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.