What Is The Biggest Challenge In Dental Billing?

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What Is The Biggest Challenge In Dental Billing?

In a complex and competitive dental healthcare industry, dentists have to navigate multiple challenges on various fronts. This could be due to a shortage of skilled manpower, time constraints, or inadequate patients leading to a downside in profitability. 

These can have an effect on a crucial component of the practice and that is dental billing. As we know that billing and collection are essential factors in any dental practice. Claims for services rendered need to be filled out accurately and on time. A lapse in billing can lead to cash flow aberrations that take a hit on revenues.

Positive cash flows enable the practice to focus on patient satisfaction, staff training as well as investments in equipment and technology. 

Challenges to address in dental billing

Dental billing is a tedious task and submitting claims as per the patients’ coverage plan can be a task as codes and regulations can also change over a period of time. 

Moreover, a survey conducted by the Bankers Healthcare Group among licensed dentists revealed that 88% are most worried about payment from patients. As per the US Consumer Financial Protection Bureau, unpaid medical bills account for just over 50% of collection services. 

Some of the big challenges that are faced by dentists in billing: 

Time Constraint

A practice that has a heavy patient flow and inadequate staff support can cause problems especially if billing is not automated. Such a situation can justify an investment in automation that can speed up billing processes and claim adjudications without having to add extra staff. 

Billing encompasses multiple areas of focus such as claim submission, appeal for incorrect or rejected claims, bill receivables management, etc. 

Updates in coding 

Billing issues are a continuous issue but this can be easily overcome. This is because there are factors beyond the control of the practice that can add to the challenge. 

Managing billing issues that are related to payer processes is important. It is critical to invest in technology and automation systems to rectify flaws in existing administrative operations or billing processes.

Resources and technology for implants and procedures are always changing. As such tools or resources enter the market, the codes need to support them increase. Coding updates that happen annually are a challenge to even experienced staff. 

These codes keep evolving in order to enhance clarity in practice or to stipulate new or additional treatment areas. The practice needs to assess and carefully document effective changes to regularly used codes and their impact on billing. 

Claim Guidelines

A practice has to pay strict heed to stringent processing criteria that are demanded by insurance companies or government bodies. A lack of obligation or compliance with such norms can result in denied or rejected claims. Following process guidelines precisely will improve the billing cycle and subsequent collections. 

Collection of Copay amounts

Copayments should generally be collected in advance by the practice. If the practice does not get the copay amount prior to the commencement of the service,  then the collection of these amounts might be a challenge at a later time. 

A more professional approach to adopt would be to collect all fees and copays at the commencement of the service. This is especially critical for a treatment that is expensive and cumbersome and payment by the patient might get difficult later on.

The collection rate gets impaired when these issues are not rightfully addressed. Furthermore, rejected claims due to coding errors or incorrect data, can add to the financial woes. The practice might not even possess the expertise needed to assist patients in comprehending insurance plans and benefits and this can result in losses arising out of unaccepted treatment options.

Meticulous follow-up

As mentioned before, a critical challenge to any practice is unpaid bills. A tight monitoring and control system can prevent patients from delaying or avoiding payments. 

A large number of patients are covered by single or multiple insurance plans. A high accumulation of errors can result in claims getting denied and payment cycles hampered. 

When a practice faces a dent in revenue, there is a focus on garnering additional patients to compensate for such losses. This places an additional burden on the dentist and the support staff. Such a ploy is not advisable as collections will still remain poor and processes might still be ineffective. 

A practice must have quality verification and billing support that enables efficient billing and reimbursement cycles. One needs to meticulously track all the details and issues in billing that will help the practice stay productive and profitable.