Any dental practice needs to offer more than quality treatment and care to survive in a highly competitive market. To succeed and thrive, it needs to pay heed to other elements such as billing and collections.
It sounds easy and logical, but the dental billing process can get tricky and cumbersome. The team must understand how dental billing works. A few careless errors, such as incorrect code usage or spelling mistakes, can affect the practice in terms of goodwill and cash flow.
One needs to pay attention to details and understand how dental billing works. An adherence to all procedures, the right codes, and efficient automation software can help the practice maximise revenue and collection.
Any activity related to collecting payment for treatment and services rendered to patients by the dental practice can be termed as dental billing. A practice has two sources of revenue. While insurance companies might contribute a major portion, a sizable contribution also comes from patients.
The dental billing process must also include a strategy for the collection of dues from both these revenue sources. The dental team needs to accurately and efficiently navigate the dental billing process. This will help to effectively manage various aspects of the practice, including the bottom line.
The practice must be aware of all issues or problems associated with the billing process. This will ensure that the practice does not collect less than what is owed to it. It can help to manage cash flows better and be less vulnerable to possible insurance fraud or billing errors.
The practice needs to know how to do dental billing as well as simplify and streamline the billing process with optimised procedures, trained experts, and automation.
The dental billing process must cover workflows that can be used by the team to collect pending dues from patients and insurance companies. It needs to consider a multitude of factors that can play a role in collecting revenues and in billing.
There can be instances where medical insurance needs to be considered when sending an insurance claim based on the treatment recommended to the patient. The steps that the dental team needs to follow and comprehend how dental billing works are as follows:
The general guidelines that the dental team must be aware of and follow are as follows: For Front-End Dental Billing
Registration
The first point of interaction between the patient and the practice is during the registration process. An appointment made with the practice is the initial step for processing all
insurance claims. This begins when a patient gets in touch with the practice to fix an appointment.
Eligibility Verification
The dental team must ensure that all details of the patient’s insurance plan are verified, even before the patient receives any treatment at the practice. The team needs to confirm services that are eligible for reimbursement and to what extent, any exclusions, deductibles, copayments, etc., before the commencement of treatment.
Collections
Once the dental team is aware of the financial responsibility of a patient, it must make efforts to collect any copayments or deductibles when the patient approaches the front desk.
Encounter Form
An encounter form or fee ticket can be used to capture details of every patient interaction. This document can list all services, codes, patient details, and clinician notes.
Check out of the practice
Once the treatment is over and the encounter form is complete, the dental team can schedule the next appointment as per the recommendation.
Charge Entry
The encounter form can be used to confirm all procedures performed and the need for the same. These charges need to be incorporated into the PMS (practice management software) of the dental practice. Payments have to be incorporated in the system, too.
Claim Generation
Claim submission begins after all treatment is completed and charges have been computed. This step includes compiling charges, revenue codes, and more. The team needs to confirm that all procedures, codes, etc., are present and precise. This scrubbing ensures that all data is complete.
Claim Submission
The dental practice can prepare and submit claims to insurance companies using manual claim submissions or use an automated software that is HIPAA compliant and other regulatory guidelines.
Claim Tracking
Submission of claims is not the end of the process. The team needs to keep reviewing the claim status at frequent intervals. If the claims go through a clearing house, then the team can use the available dashboards of the clearing house to check on the claim status.
Payment Posting
When the dental practice receives an electronic remittance advice or payment from the insurance company, the same needs to be updated on the PMS or practice management
software. Any accompanying cheques or direct deposits made to the practice must be posted.
Patient Payments
When a patient receives payment from the insurance company, the dental team needs to prepare and send the patient's statement. The statement must include all pending outstanding and all mandatory details, such as the treatment date, treatment rendered, reimbursement made by the insurance company, payment made by the patient to date, and reasons why there is a patient due amount.
Denial Management
When the dental practice is faced with a claim denial, it needs to act on the denial and related issues promptly. The team needs to understand the reason for denial and resubmit the same after considering the requirements of the insurance company.
A/R Collections
Follow-up with patients is a critical phase of accounts receivable for the practice. The team needs to follow up with patients on a regular basis, as any delay in payments can result in bad debts.
While the above steps are sequential and logical in the dental billing process, the team should pay maximum attention to dental insurance billing and patient billing.
The insurance billing process consists of claim preparation, claim submission, follow-up, and payments from the insurance company.
Crafting of the claim includes gathering verified personal and insurance information of the patient. The team needs to confirm if the patient is covered by more than a single insurance plan, as the Coordination of Benefits (COB) rules would need to be applied.
The team needs to use the appropriate CDT codes to justify the recommended treatment while also listing the dental practitioner in charge of treatment. All pertinent documentation, such as X-rays, clinical notes, charts, and the explanation of benefits need to be attached at the time of submission.
The team must ideally send the claim within two working days of completion of treatment. If the claim has not been paid within 3 weeks, the team must begin the appeal process. They must get clarity from the insurance company for reasons of denial. The team can then send a corrected claim again or a supplementary claim based on feedback.
The team should start follow-up with the oldest claims first. Once payments are received, the same needs to be posted on the PMS (practice management software).
The patient billing process must ensure transparency and convenience between the practice and the patient. The team needs to clearly highlight that the patient is eventually
responsible for the full treatment cost, irrespective of the amount covered by the insurance company.
The team can offer financial options for payment based on the patient’s needs. A detailed billing statement needs to be shared with the patient. The billing and subsequent reminders for payment can be done using an automation process.
The dental team needs to note that a poor billing experience can lead to losing goodwill with the patient and a possible loss of a revisit.
A lack of streamlined dental billing processes affects the patient experience and cash flows since reimbursements from insurance companies can be hampered. The team must understand how dental billing works. It must create and adhere to standard operating procedures to ensure that insurance billing and patient billing are done promptly and accurately. Insurance billing is not simple, and an experienced team can make a difference. Automation software can help generate timely and accurate billing.
