Billing is an essential component of the dentistry profession. It can be a complicated and time-consuming process to ensure that your practice is able to recoup full costs from insurance companies and that you are providing the ultimate in customer satisfaction to guarantee repeat business and long-term success. Keep these dental billing practices in mind as you work to maximize your collection rates.
Medical Billing Versus Dental Billing
It is important to understand the differences between medical billing and dental billing. It is most common that dental procedures will be classified as dental billing and charged to dental insurance companies. The challenge will coding and billing within dental practices is that many dental procedures might be classified as medical procedures rather than dental procedures and, as a result, require coding under medical billing.
Medical insurance claims, such as those associated with sleep dentistry, are often somewhat more complicated and time-consuming processes than dental coding and billing. Medical billing requires additional steps not required in dental billing to increase the chances of prompt payment. You may also have to train your billing team to be able to work with both medical and dental insurers to reduce billing completion times. The forms, codes and overall communication methodologies will vary from medical to dental too. These are all important aspects to consider during the hiring process and before you launch a dental practice.
Insurance Negotiations
An important part of the billing process is to negotiate pricing with insurance companies each year. If you choose to accept insurance rather than to charge fees for services, particularly as an in-network provider, the majority of your services will be covered by insurance. As a result, insurance negotiations are essential to your overall profits. If you are not comfortable negotiating with insurance companies, you can outsource this service or you might hire an insurance advocate to perform the negotiations on your behalf. Negotiating does not come easy to all people. It is a skill that many people have to learn, so expect that it will get easier over time.
Outsource Coding and Billing
Whether you are looking for Absolute Medical Billing to help out with the dental billing experience or a way to reduce your labor costs, many dental practices choose to outsource their coding and billing efforts. The advantages of doing so are typically quite significant. If you have a small practice with just a few employees, outsourcing your coding and billing can allow your team to focus on your patients rather than spending time behind a desk.
It is also often helpful to outsource to a company that specializes in outsourcing so that you save money on errors and time spent on following up with claims and new codes. You will not have to spend time training your staff on the best practices of coding and billing, and you will eliminate the amount of time you spend dealing with insurance companies. Do not forget to select a company that will also follow up with claims if that is also important to you. If you choose an in-house coder and biller, make sure they are qualified and consider paying for their certification.
Insurance Payments and Collections
The key to ensuring that insurance companies pay on time is to complete the proper forms on time and to use the right codes. You have to hire the right people or companies to speed up the process. If you do not have income coming into the business regularly, you cannot survive and pay your overhead expenses. Many new dental practices overlook the importance of payments and collections, as well as coding and billing.
You also have to dedicate the time and resources to follow up with claims and collections from both patients and insurance companies. You can either choose to have someone in-house, who is often the person who does the coding and billing, or you can outsource it. Whomever you choose to represent you in these calls, be sure they are professional and polite at all times. It has been said by both insurance claims adjusters and dentists that people who are polite get further with insurance companies than those who are rude and unprofessional.
Explanation of Benefits
One way to increase full payments and collections is to use explanation of benefits (EOB). An EOB provides both the dentist and the patient with a breakdown of which services will be covered by insurance and which services will not be covered. At this point, the dentist and patient can work together to determine the best way to move forward based on the urgency of the situation and the budget of the patient.
You will request an EOB before any services are completed so that everyone understands the costs upfront. While it may not improve the likelihood your claim will be approved by the insurance company, in the end, it is an exceptional customer service tool that provides transparency and trust between you and your patients which leads to repeat business, customer retention and free word-of-mouth advertising.
Cross Coding
Today, more and more dental procedures are considered to be medical procedures by insurance companies. As such, dental practices have to use both medical and dental coding more and more frequently. Despite the growing complexity of this practice, cross coding is believed to increase patient reimbursements significantly and improve the bottom line of any dental practice. It is important to note that cross coding is far more complicated than basic dental coding or medical coding. The coder must determine which procedures have to be filed with a medical plan and which have to be filed with a dental plan to ensure reimbursement.
Patient Retention
The profit margins can be lower for a dental practice that elects to be in-network. The key to greater financial success is patient retention and repeat business. Many dental practices either dedicated in-house personnel or outsource coding and billing so that other team members are not taken away from patient care and customer service. Just like any other business, a dental office has to provide a superior experience to ensure patients will return again and again. EOB is a great start. You can even offer something as simple as free WiFi so that people can continue to work while they wait. It is the little things that often make the biggest difference.
Claims
Claims are a big part of the billing process. Fortunately, most claims can be filed electronically today. This saves days and weeks to ensure a faster return on cash flow and reimbursement. It is also said that electronically filed claims are far less likely to be rejected. You may have to include attachments electronically too. It is also critical to follow the claims documentation guidelines for each insurance company. And it is important that you have the right tools to support electronic filing and patient information sharing with insurance providers.
If you do not hear anything from the insurance company within 30 days, you should contact them immediately. When this occurs, which is not common, the claim is not on file for some reason. It is possible the person entering the information at the insurance company mistyped some information into their system. It is also possible that the insurance company is trying to delay paying the claim in a timely manner for any number of reasons. You will have to refile a claim under these circumstances. Follow up is essential if you want to get paid. They will not bring the error to your attention.
Denial of Claims
It does happen that a claim or two will be denied now and again. If you verify insurance beforehand, the number of denied claims you receive should be minimal. However, you are sure to have at least a few each year if not more. When a claim is denied, this does not mean that you should give up and close the claim. You likely have to submit more information or supporting documentation. It is also possible that you made a coding error during the initial claims submission. Another possibility is that the patient has not updated their information, such as to have changed jobs and insurance providers. Once you make the corrections, it is likely your claim will be approved.
Billing Software and Technology
Dental billing software and complimentary technology will also be critical to your success. The right software will help you work with both patients and insurance companies to expedite the payment and claims process. This will help you to be paid in a more timely manner and to minimize the amount of time you and your team has to spend on coding, billing and filing claims.
You have to make sure you have the right technology too. If you have to send attachments along with your claims, be sure you can transfer all of the appropriate information whether it be through tablets, PCs, scans, x-rays, photographs, etc.
To maximize your profits and to improve your cash flow, establish the right billing processes and procedures for your dental practice needs. Whether you dedicate in-house team members or outsource your coding, billing and claim filing, you can spend more time on an enhanced dental experience and patient care to ensure patient retention and repeat business for long-term success.