Unraveling The Complexities Of Dental Insurance Billing: A Guide For Dentists

Dental billing is a vital component of any visit to the dentist. It is the process of generating medical claims to submit to insurance companies for reimbursement for oral health services. The dental biller monitors the claim to guarantee that their employer is compensated for their work on a patient. The process has two parts: patient billing and insurance claims processing. These are the primary revenue streams for most dental practices.

The first step to processing an insurance claim is registration, which occurs when patients contact their provider's office to schedule an appointment. Before a dental practice can receive payment for services rendered, they must verify that the patient's insurance plan covers these services. Once the patient's financial responsibility is known, the provider can collect the copay, deductible, coinsurance, or total balance due. An encounter form, also known as a superbill or fee ticket, is created for each patient encounter. This form lists services, medical codes, patient demographics, and clinician notes.

Patient billing and insurance claims processing

The patient billing and insurance claims processing is a crucial aspect of the dental billing process and a significant revenue stream for dental practices. It involves several steps, from collecting patient information to submitting and tracking insurance claims. Here is a detailed breakdown of the patient billing and insurance claims processing:

• Collecting patient information: This is the first step and is usually done during the initial phone call when the patient schedules their dental appointment. Information collected includes the patient's name, contact details, address, date of birth, insurance details, and employer or insurance plan information.
• Verifying patient insurance coverage: After collecting the patient's personal and insurance information, the next step is to verify their coverage. This can be done by calling the insurance company or logging into their insurance portal. This step provides a full breakdown of the patient's benefits and coverage details.
• Recording dental treatment and code data: During the patient's appointment, a member of the care team records the dental procedures performed and assigns specific codes to each procedure. This information is documented in the clinical notes and electronically signed by the provider.
• Submitting and tracking claims and attachments: Using the recorded information, insurance claims are created and submitted. Claims include procedure codes, patient information, and insurance details. Attachments such as clinical notes, x-rays, and periodontal charts may also be included.
• Resolving issues with outstanding claims: If a claim is denied or not reimbursed within a certain timeframe (typically 30 days), the biller needs to follow up and resolve any issues. This step requires expertise and efficiency to ensure a high collection rate and minimise overhead costs.
• Billing patients: Depending on the revenue model, patients may be billed for the entire procedure upfront (fee-for-service model) or billed for the remaining balance after insurance reimbursement (reimbursement model). Patient billing can be done before the patient leaves the dental office or through mail or email.
• Posting payments: Once the insurance claim has been reimbursed and deposited, the payment needs to be posted to the practice management software to keep records up to date and complete the life cycle of the claim.
• Running key reports: After posting payments and closing out the claim, key reports such as collections and account aging reports can be generated. These reports provide insights into the performance of billing activities and help gauge the effectiveness of the billing process.

The dental billing process, including patient billing and insurance claims processing, is complex and requires attention to detail. It is essential to follow the proper procedures and guidelines to ensure accurate and timely reimbursement from insurance providers.

Verifying patient insurance coverage

Collect Comprehensive Patient Information:

• Obtain the patient's name and date of birth, insurance company name, primary insurance plan holder's name and their relationship to the patient, policy number and group ID number, and the insurance company's contact information.
• Ask about secondary insurance and collect similar details if the patient has multiple policies.
• Request a copy of the patient's insurance card and verify the information provided.

Contact the Insurance Provider:

• Reach out to the insurance company by phone or through their online portal.
• Confirm that you are speaking with an authorized representative and that the conversation is HIPAA-compliant.
• Provide the patient's insurance information and ask the representative to confirm the details.
• Verify if the policy is active and when it expires.
• Ask about the patient's copay, deductible, and any additional documentation or coverage limitations.
• Determine if insurance authorization is required for specific treatments or referrals.

Record Accurate Information:

• Train staff to transcribe information carefully to avoid errors that may delay payments or result in claim denials.
• Double-check ID numbers and other critical details before submitting claims.

Follow Up with the Patient:

• Inform the patient about their copay and other out-of-pocket expenses as early as possible.
• Communicate any changes or updates to the patient's insurance coverage.

Utilize Technology:

Use Electronic Health Record (EHR) systems or practice management software with integrated insurance verification modules to streamline the process and reduce manual errors.

By following these steps, dental offices can ensure accurate billing, prevent claim denials, enhance operational efficiency, and improve the overall patient experience.

Submitting and tracking claims

Submission Process:

• Timing: It is recommended to create and submit insurance claims within 24 hours of the patient's treatment. This jumpstarts the billing process and helps to get reimbursement sooner.
• Method: Claims can be submitted through regular mail or electronic filing. Electronic submission is often preferred as it is easier and more efficient, and can result in faster processing and significant cost savings. However, the submission method may depend on the insurance provider's requirements.
• Attachments: Copies of X-rays, clinical notes, periodontal charts, intraoral photos, and other relevant documents may need to be submitted along with the claim form.

Tracking and Follow-up:

• Regular Monitoring: It is important to track the status of claims regularly. Claims should be checked daily, and insurance aging reports should be reviewed at least once a week to identify outstanding claims and follow up on them promptly.
• Appealing Denials: If a claim is denied, it is crucial to determine the reason for the denial and resolve any issues. This may involve correcting small mistakes, providing additional information, or appealing the decision.
• Working with Insurance Companies: Dealing with insurance companies can be challenging. It often requires persistence and expertise in navigating their processes. It may be beneficial to have a dedicated person or team focused on insurance claims processing.
• Communication: Effective communication with patients is essential. Keeping patients informed about their financial responsibilities and any changes can help avoid misunderstandings and delays in payment.

Dental billing and insurance procedure

Dental billing is a vital component of any visit to the dentist. It is the process of generating medical claims to submit to insurance companies for reimbursement for oral health services. The dental biller monitors the claim to ensure their employer is compensated for their work. Dental billing has two parts: patient billing and insurance claims processing. These are the primary revenue streams for most dental practices.

• Gather patient information: This is done during the initial phone call with the patient when they call to schedule their dental appointment. This information includes their name, phone number, address, email address, contract preferences, date of birth, name of the subscriber’s employer or insurance plan, insurance carrier, carrier’s provider phone number, and insurance ID number.
• Confirm their insurance coverage: Once you’ve collected the patient’s personal and insurance information, you’ll verify it by either calling the insurance company or logging into your insurance portal. This will give you a full breakdown of their benefits and let you know the state of their coverage.
• Document each dental treatment and its code data: As the patient receives treatment, someone on the care team records the necessary details in the clinical notes, and codes the procedures performed. Usually, an admin team member ensures this is documented, reviewed, and electronically signed by the provider in your dental software. A daily sign-off on the day sheet is a best practice to always verify that what happened in the dental chair is what is recorded.
• Submit and track claims and any attachments: With the information recorded in your software, you will now create, batch, and submit your insurance claims. The claim will include the code or codes of the procedure performed, all of the patient’s personal and insurance information, and any attachments needed. Attachments include clinical notes, x-rays, periodontal charts, narratives, primary EOBs, intraoral photos, etc.
• Resolve issues with outstanding claims: If a claim has been denied, or 30 days have passed and the claim has not been reimbursed, you will need to follow up on it. This is called working the insurance aging report. Your biller gets a list of outstanding claims, contacts the insurance company, and figures out where the claim went wrong, then works to appeal it for reimbursement.
• Bill patients as needed: Depending on the revenue model you’ve chosen, you either bill the patient for the entire amount of the procedure upfront (fee for service) or bill patients the balance after subtracting what their insurance benefits should cover (reimbursement model). Patient billing allows you to collect the patient’s portion before they leave the dental office, or request payment later by mail or email.
• Create key reports for collections, aging account reports, etc.

Potential Risks or Complications

It is essential to perform medical billing duties accurately as mistakes can be costly for revenue and increase the administrative workload. This demonstrates the importance of qualified dental billers who can accurately perform their role in the dental billing cycle.

Dental billing and insurance tasks

Dental billing is a vital component of any visit to the dentist. It is the process of generating medical claims to submit to insurance companies for reimbursement for oral health services. The dental biller monitors the claim to guarantee that their employer is compensated for their work on a patient.

The dental billing process can be broken down into two parts: patient billing and insurance claims processing. These are the primary revenue streams for most dental practices. Below are some critical steps to follow:

• Collecting patient information: This is done during the initial phone call with the patient when they call to schedule their dental appointment. This information includes their name, phone number, address, email address, contract preferences, date of birth, name of the subscriber’s employer or insurance plan, insurance carrier, carrier’s provider phone number, and insurance ID number.
• Verifying patient insurance coverage: Once the patient’s personal and insurance information has been collected, it needs to be verified by either calling the insurance company or logging into the insurance portal. This will provide a full breakdown of their benefits and coverage.
• Recording dental treatment and code data: As the patient receives treatment, someone on the care team, usually an admin team member, records the necessary details in the clinical notes and codes the procedures performed. This documentation is then electronically signed by the provider and reviewed to ensure accuracy.
• Submitting and tracking claims and any attachments: With the information recorded in the software, insurance claims are created and submitted. The claim includes the code or codes of the procedure performed, all of the patient’s personal and insurance information, and any necessary attachments such as clinical notes, x-rays, periodontal charts, narratives, etc.
• Resolving problems with outstanding claims: If a claim has been denied or not reimbursed within 30 days, it is important to follow up. This involves contacting the insurance company, figuring out the issue, and working to appeal the claim for reimbursement.
• Billing patients: Depending on the revenue model, patients may be billed for the entire amount of the procedure upfront (fee-for-service model) or billed for the remaining balance after subtracting what their insurance benefits cover (reimbursement model). Patient billing can be done before they leave the dental office or requested later via mail or email.
• Posting payments: Once the insurance claim has been paid and deposited, the payment needs to be posted to the practice management software to keep all information properly documented and reported.
• Running key reports: Once the payments are posted, it is possible to analyze how the billing activities are performing and gauge how well they are collecting payment. Running reports such as collections and account aging reports can provide valuable insights into the financial health of the practice.

Dental billing is a crucial skill for any dental practice to master, as it plays a significant role in the practice's financial health and overall efficiency. Accurate billing and prompt follow-ups are essential to ensure timely reimbursement and maintain a smooth cash flow process.

Frequently asked questions