Dental insurance billing for treatment offered to the patients keeps the cash flow running and helps the practice stay profitable. Accurate documentation, timely claims submission, and a seamless billing process help in collections as well as ensure that compliance is always adhered to. A few tips to ensure dental billing compliance tips are as below:
A practice must make insurance pre-authorization a crucial component of the treatment process as it plays a major role in getting reimbursed once services have been rendered to the patient.
It must be made a non-negotiable habit as it safeguards the clinic from not getting paid by the insurance company.
Before the practice commences any treatment especially expensive surgeries or procedures, the dental team must submit a pre-authorization request to the insurance company. This step shields the practice and the patient from any unexpected response such as a denied claim or an unanticipated deductible.
Once the team is clear about the patient’s co-payments or deductibles, it can share a detailed and precise payment plan for the patient’s consent.
Such an approach by the practice is ideal for delivering quality care to patients who involve costly procedures or services. This is even more important when dealing with evolving CDT codes. It also builds patient trust and confidence while preventing unexpected billing statements.
A dental practice's cash flow can be severely impacted if the patient's insurance coverage is not thoroughly checked and verified.
Once the team has received all personal details and information regarding the policy, it must confirm the veracity of all captured data by contacting the insurance provider directly or logging into the insurance portal.
Confirmation of eligibility for insurance coverage is a vital step for a dental practice, as it ensures that the insurance will cover the recommended treatment plans before any service is rendered to the patient.
Such a verification process enables the dental team to gain a comprehensive outline of the benefits that a patient can accrue as well as assess the current status of the coverage and scope for reimbursement.
This helps patients make an informed decision about proceeding with the suggested treatment and ensures a precise and smooth billing process.
The dental team needs to monitor the patient’s appointment schedules and request an upfront initial payment amount on the day of the appointment or before if possible.
Such transparency with regard to financial outlays for the patient can help to instill confidence in the patient and act as a retention tool too since nobody likes to be presented with an unexpected expense.
To support the collection process, the team must document and maintain records of all payments made to the patients. This not only boosts collection rates and cash flows but also lowers the chances of cancellations as a patient who has paid in advance is highly unlikely not to show up for treatment.
This step also helps the practice to stay compliant with regulatory guidelines such as the No Surprises Act. This is especially needed when the patient’s coverage is out-of-network.
The dental billing function is always evolving especially considering keeping up with updated CDT codes that are pertinent for the dental practice. The practice must have experienced billers who dedicate time to stay ahead of all the latest codes.
It is known that a wrong code submission due to careless coding habits will always result in a claim denial or rejection. To avoid such situations, the practice must have a dedicated resource who spends time understanding this challenging task. The practice can also outsource such a critical function to dental coding and billing specialists as they specialize in dental billing processes and will offer greater returns to the practice in the long run.
There are times when a dental practice might have to perform medical-dental cross-coding. This is needed when a patient requires medically necessary dental service. In such cases, the dental procedure needs to be billed to the patient’s medical plan and will not be covered by dental insurance. If the practice fails to comply with this requirement, it could also result in a claim denial.
The practice must invest in modernizing the dental billing process by deploying various methods of payment. This is important as the patient base may come from different demographics and mindsets which can influence how they like to make payments.
While some patients may be wary and uncomfortable with online payments and prefer cheques or other conventional methods, some patients may want options such as net banking or phone-based payments. Offering patients a choice always raises the chances of getting paid on time. The convenience of patients is vital and providing alternate payment modes to satisfy different preferences and tech-savviness levels can help in maximizing revenue.
The collection of outstanding patient dues is always difficult and mitigating such an issue by providing options such as cash, cards, auto-pay on specific dates, etc will always be useful.
A dental practice needs to track and maintain accurate documentation. It can help the practice if it invests in tools or software that can record the dental documentation process, including insurance verification, patient record management, and accounts to enable and accelerate the process.
Depending on the recommended treatment and services offered to the patient, the dental team needs to document essential information and assign the relevant procedure codes. A few documents that need to be covered in this process include X-rays, personal details of the patient, past medical and dental records, diagnostic notes, photographs, radiographs, etc.
These records need to be signed by the dental practitioner responsible for administering the treatment within the dental software. By maintaining a daily sign-off on the day sheet, the practice can ensure that all details and notes are precisely reflected in the software and on the ledger of patients for billing.
A meticulous dental billing process is essential to get paid by the patient and the insurance company. But more importantly, it is also essential to comply in all ways when it comes to billing. When patients schedule an appointment, the team needs to make sure that they realize what the plan will cover and what will be borne by them. The team needs to follow a few dental billing compliance tips to ensure that everything is taken care of and the practice always stays compliant.
