Special dental billing consultation refers to consultation services offered by dental billing service providers in the form of comprehensive knowledge of dental claim submissions. Billing and coding consultants code the dental record of patients and submit these claims for reimbursements to concerned health care insurance providers. The need for this kind of consultation arises in the absence of skilled professionals and experts when confusions, or rejections, or over-burdening of claim-like situations arise. Special dental billing consultations also serve as a cost-minimizing measure. Dental billing service providers are trained and qualified professionals with technical expertise and know-how on dental coding and billing. They have extensive knowledge of Current Dental Terminology (CDT). Additionally, to provide adequate, appropriate and fruitful consultation, these consultants have highly functional verbal and written communication explanation skills. At the same time, they use highly developed methodology to address all dental billing issues.

The benefits of effective special dental billing consultation are as follows:

Efficacious dental billing consultation leads to the prevention of rejected claims. It enables appeals for claim denials, and thus payment is eventually obtained from insurance companies. Therefore, it leads to growth in earnings altogether.
Consultants provide an entire range of accounting, book-keeping, and special consulting services. Billing is an arduous and time-consuming task, and billing while deciphering codes is yet another complexity. Dental billing consultants are experienced professionals who are able to mitigate insurance claims while being well-versed with these constantly changing codes.
Special dental billing consultation offers deference and HIPAA (health insurance portability and accountability act) compliant services. Treatment and patient data are considered confidential information. It is handled with the utmost security and accessed only by concerned dental health providers.
Operative consultation focuses on core areas and patient care. It provides accurate knowledge obtained from modern technology, advanced learning, and technical expertise. Outsourcing can eliminate the need to focus on the research and comprehension tasks associated with the billing procedures and insurance claims. Therefore, dental health care providers can focus on patient care and building healthy relationships.
Dental billing consultants deliver services using advanced software, and therefore, the need for investing in additional infrastructure and technology gets eliminated. It thus proves to be a cost-saving exercise.
Primary and secondary claims are processed by consultants daily. The accuracy of these claims gets checked and the rejected claims are then re-assessed, corrected, and submitted again. They also schedule follow-ups with insurers to appeal denied claims. Their services range from scheduling patients and verifying eligibility to follow-ups till the insurance claims are fulfilled and closed. Managing all these procedures while multitasking is a cumbersome process and can lead to errors. This is why it is beneficial to hire consultants as they help eliminate errors in coding dental billing which may attract civil action. Therefore, they make everything happen smoothly.
Consultants have abilities to train and up-skill the staff to maximize their potential. They employ standard procedures followed for clinical care by introducing streamlined functioning. The guidance provided through consultation elevates staff strength and ensures utilization of maximum resources. This helps prevent errors relating to insurance, receivables, and coding procedures. It also ensures better productivity and financial health.
By providing accountability, stability, and organized insurance collection and faster receivables, the flow improves significantly . Under the guidance of consultants, the factors at play get addressed like lack of technical know-how, unavailability of infrastructure and technology, weak assertion and manipulation skills of existing staff members, etc.
Comprehensive track record of patients' dental histories and previously availed treatments deliver quality patient care. This ensures patient data safety as these records can be assessed by concerned dental professionals as and when required. Coding and document diagnosis can help in preparing and sending invoices for reimbursements and payments.
As a result of successful consultation, the possibility of lost revenue gets eliminated, resulting in profitability.

Dental billing services are crucial and time-sensitive services that need specialization and accuracy. Managing these tasks can easily become a tedious and cumbersome process for concerned practitioners.

Outsourcing:
A process in which companies outsource the handlings of their business functions to external vendors or companies. This includes functions such as transaction processing, accounting, editing, marketing, content writing, social media management, book-keeping, transcription services, billing, surveying, payroll and order, inventory management, and other similar services. Several BPO services prefer outsourcing. Outsourcing brings with it benefits relating to cost-saving and higher quality. It is also becoming clearer that low cost in outsourcing does not mean substandard quality. Outsourcing these services brings with it a bundle of advantages.

We at Capline Dental Services offer billing systems that increase efficiency in diverse ways leading to higher profitability and streamlined procedures. Being an esteemed dental insurance billing and collection company, our team comprises the most qualified and experienced billing experts.

Capline dental services has established itself as one of the leading dental billing outsourcing companies.

We aim to collect all the insurance money owed to our clients.
Specialists at our company are highly qualified with handling simple as well as complex billing collections.
We compute claim amounts.
Our professional staff is well versed with extensive knowledge of Current Dental Terminology (CDT).
Our qualified and skilled professionals efficiently take care of your credentialing needs.
We deliver services to our clients using advanced software therefore, eliminating the need for additional expenses on infrastructure and technology, thereby saving costs.
We have highly flexible pricing packages catering to diverse business requirements and budgetary preferences.
We have a highly developed methodology to address all dental billing issues.
Our specialized systems and mechanisms provide enhanced focus on core areas, access to skilled experts, and advanced resources for results that are hassle-free, accurate, and delivered on time.

Focus on Core Areas:

Specialized and prioritized focus with an emphasis on research and development leads to accuracy and error-free results.

Access to Skilled Professionals:

Expenses on recruiting and training professionals is an added task which gets eliminated by availing our services.

Our Key Services include:

Daily processing of primary and secondary claims
Using clean claims tool to confirm the accuracy of claims before submitting to insurer
Claims correction and re-submission
Claims management and tracking
Insurance payments posting and adjustments (if required)
Follow-up with insurers and appeal of the denied claim
Regular reports that show how your practice is doing in terms of collections
Patient statements (Add on Service)

Capline dental services assist right from patient scheduling to eligibility verification till the claim process gets completed. Our team of highly skilled and experienced medical coders accurately provides CPT and ICD-10 dental billing and coding services. We ensure that no claims get rejected due to invalid dental coding. Denials are addressed efficiently under our supervision. We analyze denials and identify the reasons for rejection. Our team schedules follow-ups and appeals for re submissions after rejections get rectified. Financial details are cross-checked and evaluated minutely. Patient-related data is confidential material and treated securely.

All our services are HIPAA (health insurance portability and accountability act) compliant. The components of HIPAA security rule compliance include administrative security, physical security, and technical security. All patient and treatment data is safe and accessed only by concerned authorities. Our team schedules follow-ups and ensures that payments are on time.

Our team has impressive, assertive, and highly functional verbal and written communication skills that help practitioners resolve conflicts, explain procedures and manage requests. We maintain a record of data that covers all information related to insurance EOB, treatments, and the patient’s information. Our clients may contact us for copies of these databases as and when required.

Dental offices find dealing with both insurance firms and claim denials to be a daunting process. Claims are often denied due to missing patient information, inconsistencies in submitted codes, a lack of verification of the patient's dental eligibility, and other factors. In the event of a claim denial or dismissal, dental practices must first check the claim and assess the necessary corrections. Post such confirmation if there are no discrepancies in the claim, filing for an appeal is the most appropriate step.

This article will discuss what an appeal is, why it’s required, and how dental practices can appeal during a dental claim denial in order to make sure that they get reimbursed on time for the services rendered!

What is an appeal and why is it required?

A formal request by dental practices to reprocess the claims with no inconsistencies is simply known as an appeal. A proper appeal involves sending a written request to the insurance company to reconsider the claim. Few general things to remember when appealing a claim:

Submitting the appeal within the time frame allowed as per the insurance company norms or state laws
Making sure to submit the appeal to the specified department
The written request should clearly mention the word ‘Appeal’
Give a call to the insurance company to get all the details in case of any confusion

By submitting requested details to a claim support centre or relevant authorities, most claim problems can be resolved quickly. Unless otherwise provided by contract or state statute, practices must appeal within 180 days of obtaining the adverse decision.

Levels of appeals

As a dental practitioner, you have correctly filed a claim and you know you did everything right but the claim still got denied and now you have to appeal the claim.

The first level of appeal is to follow the appeal protocol of the insurance company that denied the claim. Usually, information related to the same is mentioned on the denial EOB.
You need to create a formal letter on your practice’s letterhead and make sure that all supporting documents are included with the claim. Also, it’s a wise idea to include any relevant information that you may have missed submitting with the original claim.
The next level of the appeal demands you to involve all the possible details on the appeal letter such as your full address, phone, and email address; the patient’s full name, address, contact number, date of birth (DOB), Member ID, claim number, and also a claim reference number if you have one.
Provide more details that support the treatment or medical condition like explaining the procedure and history of the treatment. Make sure these details are additional information and add to the data provided in the original claim.
If you had sent the x-rays as supporting documents while submitting the original claim, try taking a look at them again. Check if they are of good diagnostic quality and show enough visible evidence.
Do not use the technical language that was used in the denial to describe the condition. Use the regular dental terms that explain the treatment. There have been instances when a single wrong word has triggered a denial.
You should inform the patient that you are appealing the denial of his/her claim. She/he might like to call the insurance company to know the cause of the denial or why the claim was denied in the first place!

A few documents that may support your appeal are radiographs, charting, study models, and a narrative description providing as much information as possible.

As you can see the appealing process is not an easy one and you may like to avoid doing all of this in the first place. Here are a few tips to avoid dental claim denials and rejections:

Use accurate dental codes while submitting a claim
Explain the procedure with proper treatment notes
Understand policies of the insurance company before submitting a claim
A claim should have all the possible information required
Outsource dental billing services

The best way to avoid the entire process of claims and appeals is to outsource dental billing services to professionals. CAPLINE DENTAL SERVICES is one such team of dental billing professionals that can take away all your worries related to dental billing and claim denials.

What is the focus of dental billing?

The objective of dental billing is to make the billing of dental services easier for clients as well as dental offices. The primary focus of any healthcare provider like dentists is to provide the best services to their patients. While the most important area of dental billing is the coding of services and collecting the payment, managing denied claims, following the HIPPA guidelines, and keeping the payment cycle running. Dental billings companies interact, provide end-to-end services, follow the HITECH act, and coordinate with insurance companies, patients, hospitals, and verify payment processing. These companies also check payment posting, patients scheduling, credentialing, claims submission, and process claims.

What are some benefits of outsourcing billing dental services?

Managing dental services requires much more than providing dental services to patients. A dental office needs to hire and handle office staff, check timely billing of all services availed, and much more than that. Additionally, dental offices also need to ensure that claims of dental services need to be submitted within the time limit. Thus dental outsourcing is an important aspect of dental billing wherein experience staff handles all administrative tasks of dental offices. With the help of the dental outsourcing team, dental offices are able to easily manage dental verification, claim-related issues, coding, billing, and other admin tasks like accounts receivable management and claims settlement giving dentists more time to focus on their number one priority which is patient care. This is a practical solution that not only benefits dentists but office staff as well. With an experienced dental outsourcing company, dental offices have great control over the practice, spend more time with patients, and can make a strong bonding with them.

What can be outsourced in dental offices?

Dental outsourcing companies can manage every task including appointment scheduling, verifying insurances, doing dental billing, coding, and other services that can be outsourced. To run dental offices smoothly, to reduce the workload, and to focus on the core tasks, it has become important to hire dental billing, coding, and insurance specialists.

What is the role and responsibilities of dental billing companies?

The main aim of dental billing companies is to make the entire process of revenue cycle management easy for the dentist as well as their offices. After choosing the best dental billing company, there is no need to give extra training to staff related to payment settlements. You just need to pay for the work hours and there will be no interruption of phone calls from both patients and active insurance firms. When you hire an experienced dental company it gives a chance to the dental office to indulge more in making better relations with patients.

What are some common insurance billing problems faced by dental offices?

Some common problems faced by dental offices if they don't have proper dental outsourcing staff:

1) Due to the high number of patients and lots of things to do, dental practitioners do not have time to do follow-ups for the claims processed and filled. Dental outsourcing companies can easily handle such issues with assurance and are consistent with regular follow-ups.

2) Most of the patients feel frustrated about the surprising high-cost of fees. It is a very common issue, as when patients unexpectedly get to know about unexpected deductibles, fees, copays at a time when they are not expecting it they are quite appalled. The dental outsourcing team will help to cut down this frustration by informing the patient about the due fee before the beginning of treatment.

3) Many times patients change their insurance policies and plans and when they go to avail dental services then dental offices, as well as a patient, they miss out on provided key things as they don’t have them properly documented. However, the dental outsourcing team helps to prevent such issues by making sure that everything in the system is up to date and change the active insurance plan only after giving a complete hand over.

Artificial intelligence has become the mainstay in dentistry for dental professionals when it comes to diagnosis and surgeries. This, in particular, holds a mixture of amusement and fear for dentists embracing technological advancement. Indeed, dentistry is no more virgin to this revolution like other revenue generating businesses. The essence of a dentist changes when working in fear of being sued. This has made us ask the question: why doesn't the patient always trust the dentist?In order to avoid that threat, most dentists refer to specialists to perform the duty well. In this line, artificial intelligence will help dentists work smarter, faster, and more accurately. The benefit of AI is that it can help keep a pulse on your practice.

Learning to live in the AI world

AI involves the usage of digital imagery (computer vision), predictive analytics (statistical modeling in the domain of forecasting), and machine learning (data-driven algorithms to seek and reveal the patterns). Indeed the very idea of AI is already applied in hospitals everywhere to eliminate the abnormalities. AI measurements like computer vision allow the scans to be more specific and concentrated than the ones supplied from a panel of radiologists. At the current speed of modern life, there is no space for probability.

Moreover, computer vision expands when applied to dental imagery such as past dental work, x-rays annotation, natural anatomy, creating a larger surface to identify tooth decay and bone loss. In this way, predictive analytics can be a great tool to educate about the patient history and medical records, the attention to detail helps decode the trend of past treatment plans. When you begin using AI software, it will play a prominent role in dental office operations.

Patient Treatment benefited through AI technology:

Many patients trust computers more than their dentists for calculative reasons. The challenge for the practitioners at the same time is to maintain both accuracy and early diagnosis. This is all the more reason for the solo practices to use AI-backed diagnostic reports so that the treatment plans take into consideration factors like empathy and compassion. The practice of predictive analytics for patient dental health will analyze the unstructured medical data into a desirable format to discover other concerns. For practitioners, this means there is an integrative methodology to map the patient's overall health.

Business Operations through AI:

While assisting the patients, accuracy, and speed is the key. The machine has outperformed the dentists in managing staff, evaluating new equipment, planning, and giving more time for patient interaction. This is why they are preferring to focus on predictive analytics as you hold the data for better insights. The larger the data, the better the trends to understand the diagnosis, treatment plans, and other decisions like buying a $50,000 dental laser.

AI promises Talent Development:

Through AI, the dentist can begin to evaluate a potential hire, particularly with large networks. The new generation of tech-savvy doctors incorporates e-learning and gamification schemes to perform more profitable, accurate, and trusted treatments.

Public Health lies in AI:

This is equally true as AI provides a lot of benefits when it comes to public health. The AI’s vast potential enables it to study trends within the subpopulation by crunching the large data set and finding the correlation between patient symptoms or abnormalities. The related health concerns indicate the need for further study in the area with informed patient care. AI promises accessibility, time consumption, and economic viability that is ready to revolutionize the dental industry.

Even though plenty of dental billing tools are available in the market, dental billing errors still occur! Some errors are caused by simple human negligence while some happen due to lack of knowledge. Some common dental billing errors do not just impact patient satisfaction rate negatively but dental practices’ revenue generation as well. Dental practices need to learn how to avoid these general billing errors to stay on top of their business. This article will discuss the four most common dental billing errors and how dental services providers can prevent them!

Four Most Common Dental Billing Errors

Missing or Incorrect Patient Information: This is one of the most common dental billing errors. As per the reports, a huge percentage of dental bills are presented with either missing or wrong patient information such as patient name, address, date of birth, etc. Simple negligence or not verifying patient and other information during bill preparation can cause this type of error.
Use of incorrect Dental Code: This type of billing error occurs when billing staff is either unaware of the latest or updated dental codes or not experienced enough to code a specific dental procedure or service accurately. Claims submitted with incorrect dental codes are likely to get denied straightaway. This will not only hamper the revenue generation but the image of dental practice as well.
Bundling errors: Some dental procedures and charges need to be bundled together under a single dental code. If billing staff has entered these charges separately instead of bundling them together, it will increase the bill amount unnecessarily. Also, it can cause claim delay or denial if proper supporting documents are not submitted to clarify the bundling of charges.
Incorrect Claim information: Another common dental billing error is wrongly filled claim information such as incorrect policy number, subscriber ID, dentist’s name, address, NPI, and other details. As clean claims submission is extremely crucial to increase revenue generation, it’s vital for dental practices to make sure that the claim information is filled correctly before submitting the claim to the insurance company.

How to avoid common dental billing errors?

Outsource Dental billing services: The best and the easiest way to avoid all types of dental billing errors is by outsourcing the dental billing services. When a team of dental billing experts handles the entire billing process, it’s likely to have almost no errors. Dental practices can consider outsourcing their billing services to a reliable partner. Capline Dental Services is one such partner providing complete dental billing solutions.
Train billing staff: Dental practices can avoid common billing errors simply by giving proper and regular training to their in-house billing staff. The training can include the knowledge about dental codes, filling patients and other information correctly, and how to make attention to detail a daily task. Practices can also hire trained and experienced billing staff to avoid these simple mistakes. Skilled billing staff is likely to perform fewer mistakes in comparison to inexperienced staff.
Stay updated with Codes: Dental practices need to stay updated with the changes introduced to CDT codes. It will allow them to eradicate errors related to coding and the billing staff would be able to code dental procedures, services, and treatment accurately that will result in clean claims submission and eventually increased revenue.
Communicate with patients: Dental practices can establish a clear communication channel with their patients in order to avoid errors related to patient information. While filling in patient information, billing staff can simply communicate with the patient and cross-verify all the information.
In-house communication: Common dental billing errors as mentioned earlier in the article can be erased easily by creating a transparent in-house communication system. Transparent communication between front-end executives (generally the first point of contact when a patient visits) and billing staff is likely to remove common billing errors such as wrongly filled patient information.

Capline keeps it simple and accurate when it comes to dental billing. The billing experts at Capline reduce the chances of billing errors to nil and submit clean claims on behalf of dental practices to increase their revenue.

The availability of new-age tools and software has transformed dental practices. However, managing dental billing processes like billing dental procedures, dental claims submission, and getting reimbursed for the services provided still seems to be a challenging task for many dental services providers.

As billing is one of the most crucial aspects of revenue cycle management, it needs to be addressed precisely by dental practitioners and other healthcare professionals. Although outsourcing seems to be one of the easiest solutions to overcome these challenges, it’s vital for dental practices to stay aware of common dental billing issues so that it neither impacts their practice nor their revenue.

This article will talk about the dental billing challenges faced by modern-day dental practitioners and how they can overcome these challenges!

Common Dental Billing Challenges

Not enough in-house staff to handle billing: A lot of dental practitioners do not have enough in-house billing staff thereby creating visible mismanagement in dental billing. This directly appears in the form of common billing errors resulting in claims denials and delays. It directly impacts the revenue cycle.
Denied, delayed, or rejected claims: Clean claims submission and getting reimbursed for the services rendered have always been a major challenge for dental practitioners. A small error in dental billing can cause claims denial directly impacting their revenue.
Changing CDT codes: Keeping up to date with changing CDT codes is one of the challenges faced by dental practices today. The use of incorrect codes can directly result in claims denial. Code on Dental Procedures and Nomenclature, commonly known as CDT, is a set of medical codes for dental procedures. Developed by American Medical Association (AMA) and identified by Centres for Medicare and Medicaid Services (CMS), these codes are updated annually.
No CDT code available to define service provided: It’s been a notable challenge for dental practices when they are unable to find a CDT code that can accurately describe the service provided to a patient. This happens when the CDT code maintenance process is not synced with the new or modified dental procedures. In this kind of situation, ADA (American Dental Association) advises dental practices to submit supporting documents explaining the service provided.
Policy-based denials: Insurance policies have limitations such as the limited number of visits to a dentist, coverage of costly dental treatments, etc. If a claim has been denied or delayed due to some policy issue, it becomes a challenge for dental practices to appeal it or get reimbursed for it.

Ways to overcome Dental Billing challenges

To overcome the above-mentioned challenges, dental practices can take some measures/steps given below:

Check Patient’s Insurance Coverage: Dental practices need to check every patient’s insurance coverage. They need to verify what a patient’s insurance covers and how much he/she needs to pay. Insurance companies will pay only for the services covered under their policy. Dental practices are advised to provide the services covered under the patient’s dental health policy.
Adhere to the guidelines of Insurance companies: It’s important for dental practices to adhere to the guidelines created by insurance companies. Dental practices may struggle to get reimbursed for a claim submitted that is not adhering to the guidelines of the insurance company. A claim submitted as per the guidelines of the insurance company along with other required details is likely to get paid quickly.
Stay updated with coding (CDT) changes: Dental practices need to stay updated with the relevant coding changes so that there is no delay in the claims approval process by insurance companies. All treatments, procedures, and services need to be coded correctly as it will directly impact the claims submission and reimbursement process.
Outsource Dental Billing services: One of the best ways to overcome billing challenges is outsourcing the dental billing services. It reduces in-house cost, improves the quality of dental billing services as it is handled by billing experts, and dental practices can focus on the core i.e. providing quality dental services to patients.

Capline Dental Services provide end-to-end dental billing solutions so that you never worry about it again. Dental practices are advised to communicate with their billing partners properly to know about the services they provide, and clients they currently serve or past clients. They can also get in touch with one of their existing clients to understand the quality of the services.

The amount left after you have paid your deductible and your insurance plan has paid for the medical services you received as per the terms & conditions of your policy is known as Balance Billing. In other words, it’s the difference between the total cost of the services you are charged for and the amount your insurance plan pays.

How Balance Billing works?

Let’s assume that you go to the doctor and get treatment. At the time of receiving the treatment, you pay your deductible and your insurance plan supposedly covers the rest. Now, as per the process, you have paid all your bills for the treatment. But months later, you receive a bill from your doctor for the amount your insurance plan didn’t cover. And, this bill is the Balance Billing.

Although it seems like you have been charged extra as per the terms used, you are simply paying for the services you received. It’s just the amount that your plan didn’t cover!

A balance bill can be quite triggering for a patient, especially if it’s a large amount. However, you need not worry as your healthcare provider can help you understand the same. Let’s know what healthcare professionals can do to make sure that the patients aren’t confused about the balance billing!

What healthcare providers can do?

While balance billing may come as a surprise for patients, especially when they are unaware of it, healthcare providers count on it as far as revenue is concerned.

Being a medical services provider, you need to make sure that the patients’ care always stays on top so that they do not care whether you fall under their insurance plan’s network or not! In that case, even if there are stances of balance billing, patients may not care much about it as they are getting the desired services at their comfort.
Healthcare providers need to make sure that patients are well informed about the balance billing. It will not just improve their trust in you, but inspire them to continue with your medical services instead of giving much importance to balance billing.

Although no patient would like to experience balance billing as nobody wishes to pay extra, if your patients are well informed at the time when they are taking your services, it will solidify their trust in you as their medical services provider.

What can patients do?

Patients should not confuse balance billing with other billing and insurance terms such as deductible, copays, and coinsurance. Knowing these terms would help them understand the concept of balance billing better.

Deductible - The ‘minimum’ amount you need to pay out-of-pocket to your healthcare provider before your insurance policy starts paying for your treatments is known as Deductible.
Copay - The fixed amount you directly pay to your healthcare provider on every visit, regardless of the treatment you receive is called a copay.
Coinsurance - The cost that remains after your insurance policy pays for your treatment as per the policy’s terms & conditions is called coinsurance.

When do you receive Balance Billing?

Balance billing usually does not happen with in-network healthcare providers as the insurance company takes care of the bills and the patient is already aware of the charges. It generally happens when an out-of-network healthcare provider bills a patient for the services that are not covered by his/her insurance plan. The patient may not be aware that the services s/he has received are out-of-network even though s/he received it at an in-network healthcare provider.

Reasons when you are likely to get balance billing:

Visiting an in-network healthcare provider and receiving service/s that are not covered by your insurance policy lead to balance billing.
Visiting an out-of-network provider and the provider bills you for the amount that your insurance company did not pay.
When an in-network provider moves out-of-network of your insurance plan and you take services without knowing the provider’s network status.
The doctor that treats you at your in-network hospital chooses to no longer participate in your insurance plan’s network.

FAQs

There are some general questions asked by patients regarding the balance billing. Let’s take a look at some of them.

1. Is balance billing legal?

Ans. A medical provider has the right to bill you for any amount that is not paid by your insurance. As a patient, you should be aware of all the costs that your insurance plan covers after paying your deductible.

2. How can I not receive balance billing?

Ans. The healthcare providers will not charge you unnecessarily for any service that’s been paid and covered by your insurance. However, if you wish not to receive any balance bills, you need to stay updated with your insurance plan. Having complete knowledge about your insurance policy will allow you to know the list of in-network healthcare providers and the list of services covered under it. So, when you know that you are going to an in-network or out-of-network healthcare provider and whether the services you need are covered by your insurance plan or not, you are unlikely to get a balance bill.

The other best way to avoid it simply by asking your healthcare provider upfront whenever you go for a treatment. You can ask whether a particular doctor who is attending you is in-network or not and the services you need are covered by your plan or not.

3. Do all treatments have or can fetch balance billing?

Ans. A healthcare provider cannot bill you for medically necessary treatments. However, if you have taken any medically unnecessary treatment, the provider may bill you for it as insurance generally does not cover medically unnecessary treatments.

Payment Posting, also called cash posting, plays a vital role in the revenue cycle. It has the power to maximize your revenue if executed properly. It’s significantly important for your practice to have a payment posting team that can track and analyze insurance payments from EOBs, ERAs, patient payments, etc.

Placing an effective and efficient payment posting system in place will allow you to track and improve your RCM. Payment posting helps in finding payer problems such as denials, prior authorization, and non-covered services and can be addressed timely by the billing staff. It helps to make your dental billing process more efficient which is directly proportional to improved revenue.

Terms used in Payment Posting

Before knowing about the payment posting in detail, it’s important to know the relevant terms such as EOB, ERA, Patient Responsibility, etc. Knowing these terms will allow you to understand payment posting better.

EOB: Explanation of Benefits, also known as Explanation of Review (EOR) is a document that explains the entire claim process to the dental practice and the patient.
ERA: The electronic version of EOB is known as ERA (Electronic Remittance Advice). It’s the explanation of the insurance processing sent to the practice electronically.
Patient Responsibility: It’s the amount that a patient must pay to the dental practitioner.

Process of Payment Posting

Payment posting is done either manually or electronically (auto) after the claim settlement from the insurance company, EOB/ERA is sent to the healthcare provider, the dental practitioner in this case, and the insured (the patient) towards the payment of a claim.
The payment posting team analyses, the patient’s insurance denial, patient responsibility, the EOB that contains the payer's name & address patient’s name, the dental practice’s name & address, the claim received date, claim number, payment or denial date, policy identification number, date of service, dental procedure code, and billed amount.

In case the claim is paid, EOB would also have the following details:

Allowed amount i.e. an amount the insurer finds fair for specific services or procedures. The allowed amount combines the paid amount and patient responsibility.
Paid amount i.e. the amount paid by the insurer minus patient responsibility.
Patient responsibility i.e. the balance percentage of compensation that the patient or his/her secondary insurance (if applicable) needs to pay as per the policy with the insurance company.
Write off the amount i.e. the amount waived off by the provider. In simple words, it’s the billed amount minus the allowed amount.
Cheque, cheque date, EFT, EFT date.

In case the claim is denied, EOB would also include a denial code and reason.

The payment posting team accounts for the payment received from the insurer against the claims submitted for the dental services provided. The process includes identifying the patient accounts, procedure, billed amount, paid amount, allowed amount, write-off amount, etc.
The team, then, posts the payments to the respective patient’s accounts against that specific claim to settle it. If the patient is not able to pay as per the statement provided to him/her or makes no attempts to pay after multiple follow-ups, the process goes to collections.

A dental practice with accurate payment posting is likely to register better revenue. When issues like denials, mismatch of payments received from the insurer, patient payments, etc. are identified and resolved at the front line, it will smooth the entire dental billing process and your practice will register a better cash flow.

Timely claim submission and approval is one of the top priorities of healthcare professionals involved in dental practices. What makes it a top priority for dental practitioners is its contribution to revenue generation.

As the world is living under COVID-19 scare and industries across the globe are working towards repairing the fallen economy, dental practitioners also need to make sure that their revenue cycle keeps moving smoothly.

Claim Submission plays a pivotal role in maintaining and improving revenue cycle outcomes, but the process of claim submission and approval is not as easy as it sounds. Even a slightest mistake in the patient’s details or dental codes can result in claim denial or delay.

To keep the revenue running, dental professionals need to focus on the reasons that can cause claim denial or delay in the claim approval process.

This article will talk about the 5 of such most important reasons for claims denial and delay, and the measures to be taken by the dental practitioners to avoid them.

Incorrect or wrong information – While sending a claim for approval, it is vital for intake staff to verify all the details of a patient. Sending wrong information in such cases becomes the first reason behind the claim denial. During registration of a patient, make sure that all the details are cross-checked. Creating a list of common mistakes, especially while doing insurance verification, such as generally misspelled names, commonly missed fields in the form, etc. It might consume a bit more time but it will definitely reduce all the chances of claims denial.
Incorrect or missing Billing Codes – Specifications are important when it comes to billing codes. Invalid, incomplete, or erroneous codes will directly result in claim denial. Billing staff or coding specialists should be extremely careful while entering codes. Even the slightest mistake in medical codes can postpone or deny claim approval.
Unauthorized claims – There are many dental services that require pre-authorization. Insurance providers are likely to decline or deny any claim sent to them without proper or prior authorization. Categorize these dental services in advance and submit the claims accordingly.
Late submission – The term is self-explanatory. Any claim, if submitted late, will obviously be denied even if it has all the correct details and medical codes. For timely claim submission, keeping a track of each patient’s deadlines is important. Make sure not to miss them to avoid any reason that can cause claim delay or denial.
Credentialing – It’s a crucial factor. Dental practitioners need to be credentialed with insurance providers. And if they are not, getting claim approvals does not come easy. It’s essential for dental practitioners to be credentialed with the insurance providers, not just one but with other insurance providers as well.

Apart from these reasons, there are some other common reasons as well for claim denial and delay. Let’s take a look at them.

A claim submitted with expired health insurance will automatically be denied. Make sure to check the validity of the insurance before submitting a claim.
Some insurance companies have the policy to provide only one service in a day. If the claim is submitted for two or more services and the provider complies with this policy, the claim is likely to be denied.