Besides the delivery of quality care and service to patients, a dental practice also needs to ensure timely and accurate dental medical billing in order to be sustainable and profitable. The team needs to know how dental billing works and its implications for the practice.
Dental billing appears simple, but it needs adherence to dental billing guidelines. Multiple factors are to be considered. This can include the usage of the right codes, compliance guidelines, coordination of benefits, etc. Inaccurate billing or errors can lead to rejected insurance claims.
The dental team needs to pay careful attention to all the steps that have to be followed for insurance and patient billing. Following billing guidelines, dental billing automation, and timely completion of billing can help the practice to maximize its business revenue.
As in any business, dental billing is the process that ensures payments are collected for all activities and services rendered by the dental practice to patients in the clinic. Payment to the practice can come from insurance companies and directly from the patient.
The team needs to accurately and efficiently navigate the dental medical billing process, as this will have consequences on the other elements of the dental practice, such as cash flows.
Since the practice earns revenues from patients and insurance companies, any flaws or errors in documentation and procedures affect the billing process. The dental team needs to ensure that it follows all the vital steps that are required for all treatments. This includes patient scheduling or even collections.
Streamlining the process with optimized procedures and regular training can facilitate smooth and timely billing that yields positive results.
As covered earlier, the dental billing process incorporates workflows that mandate the collection of monies from patients and insurance companies and patients. A large number of variables and steps can have a bearing on how much revenue can be collected and maximized by the practice.
To consider an example, the dental team would need to consider taking medical insurance of the patient for certain oral procedures while sending insurance claims to the insurance company. This, of course, is dependent on the type of treatment performed.
The process and key steps to be followed include the following:
The dental team needs to fix appointments and schedules for every patient. The dental team needs to confirm insurance details and policy coverage before the appointment date. Based on the treatment recommended and implemented, claims need to be prepared that are precise and well-documented.
The two key steps that need a clear understanding by the dental team are as below:
An important component of billing is the process that raises bills and claims to insurance companies. The team needs to be adept at creation, submission, follow-up, and payment collection. These basic steps can be elaborated as follows:
The dental team must check and verify patient details before the patient arrives for treatment at the clinic. It is possible that a patient can be covered by more than one insurance company. For example, a patient can have an insurance policy provided by the employer as well as a personal policy for extra coverage.
A patient can be covered by an employer as well as by the employer of the spouse. In such cases, the dental team needs to create multiple claims by using the coordination of benefits rules. All claims must have CDT or CPT codes accurately, as this helps to justify the treatment recommended to the patient.
The dental team needs to incorporate all the relevant documents along with the claim. This will include items such as X-rays, clinical notes made by the dental practitioner, narratives, photographs, and the primary Explanation of Benefits.
In order to ensure that the process is effective and reimbursements happen on time, the team must submit all claims within two working days of treatment provided to the patient. The earlier a claim is submitted, the better it is for the practice.
The team must also monitor receipt of the monies by the insurance company once the claim has been submitted. If the practice has not received payment within three weeks, the team must make preparations for the appeal process.
The dental team must monitor all claims submitted by the practice to the insurance companies. In case claims have been rejected or denied, the team must ascertain all reasons for the same. A supplementary claim or a corrected claim must then be submitted at the earliest.
While monitoring claims, the team should commence with the oldest claims first and then work on the more recently submitted claims. This will help ensure that any submitted claims are not left unattended and forgotten over a period of time.
While making follow-up calls, the team must keep all details regarding the claim handy at the time of calling the insurance company. Once the practice receives reimbursement from the insurance company, the team must post the details on the PMS (practice management software) of the practice.
The team must be aware that insurance billing can get complex. This is because patients can change their insurance company or even change the policy coverage elements. CDT or CPT codes can change, and complications can arise when medical insurance needs to be included. The practice must ensure that a billing expert is assigned to handle dental insurance billing. This helps the practice to maximize collections from the insurance company at the earliest.
Equally important to the practice is the dental patient billing process. It has a lesser number of steps than dental insurance billing. This process, however, needs higher interaction with patients, and this can be a challenge.
The key elements of the patient billing process must involve transparency, convenience, and simplicity in making payments by the patients. The steps include:
The team must highlight the fact that the patient is ultimately responsible for complete payment of the treatment fee, irrespective of how much is covered by the insurance company. The team can also showcase multiple payment plans and other payment options. This can be done by the team during the pre-treatment presentation with the patient.
The team needs to collect dues from the patient once insurance payments have been made. It is important to produce a detailed billing statement for the practice’s records as well as for the patient. This statement can be mailed to the patient or sent electronically if the practice has invested in a modern and automated software solution.
Patients who have outstanding dues that need to be cleared must be sent periodic reminders with multiple payment options. A poor patient billing experience can result in a loss of goodwill and potential repeat visits.
Bills sent to patients after a clear explanation and with due diligence done can result in patients making payments without a dispute. Patients must also be told well in advance about what the estimated liability would approximately be.
The dental practice must accord the highest importance to having a billing expert to manage key aspects of dental billing. The practice must understand that billing can be straightforward, but it can also come with challenges and complications. The team must follow the best measures for ensuring optimal dental insurance billing as well as dental patient billing. This will help build a reputation with patients as well as boost cash flows for the practice.
