instead of relying on old chart notes or assumptions
Set automated reminders to flag appointments for verification at least a day (two or three days is better) in advance of the appointment.
If necessary, cross-train team members to handle verifications during peak hours. Don’t let this task disappear just because the phones are busy. Aim for 95 percent of appointments verified for insurance coverage before the patient arrives. Anything less risks lost revenue.
2. Coding Complexity and Errors
Coding errors delay payments, trigger denials, and create extra work your team doesn’t have time for. With CDT codes updated every year, even small mistakes can lead to underpayment or compliance issues.
Procedures often require supporting narratives. Skip them, and your claim may be rejected as incomplete. Multi-code treatments add another layer of risk; using the wrong bundle or missing a required modifier can result in a partial payment or full denial.
Upcoding and undercoding bring their own problems. Whether intentional or not, both can lead to audits, financial penalties, or worse. Stay ahead with quarterly training on code changes and documentation standards. Use laminated cheat sheets for quick reference, and conduct random chart audits each month to catch mistakes early. AI-assisted coding tools can also reduce errors and improve consistency.
3. Claim Submission, Tracking, and Denial Management
Small mistakes in claim handling can stall cash flow. Missing attachments, unchecked boxes, or batching delays often lead to denials before a payer even reviews the claim. The key to smooth claim processing is speed, accuracy, and consistent follow-up. Here’s how to keep your claims moving:
Submit claims within 24 hours of treatment: Include all required documentation, such as x-rays, narratives, and pre-authorizations. Electronic submissions process faster, but many practices still run into delays due to manual uploads or waiting until the end of the day to send everything.
Use real-time submission and tracking: Set up your practice management software or clearinghouse to submit claims as soon as they’re ready. Set up alerts that flag incomplete claims and track their status. Claims that sit too long should appear in your dashboard before they show up in aging reports.
Respond to denials immediately: When a denial comes through, check the reason code, gather the correct documentation, and send either a corrected claim or an appeal. Do not submit both. If the portal shows no progress after ten business days, follow up by phone and schedule a reminder to check in on the status at the 30-day mark.
4. Ballooning Accounts Receivable (A/R) Days
When A/R grows beyond 30 days, cash flow tightens, and your practice takes a hit. Claims become harder to collect the longer they sit, and delayed revenue affects everything from payroll to reinvestment.
Start by reviewing your aging report weekly. Break balances into four categories:
0–30 days
31–60 days
61–90 days
91+ days
Nearly 80% of collectible revenue falls within the first 60 days. Aim to keep at least 70% of your total A/R in the 0–30 day range. If you’re outside that window, identify your slowest payers and look for patterns: specific insurers, missing pre-auths, or repeat claim errors.
Begin each week by flagging the ten oldest balances. Assign a staff member to follow up by payer or patient, depending on the reason for the delay. Use your software to auto-post balances under $5. This clears out clutter and lets your team focus on high-value accounts.
For patient collections, offer digital statements with secure text-to-pay links. These tools speed up payments and reduce the need for manual follow-up. If a balance hits 60 days, send a reminder by SMS, then follow up with a live call if needed.
5. Patient Payment Collection Hurdles
With more costs shifting to patients, collecting payments has become harder. High-deductible plans, unclear EOBs, and multi-visit treatments often lead to confusion about what’s owed. If you're relying on paper statements or outdated billing tools, payments get delayed, and A/R builds up quickly.
Start by giving patients a clear number before treatment begins. Confirm insurance benefits, calculate the out-of-pocket cost, and present a written estimate at check-in. A quick conversation can prevent misunderstandings:
"Your insurance covers $750, so your portion is $220 today. Would you prefer to pay in full or set up a payment plan? We can automate it to make things easier."
For larger balances, use a simple tiered structure:
Under $250 – Collect in full at checkout
$250 to $1,000 – Collect 50% upfront, auto-draft the rest in 30 days
Over $1,000 – Collect 25% upfront, with three equal monthly payments
Offer digital tools like online payment portals and secure text-to-pay links. These speed up collections and reduce the need for phone follow-ups. Reinforce payment expectations with clear signage at the front desk and on every statement.
Peak check-out times are when payment plans often slip. Bringing in additional staffing during those windows keeps things moving and ensures every patient leaves with a signed agreement or completed payment. This keeps your A/R in check and gives your team space to focus on care, not collections.
Turning RCM Weak Spots into Wins
RCM breakdowns are avoidable. Missed verifications, coding mistakes, delayed claims, and aging balances all come down to one thing: processes that need support. When your workflows are clear and your team has the coverage to follow through, revenue moves faster, and fewer claims fall through the cracks.
That’s where Teero comes in. Whether you need a temporary hygienist during training, front desk support for eligibility checks, or extra help with end-of-month follow-ups, Teero connects you with experienced dental professionals who keep your systems running.
Build the right team, fix the weak points, and turn RCM from a daily frustration into a consistent growth driver. Schedule a call with Teero to get started.