Accurate documentation of dental billing is essential for the financial health and success of your practice. From accurate documentation to seamless communication with insurance providers and patients, following some key billing tips would ensure a streamlined process. The dental billing process encompasses a series of actions necessary for securing payment from both insurance companies and patients for the services provided by your dental practice.
Essential Dental Billing Tips
Here are some key billing tips for dental practices:
- The significance of obtaining pre-authorization: Utilizing a pre-authorization becomes particularly valuable when there’s uncertainty regarding whether a specific procedure will be eligible for reimbursement under your patient’s insurance plan. Submitting a pre-authorization serves as a protective measure for both you and your patient, shielding you from unforeseen deductibles or claim rejections. Moreover, it allows for the establishment of a straightforward payment plan, as you gain clarity on the precise co-payment amount for the patient. Employing this approach is considered a best practice, especially for extensive treatments or when dealing with new CDT codes, as it helps maintain patient trust by minimizing the occurrence of unexpected billing statements.
- Manage expenses: Investigate ways to alleviate the costliest aspect of dental billing, which is typically the processing of insurance claims. Regrettably, insurance billing frequently contributes significantly to rising operational expenditures. Each unresolved claim necessitates subsequent actions, which can be challenging. Most busy teams struggle to keep pace with the insurance company’s delaying tactics, often involving extended periods on hold. Additionally, there are ongoing industry alterations beyond your influence, such as federal and state regulations, modifications in CDT coding, shifts in insurance policies, updates to patient information, and the various tactics employed by insurance providers to reject, delay, or reduce payments.
- Simplify the process of receiving your payments: Patients represent diverse demographics, and their proficiency with online payments or phone-based payments can vary. Enhance the likelihood of receiving timely payments by providing a wide range of payment options to accommodate various preferences and tech-savviness levels.
- Cash
- Credit/debit card
- Auto-pay on specific dates
- Online payment portal
- 24/7/365 automated phone payments
- Gathering patient information: This is a crucial step in the process, which occurs during the initial contact with the patient when they schedule their dental appointment. This data typically includes the patient’s full name, contact details (phone number and address), email address, preferred method of communication, date of birth, information about the primary subscriber (such as employer or insurance plan), details regarding the insurance carrier, the carrier’s provider contact number, and the patient’s insurance ID number.
- Checking patient’s insurance coverage: After obtaining the patient’s personal and insurance information, it is crucial to verify its accuracy by either contacting the insurance company directly or accessing your insurance portal. Dental eligibility verification is a crucial step in ensuring that patients’ insurance coverage aligns with their treatment plans before any procedures are performed. This verification process allows you to access a comprehensive overview of the patient’s benefits and assess the current status of their coverage. It helps you understand the extent of their insurance benefits and provides valuable insights into how well their coverage is currently serving their healthcare needs. This step is essential for making informed decisions regarding their treatment and ensuring a smooth and accurate billing process.
- Documenting dental procedures and coding information: During the patient’s appointment, as they undergo treatment, a member of the care team is responsible for documenting essential information in the clinical notes and assigning procedure codes. Typically, an administrative team member oversees the process, ensuring that it is thoroughly documented, reviewed, and electronically signed by the provider within the dental software. Implementing a daily sign-off on the day sheet is considered a best practice to consistently confirm that the treatment provided in the dental chair is accurately reflected in the software and on the patient’s ledger for billing purposes.
- Filing and monitoring claims along with any associated documents: Using the data stored in your software, you can proceed to generate, consolidate, and file your insurance claims. These claims will encompass the procedure code(s) executed, comprehensive patient and insurance details, as well as any required supplementary materials such as clinical notes, X-rays, periodontal charts, narratives, primary EOBs, intraoral photos, and so forth.
- Addressing issues related to pending claims: In case a claim faces denial or remains unpaid after 30 days, it becomes necessary to initiate a follow-up process. This involves reviewing the insurance aging report, in which your biller compiles a list of unresolved claims. They will then reach out to the insurance provider to identify the root cause of the issue and subsequently engage in the appeals process to secure reimbursement. This pivotal phase heavily relies on the biller’s proficiency and effectiveness, ultimately shaping the outcome in terms of collection rates and overhead costs.
- Invoicing patients: Based on the revenue model you’ve selected, you will either charge patients the full procedure cost upfront (fee-for-service) or bill them for the remaining balance after deducting what their insurance should cover (reimbursement model). Patient billing enables you to obtain the patient’s share of the cost before they depart from the dental office or request payment through mail or email at a later time. Subsequently, you process the claim for reimbursement from their insurance. Regardless of the approach, it is vital to efficiently collect payments from patients as this accounts for approximately half of your total revenue.
Many dental practices have improved their revenue and efficiency by utilizing professional dental billing services. In the present day, an increasing number of dentists are recognizing the cost-effective benefits of entrusting their dental billing to external service providers. These specialized companies possess an intricate grasp of the complexities within insurance processes, guaranteeing swift and efficient claims submission to optimize practice reimbursement. Collaborating with a dental billing service proves to be a financially prudent choice compared to establishing an internal team, as it eliminates expenses related to sick leave, insurance, vacations, time off, and employment taxes. Furthermore, outsourcing releases your staff from administrative burdens, enabling them to dedicate their attention to providing top-notch patient care.
Amber Darst is our Solutions Manager in the Healthcare Division, Practice and RCM. With a rich background in dental services, her expertise ranges from insurance coordination to office management.