It is important for any dental practice to understand how insurance verification can alter the outcomes of claim submission.
What patient data in billing needs to be incorporated in billing without errors or missing elements cannot be undermined. Smooth and effective billing by the dental team or a dental billing company can garner increased revenue, positive cash flows, and more importantly, a satisfied patient.
Getting pre-authorization for every patient is a habit that safeguards the dental practice at all times. It may not be always possible for a practice to gauge if all procedures or treatments can be reimbursed by the insurance company of the patient.
Before performing any procedure, the team needs to submit a pre-authorization request to avoid any unpleasant surprises once the treatment is done. A preauthorization helps to determine the possibilities of a unexpected deductibles or claim denials. If a practice can ascertain the patient’s co-payment amount, then a payment plan can be worked out by the practice.
By following such a step, a practice can manage costly and extensive treatments or deal appropriately with the latest CDT codes to the advantage of the patient and the practice. Minimizing the chance of an unexpected billing statement also boosts the trust and confidence of the patient.
Practice management software are proven means for optimization of the billing process. These solutions are crafted to support the billing function and other aspects of managing a dental practice. The software can help with online booking and automated reminders.
The scheduling process can be made robust with a negligible chance of errors. In case of claims getting denied, the software is armed with features for maintaining patient records.
The practice can also outsource this critical function of billing to a specialist dental billing company that can not only boost efficiency but also improve collection rates.
The payment process can be enhanced by deploying multiple payment methods. The patients who visit the practice can have varying backgrounds and have different preferred modes of payment. While one set of patients may prefer traditional payment methods some might be comfortable with online transactions or phone-based payments.
When various payment options are offered to a patient, the possibility of getting timely payments increases. The ease and options of making payments must be a priority for the practice as it aids in boosting revenue and makes the collection of outstanding patient balances much easier.
The practice must evaluate all aspects of the billing process that have higher operational expenses. Some aspects such as processing of insurance claims consume time and money. This is because rejected claims need further actions and this can be a challenge. The dental team at times struggles to deal with the delaying tactics of the insurance organization. While these actions may cause delays in reimbursements, there are other factors to consider such as understanding industry changes like state regulations and changes in CDT codes. There are periodic patient information updates that need to be done.
It is a common observation that a dental practice might not have checked or verified the policy details of the patient in advance. This can hamper the cash flows of the practice to a large extent.
Once the practice has received all personal and insurance policy details of the patient, it is vital to validate the accuracy of this information by directly approaching the insurance company or checking the details on the insurance portal.
An insurance eligibility check is a key step that ensures the insurance coverage of the patients is in sync with the procedures suggested by the practice before they are performed. Such actions allow a practice to gauge the gamut of benefits that are available to a patient while also assessing the present status of insurance coverage. This results in selecting the best treatment for the patient and a smooth billing process.
The dental team needs to monitor the appointment schedules of the patients and request the co-payment amount on or before the day of the treatment. Such a habit can earn the trust of the patient as nobody wants to be surprised with any unexpected payments while the patient is also made aware of all financial responsibilities associated with the treatment. This even helps the practice to secure dues to it before the service or treatment is rendered.
The dental team needs to document and maintain precise records of all the patients as some might have paid in full while some might still have pending dues. his helps improve the collection rate of the practice and also reduces probable cancellation of appointments as patients who have paid in advance are less likely to not turn up for treatment.
Practices can also remain compliant with government regulations such as the No Surprises Act in case a patient’s coverage is out-of-network.
The dental billing landscape is complex and always evolving. CDT codes are constantly changing and the practice needs to stay updated on all changes that are relevant to it.
If the practice does not have a dedicated or experienced dental coder, a lot of time must be spent understanding the changes or additions in codes and the impact on billing.
Claim submissions made using incorrect codes will result in rejections. To avoid such situations, the practice can deliberate on outsourcing dental billing and coding requirements to an experienced third-party specialist.
Today, many dental plans need the submission of dental procedures that could be considered medical rather than dental. A failure to comply with such demands can also result in a denial.
The dental team needs to maintain accurate documentation of all procedures and notes of the patient. This is a critical requirement and if needed, the practice may develop or purchase tools for the same.
During treatment, the dental team must document all key information such as x-rays, past medical or dental records, personal information, diagnostic notes, photographs, etc. These can then be electronically signed within the dental software. Such a process helps ascertain that the treatment provided to a patient is reflected precisely in the software and on the ledger at the time of billing.
The integration of electronic health records within the practice management software is vital. This enhances the billing process due to the automation of the claim submission process. This also results in faster responses from the insurance company as well as more payments on time.
An integration of EHR will also align with the services offered and result in accurate claims. Also, these EHRs maintain all the billing-related data in one place and this makes it easier for the billing team to access and handle.
An optimized and efficient dental billing process can lead to higher revenue, positive cash flows, and a more productive dental team. Besides a happier patient, it also builds a strong and solid reputation for the dental practice.
